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A telescopic ventriculoatrial shunt that elongates with growth

Technical note

Burton L. Wise

✓ A ventriculoatrial (VA) shunt catheter has been developed, based on a double telescopic principle, that elongates during longitudinal growth of the child. It is implanted in patients by a technique similar to that used for other VA shunts, with minor modifications. Radiopaque markers on the expandable portion of the shunt allow radiographic measurement of the “growth” of the shunt. These shunts have been implanted in 18 children with hydrocephalus; in 15 they continue to function, a duration of from 1 to 4 years. In eight this was the initial shunt, while in 10 others the telescopic shunt was implanted at the time of revision of a standard shunt. One additional special model was implanted directly in the auricle by thoracotomy and is functioning over 5 months later. This type of shunt may largely eliminate the need for prophylactic lengthening of VA shunts during growth and prevent the problem of distal shunt obstruction due to growth.

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Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy

Robert C. Heim, T. S. Park, George P. Vogler, Bruce A. Kaufman, Michael J. Noetzel, and Madeleine R. Ortman

✓ Selective dorsal rhizotomy is increasingly used for management of spastic quadriplegic cerebral palsy but rates of hip stability following the operation have not been reported. Determining hip stability by radiographic measurement of lateral migration of the femoral head beyond a lateral edge of the acetabulum after dorsal rhizotomy allows an objective assessment of the outcome of the operation. This prospective study examined the effect of selective dorsal rhizotomy on lateral migration of the femoral head in 45 children with spastic quadriplegic cerebral palsy. The children ranged in age from 2 to 9 years (average 5 years 1 month) and were grouped according to their ages with 23 children in the 2- to 4-year-old group and 22 children in the 5- to 9-year-old group. Postoperative follow up ranged from 7 to 50 months (average 20 months). The Reimers migration percentage (MP), a measure of the lateral migration of the femoral head, was calculated from anteroposterior hip radiographs taken prior to the operation and at the last follow-up examination. Of the 90 hips involved, 9% improved, 80% remained unchanged, and 11% worsened, yielding a radiographic stability rate of 89%. The hips with postrhizotomy worsening of the MP had an average preoperative MP of 14% (range 9% to 38%) and an average postoperative increase in MP of 18% (range 11% to 37%). Of the 45 children, four subsequently underwent unilateral derotational femoral osteotomies for persistent or worsening hip subluxation. There was a significant tendency for the MP to worsen in patients with lower prerhizotomy MP values (χ2 = 20.74, df = 4, p = 0.001), but the age of patients and their ambulatory status at the time of rhizotomy had no bearing on postoperative hip stability. The data indicate that selective dorsal rhizotomy prevents progressive lateral migration of the femoral head in the majority of children who undergo the operation for spastic quadriplegia.

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Outcome after laminectomy for lumbar spinal stenosis

Part II: Radiographic changes and clinical correlations

Gerald F. Tuite, Stephen E. Doran, Joseph D. Stern, John E. McGillicuddy, Stephen M. Papadopoulos, Craig A. Lundquist, Dotun I. Oyedijo, Susan V. Grube, Holly S. Gilmer, M. Anthony Schork, Steven E. Swanson, and Julian T. Hoff

to spondylolisthesis and angulation in the opposite direction. Radiographic Coding Data for all measurements were recorded relative to lumbar spine disc spaces (including L1–2, L2–3, L3–4, L4–5, and L5—S1). Based on operative reports, the radiographic measurements were further stratified according to whether a laminectomy had been performed at that level. Measurements were coded as operative if a laminectomy had been performed on the lower half of the lamina above and/or the upper half of the lamina below ( Fig. 2 ). For example, if a patient had the

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Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis. Part I. Clinical, radiological, and neuropathological features

Adrian T. H. Casey, H. Alan Crockard, Jennian F. Geddes, and John Stevens

spine fusion in rheumatoid arthritis. J Bone Joint Surg (Am) 61 : 1003 – 1010 , 1979 Ranawat CS, O'Leary P, Pellicci P, et al: Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg (Am) 61: 1003–1010, 1979 36. Redlund-Johnell I , Pettersson H : Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol (Diagn) 25 : 23 – 28 , 1984 Redlund-Johnell I, Pettersson H: Radiographic measurements of the cranio-vertebral region

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Vertical translocation. Part II. Outcomes after surgical treatment of rheumatoid cervical myelopathy

Adrian T. H. Casey, H. Alan Crockard, and John Stevens

loop fixation. J Bone Joint Surg (Br) 68: 173–177, 1986 34. Redlund-Johnell I , Pettersson H : Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn 25 : 23 – 28 , 1984 Redlund-Johnell I, Pettersson H: Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn 25: 23–28, 1984 35. Redlund-Johnell I , Pettersson H : Vertical

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Accurate placement of coronal ventricular catheter using stereotactic coordinate-guided free-hand passage

Technical note

Dachling Pang and Paul A. Grabb

radiographic measurement AX (left) . The factor correcting for the skull curvature, CD, is the small vertical height between points A' and A. The factor correcting for the reservoir base height (the distance between the top of the catheter and the outer skull table from which all radiographic measurements are made) is exactly 4 mm with the Cordis-Hakim shunt. This correction factor varies according to the type of reservoir used. To achieve this ideal trajectory, the following surface coordinates are drawn on the scalp before draping. 1) A midsagittal line is drawn

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The influence of transoral odontoid resection on stability of the craniovertebral junction

Curtis A. Dickman, Jacqueline Locantro, and Richard G. Fessler

–1010, 1979 32. Redlund-Johnell I , Pettersson H : Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol (Diagn) 25 : 23 – 28 , 1984 Redlund-Johnell I, Pettersson H: Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol (Diagn) 25: 23–28, 1984 33. Saldinger P , Dvorak J , Rahn BA , et al : Histology of the alar and transverse ligaments

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Predictors of outcome in the quadriparetic nonambulatory myelopathic patient with rheumatoid arthritis: a prospective study of 55 surgically treated Ranawat Class IIIb patients

Adrian T. H. Casey, H. Alan Crockard, J. Martin Bland, John Stevens, Ronald Moskovich, and Andrew Ransford

, Crockard HA, Pozo JL: Craniocervical instability treated by contoured loop fixation. J Bone Joint Surg (Br) 68: 173–177, 1986 31. Redlund-Johnell I , Pettersson H : Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol 32 : 23 – 28 , 1984 Redlund-Johnell I, Pettersson H: Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol 32: 23–28, 1984 32. Ropes

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Frameless stereotaxy using bone fiducial markers for deep brain stimulation

Kathryn L. Holloway, Steven E. Gaede, Philip A. Starr, Joshua M. Rosenow, Viswanathan Ramakrishnan, and Jaimie M. Henderson

Publications, 1993, pp 259–270 10. Maciunas RJ , Galloway RL Jr , Latimer JW : The application accuracy of stereotactic frames. Neurosurgery 35 : 682 – 695 , 1994 Maciunas RJ, Galloway RL Jr, Latimer JW: The application accuracy of stereotactic frames. Neurosurgery 35: 682–695, 1994 10.1227/00006123-199410000-00015 11. O'Leary ST , Yoshida K , Arzbaecher J , Bakay RA : How accurate is accurate? Intraoperative radiographic measurement of microelectrode and DBS lead location: AANS May

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Complications associated with the halo-vest

A review of 245 cases

John A. Glaser, Richard Whitehill, Warren G. Stamp, and John A. Jane

application of the halo-vest and at all subsequent times at which they were obtained. Reductions were judged as complete when spinal alignment was anatomic and incomplete when it was not. In cases in which a dramatic change in reduction had taken place with patients in halo-vests, such as redislocation of facet dislocations, plain x-ray films readily demonstrated such changes qualitatively. In other cases, radiographic changes were more subtle. Thus, reductions were also assessed quantitatively with linear and/or angular radiographic measurements of: 1) the para