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Mitchel Seruya, Albert K. Oh, Michael J. Boyajian, Jeffrey C. Posnick, and Robert F. Keating

influence cerebral blood flow and ICP, as a result of the indirect vasoconstricting effect (decreased cerebral metabolism) predominating over the direct vasodilatory mechanism (arterial smooth muscle relaxation). 26 Furthermore, we routinely observed stepwise decreases in ICP with the serial removal of calvarial bone. Indeed, removal of the frontal bone followed by the parietal bone or vice versa led to serial decreases in ICP of 41.2% and 58.2%, respectively. This sequential decrease in ICP provided further validation that these intraoperative ICPs were genuinely

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Edward R. Smith and R. Michael Scott

populations, such as the very young, children with developmental delays (such as Down syndrome), and children who may have preexisting high tolerances to pain medications (such as sickle cell patients). 19 , 22 , 42 One of the greatest concerns regarding surgery is the risk of perioperative stroke, reported to occur in 4%–10% of operations. 38 There is evidence that the use of pre- and postoperative hydration may reduce the risk of stroke by minimizing blood pressure fluctuations. Selective use of neuroprotective anesthetic agents (such as propofol) to reduce cerebral

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Mony Benifla, Francesco Sala, John Jane Jr., Hiroshi Otsubo, Ayako Ochi, James Drake, Shelly Weiss, Elizabeth Donner, Ayataka Fujimoto, Stephanie Holowka, Elysa Widjaja, O. Carter Snead III, Mary Lou Smith, Mandeep S. Tamber, and James T. Rutka

hemisphere after stimulation of the contralateral median nerve at the wrist. Averaging of 400 trials at a 5-Hz stimulation rate and a 2500-Hz sampling rate was used. Our definition of a clinically significant MEG spike cluster has been previously reported. 21 Positron Emission Tomography Scanning To examine cerebral metabolism in selected patients, we used interictal FDG-PET scans. In children in whom sedation was not used, the interictal FDG-PET scans were obtained using a GEMS 2048 system (Scanditronix). We analyzed a set of 15 slices, 6.5-mm slice thickness

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Anna L. Huguenard, Brandon A. Miller, Samir Sarda, Meredith Capasse, Andrew Reisner, and Joshua J. Chern

, Riley J , Shoja MM , Tubbs RS , : Return to system within 30 days of discharge following pediatric shunt surgery . J Neurosurg Pediatr 13 : 525 – 531 , 2014 8 Chern JJ , Sarda S , Howard BM , Jea A , Tubbs RS , Brahma B , : Utility of surveillance imaging after minor blunt head trauma . J Neurosurg Pediatr 14 : 306 – 310 , 2014 9 Engel J Jr , Kuhl DE , Phelps ME , Rausch R , Nuwer M : Local cerebral metabolism during partial seizures . Neurology 33 : 400 – 413 , 1983 10 Faul MD , Xu L , Wald MM

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Chiaho Hua, Barry L. Shulkin, Daniel J. Indelicato, Yimei Li, Xingyu Li, Frederick A. Boop, and Thomas E. Merchant

removal of the mass. Conclusions This study identified specific cerebral regions of hypometabolism in pediatric craniopharyngioma patients receiving surgery and proton therapy. Metabolic abnormalities were present before proton therapy and occurred more often in female patients and those with hydrocephalus or receiving multiple tumor surgeries. The ability to identify abnormal regions of cerebral metabolism in individual patients may facilitate personalized treatment plan adaptation and the investigation of neurotoxicity in children with craniopharyngioma