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Recent advances in the neurosurgical treatment of pediatric epilepsy

JNSPG 75th Anniversary Invited Review Article

Jarod L. Roland and Matthew D. Smyth

-quality studies reporting significant numbers of pediatric patients achieving seizure freedom, seizure reduction, and increased quality of life. One nontrivial barrier for many patients, families, and referring practitioners is the morbidity associated with open craniotomy. This barrier persists despite published rates of complications from high-volume epilepsy centers that are quite low and the nontrivial morbidity and mortality of poorly controlled epilepsy. The morbidity associated with surgery is typically concentrated at the immediate perioperative period. In contrast

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Matthew D. Smyth, Marissa J. Tenenbaum, Christian B. Kaufman and Alex A. Kane

performed. Two to four units of packed red blood cells were cross-matched prior to the procedure. All patients’ parents signed informed consent for the procedures as well as for photographic documentation for clinical management and research publication. Intraoperative Positioning and Monitoring Intraoperative monitoring consisted of placement of a central venous catheter or two large-bore peripheral venous catheters, an arterial catheter, and an end-tidal CO 2 monitor to assess the patient’s volume status as well as for possible air emboli. 13 An intravenous

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Matthew D. Smyth, Eric E. Klein, W. Edwin Dodson and David B. Mansur

family, both open posterior callosotomy and minimally invasive radiosurgical callosotomy were offered. Treatment The patient underwent Gamma Knife surgery in August 2005. General anesthesia was used during frame placement, MR and computed tomography image acquisition, and treatment delivery. The residual corpus callosum and splenium (934 mm 3 ) was targeted using a bilaterally plugged configuration for each helmet to minimize lateral spread of the treated volume. Radiation was delivered using two 8-mm and two 4-mm collimators with a prescribed dose of 65 Gy to

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Rory K. J. Murphy, Matthew R. Reynolds, David B. Mansur and Matthew D. Smyth

diagnostic radiology service for contrast-enhanced thin-cut (1-mm) axial MRI and CT scanning. The MRI study was imported into the GammaPlan workstation, and the hemangioma was identified and contoured. This target volume measured 1.5 cm 3 . Image registration with the CT data set was used to ensure that no distortion of MRI was present. The optic chiasm was also contoured to determine the dose to this critical structure. A conformal plan utilizing 9 shots was then generated by the team. Once the plan was agreed upon, a dose of 16 Gy prescribed to the 50% isodose line was

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Jeffrey H. Miller, David D. Limbrick Jr., Matthew Callen and Matthew D. Smyth

result from developmental hypoplasia of the occipital somites creating a congenitally small posterior fossa. This reduced posterior fossa volume may in turn result in compression and herniation of the cerebellar tonsils. 6 , 13 Acquired CM-I has also been described in infants, particularly after lumbar puncture or placement of a lumboperitoneal shunt. 10 It should be noted that the first twin in the present study did undergo a lumbar puncture although only a small volume of cerebrospinal fluid was obtained for diagnostic purposes (< 1.5 ml); this was unlikely to

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Matthew D. Smyth

protocol. With an excellent average estimated blood loss (EBL) of only 25 ml for sagittal synostoses, why should the transfusion rate approach 50%? It seems that they are giving a relatively small volume of blood products back to balance a relatively small blood loss and exposing a large number of infants to potential transfusion risks. With the use of a narrow strip technique, the transfusion rate at our institution is less than 5% for sagittal synostosis, although in every case we have blood products ready if needed (we have had two instances of sagittal sinus

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David Y. A. Dadey, Ashwin A. Kamath, Eric C. Leuthardt and Matthew D. Smyth

, medical therapies for SEGAs have been a subject of significant investigation. Specifically, mTOR inhibitors have been shown to have efficacy in clinical trials, where tumor volume reductions of greater than 50% were observed in patients treated with everolimus. 5 , 9 Though these results are promising, additional investigation is required to determine if long-term therapy is required to prevent SEGA regrowth. Another noninvasive strategy is Gamma Knife radiosurgery, but there is limited evidence to support its efficacy as a treatment for SEGA. 13 To our knowledge

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Jarod L. Roland, Syed Hassan A. Akbari, Afshin Salehi and Matthew D. Smyth

incomplete treatment. In this fashion, we stacked successive treatments to create a cylindrical treatment volume along the length of the CC ( Video 1 ). VIDEO 1. Video showing intraoperative thermography and thermal damage estimates while performing an anterior two-thirds corpus callosotomy. The video begins with ablation at the distal body fiber and progresses anteriorly. Then we switch to the second fiber to ablate the rostrum and genu to complete the anterior callosotomy. The left frame shows real-time thermometry and the right frame shows the calculated thermal

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Giant intracranial teratoma with epignathus in a neonate

Case report and review of the literature

James M. Johnston, Nilesh A. Vyas, Alex A. Kane, David W. Molter and Matthew D. Smyth

second complication was probably the result of the rapid change in the volume of intracranial contents after resection of the giant tumor. Conclusions The combination of intracranial teratoma with epignathus is a rare entity. Infants with large intracranial teratomas often have a poor prognosis or are stillborn. Diagnosis on prenatal ultrasonography allows for early consultation with surgical subspecialists, discussions with parents regarding possible developmental delays, and appropriate preparations for delivery including cesarean section and tracheostomy in a

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Nicholas A. Pickersgill, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth and Kamlesh B. Patel

helmet therapy . J Neurosurg Pediatr 7 : 620 – 626 , 2011 21631199 10.3171/2011.3.PEDS10418 26 Schmelzer RE , Perlyn CA , Kane AA , Pilgram TK , Govier D , Marsh JL : Identifying reproducible patterns of calvarial dysmorphology in nonsyndromic sagittal craniosynostosis may affect operative intervention and outcomes assessment . Plast Reconstr Surg 119 : 1546 – 1552 , 2007 10.1097/01.prs.0000256067.42651.30 17415249 27 Sgouros S , Hockley AD , Goldin JH , Wake MJ , Natarajan K : Intracranial volume change in craniosynostosis . J