years of age and older with hydrocephalus. Excellent reliability and validity have been demonstrated. 36, 37 Imaging Measurements Frontal and occipital horn ratio is a measurement of ventricular size on axial brain images (computerized tomography or magnetic resonance imaging) that more accurately reflects ventricular volume than the Evans ratio does. Its interrater reliability is very good. It is obtained by averaging the widest distance across the frontal and occipital horns and then dividing it by the largest biparietal diameter. Measurements can be taken
Paul Klimo Jr. and John R. W. Kestle
Paul Klimo Jr., Clinton J. Thompson, James Drake and John R. W. Kestle
during the trial, we would find better results at higher-volume centers and/or improved results as the course of the accrual period progressed. Absence of either of these phenomena would indicate that the trial was not conducted during the learning phase for the procedure and that the negative result is valid. Clinical Material and Methods The detailed methods of the ESIT have been published previously. 15 The accrual period for the trial was 3.5 years. To test our hypothesis, demographic data were collected for patients randomized to the endoscope-treated group
Warren R. Selman
research designs. 1 Additional considerations include the lack of a consistently good response in earlier studies of CSF drainage. It is unclear why lumbar drainage of CSF would be as dramatically effective as shown here, when drainage from subarachnoid catheters has not met with uniform success. The investigators did not determine whether having the same volume of fluid drained for the same period of time with lumbar drainage is more beneficial than ventricular drainage. Although some patients may demonstrate a dramatic difference in the amount of blood in the lumbar
Paul Klimo Jr., Garrett T. Venable, Frederick A. Boop and Thomas E. Merchant
tailored to the child's symptoms and the tumor's imaging features. For example, tumors that are causing obstructive hydrocephalus or visual loss as a result of compression of the optic apparatus are often debulked to re-establish CSF pathways or to decompress the visual apparatus, respectively. Tumors that are primarily cystic are often treated by placing a catheter—stereotactically or via craniotomy—into the cyst with immediate decompression, thus reducing the volume needed to be treated with radiation. Aggressive extirpation in an effort to accomplish a GTR is, in
Prayash Patel, Aaron A. Cohen-Gadol, Frederick Boop and Paul Klimo Jr.
were 5 female patients (42%) and 7 male patients (58%) with a mean age of 9 years (range 2–19 years). Nine patients (75%) were Caucasian, 2 (17%) were African American, and 1 (8%) was of Asian descent. The mean follow-up duration for patients was 16 months (range 6–34 months). TABLE 1: Summary of 12 patients who underwent the expanded transforaminal approach to the third ventricle * Case No. Age (yrs), Sex Presenting Signs & Symptoms Hydrocephalus on Presentation Tumor Type & Origin Estimated Tumor Volume (cm 3
William E. Gordon, William M. Mangham, L. Madison Michael II and Paul Klimo Jr.
operation. This yields a conservative estimate of the actual work value of the resident during such procedures. Results Consultations and Admissions The primary author’s call volume in terms of days and hours over 2 years is summarized in Table 1 . During this time, he evaluated 1929 new patients in consultation or as an admission to the neurosurgical service while on call. Of these, 284 were admitted to the neurosurgery service and 1645 were seen as consultations. The breakdown of where the admissions or consultations occurred is as follows: UH (n = 886, 46%); ATC (n
Michael DeCuypere, Michael S. Muhlbauer, Frederick A. Boop and Paul Klimo Jr.
of the admission GCS score in a patient whose neurological function is depressed iatrogenically or in response to inadequate volume resuscitation or hypothermia. In agreement with other authors, we found a strong association between bilaterally fixed pupils and death. 10 , 23 , 26 The significant association of anemia (hematocrit < 30%) and intravascular volume depletion (base deficit < −5 mEq/L) with mortality reflects the critical importance of rapid correction with fluid and/or blood. Coagulopathy at presentation (INR > 1.5) was not significantly associated
Report of 3 cases
Paul Klimo Jr., Patrick J. Codd, Holcombe Grier and Liliana C. Goumnerova
sarcomas are rare; nevertheless, the literature is replete with numerous case reports. Examples of adult patients include those with epitheliod angiosarcoma, 55 osteosarcoma, 36 , 41 chondrosarcoma, 47 , 56 , 76 and liposarcoma. 35 A recent retrospective review from a high-volume tertiary cancer center spanning a 12-year period identified 29 patients who underwent surgery for a primary spinal sarcoma (excluding Ewing sarcoma). The most common histological type was chondrosarcoma, found in 16 patients (55%). 65 There are fewer reports of such lesions in children, but
Paul Klimo Jr., John R. W. Kestle, Joel D. MacDonald and Richard H. Schmidt
subarachnoid hemorrhage: a cooperative study in Europe, Australia, and New Zealand. J Neurosurg 84: 221–228, 1996 30. Kassell NF , Peerless SJ , Durward QJ : Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11 : 337 – 343 , 1982 Kassell NF, Peerless SJ, Durward QJ: Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11: 337–343, 1982 31. Kassell NF
Paul Klimo Jr., Clinton J. Thompson, Brian T. Ragel and Frederick A. Boop
-run German health care system. Even with a much lower cost in treating a shunt infection, they still saved approximately $50,000 with nearly 200 shunt operations. We chose $50,000 as the total cost because we believe it most likely reflects the cost of a shunt infection in the US. Annual cost savings were calculated based on 200 shunt operations being performed during that year, a number we thought was reasonable for a typical high-volume children's hospital where the impact of savings would be the greatest. Conclusions Shunt infections can have long