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Mark S. Souweidane

Africa. Although the results of that experience have been carefully analyzed, inherent limits exist in extrapolating that experience to children in developed countries due to inherent and uncontrollable population differences. The level of neonatal and perioperative care, threshold for seeking medical care, lifelong risk of shunt dependency, imaging capabilities, infectious disease practices, nutritional status, cultural beliefs, and different shunt device designs are several differences that obscure accurate comparative assessments when using clinical case series from

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Abhaya V. Kulkarni and Iffat Shams

measure of QOL. Investigating prevention strategies for shunt infection and shunt overdrainage (for example, changes in technique or device technology) appear to be justifiably important, given their demonstrated impact on QOL. Conclusions In this study we have demonstrated that children with hydrocephalus encounter a range of long-term QOL, from very good to very poor, but cognitive function appears to be the most affected. The factors associated with a worse overall outcome include frequent seizures, longer LOS for initial treatment of hydrocephalus, longer LOS

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Abhaya V. Kulkarni, Janine Piscione, Iffat Shams and Eric Bouffet

:// , accessed October 1, 2012) and whether either parent was a university graduate. The parents were also asked to complete the General Functioning Scale of the McMaster Family Assessment Device or the GF-FAD. 4 , 25 This scale has proven reliability and validity and is based on a multidimensional model of family functioning that incorporates problem solving, communication, roles, affective responses, affective involvement, and behavior control. The scores on the GF-FAD range from 1 to 4, with an increase in the score indicating increased

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representativeness of this study. The adequate selection of the patient, the biopsy target, optimal trajectory, and choice of biopsy device are essential for both low risk and high diagnostic validity of the stereotactic approach. 1 Each study that deals with the risk and effective of stereotactic biopsy should focus on these points. We agree that the risk of stereotactic biopsy should not be underestimated. The CT-guided stereotactic approach is an extremely effective, safe procedure only in experienced hands. We now consider a workstation mandatory for adequate simulation of

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applicability to their own practice, the physician must compare the patient population (including the pathological composition of the tumor and its location) and intervention (including biopsy technique and experience) with that at his/her own institution. Although 5384 stereotactic biopsies performed by Dr. Warnke and colleagues represents an incredible experience, prospective data from our institution are probably relevant to many neurosurgeons. Furthermore, with the increasing availability of frameless stereotactic or navigation devices, as well as intraoperative real

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Benjamin C. Warf, Salman Bhai, Abhaya V. Kulkarni and John Mugamba

, the ETV attempt had to be abandoned for shunt placement because of difficult anatomy, poor visibility, or a severely scarred prepontine cistern discovered upon creation of the ETV. Patients with nontransparent CSF were not treated with immediate shunt placement but, rather, underwent placement of a ventricular access device for serial tapping until the CSF cleared. These patients subsequently underwent repeat endoscopy for attempted ETV or, in the case of the primary shunt treatment group, VP shunt placement. The results for the initial intention to treat by

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Abhaya V. Kulkarni, James M. Drake and Maria Lamberti-Pasculli

, and changes in clinical practice should address them as follows. 1) Great care should be taken intraoperatively to avoid a postoperative CSF leak. 2) Alternatives to CSF shunt placement in premature infants should be studied and such patients should be considered high risk. 3) Surgeons should minimize manual contact with the shunt system and consider the use of double gloves. These findings may have implications for other clean surgeries involving implantation of prosthetic devices and biomaterials. Acknowledgments The authors thank Professor Kevin E

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William E. Whitehead, Andrew Jea, Shobhan Vachhrajani, Abhaya V. Kulkarni and James M. Drake

sagittal plane. The surgeon begins by identifying normal anatomical landmarks, looking for the falx cerebri, ventricular walls, and CSF spaces. The falx is a linear hyperechoic structure seen 4 to 6 cm deep, with an oblique orientation on the display screen. The ventricular walls are also hyperechoic, whereas the CSF is hypoechoic. Once landmarks are identified, the head of the transducer is rotated clockwise or counterclockwise along the long axis of the device to achieve a more standard anatomical image (that is, coronal, axial, or sagittal). The handle of the probe

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James M. Drake, Ash Singhal, Abhaya V. Kulkarni, Gabrielle DeVeber, D. Douglas Cochrane and The Canadian Pediatric Neurosurgery Study Group

complications or adverse events. Regarding pediatric neurosurgery, we have previously reported unusual complications of CSF shunt devices, 6 unexpected delayed (and often fatal) rapid deterioration after endoscopic third ventriculostomy, 9 fatal embolization of a sclerosing agent into an aneurysmal bone cyst, 20 and a near-miss injection of anesthetic agent into an external ventricular drain. 10 These were rare and unexpected events but brought attention to their possible occurrence and suggested methods to prevent them. Pediatric neurosurgery services provide care and

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Cian J. O'Kelly, Abhaya V. Kulkarni, Peter C. Austin, David Urbach and M. Christopher Wallace

the literature related to hydrocephalus after SAH. Demirgil et al. 7 also found no significant increase in mortality for shunt-dependent patients post-SAH. Akyuz and Tuncer 1 found that shunt-dependent hydrocephalus predicts poorer clinical outcome as measured on the Glasgow Outcome Scale. However, the majority of studies—likely owing to their retrospective nature—do not include clinical outcome data. 5 , 6 , 9 , 10 In most settings there is a steady attrition of ventricular shunt function over time. 4 , 17 As imperfect mechanical devices, shunts are prone to