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Jeffrey W. Brennan, Michael K. Morgan, William Sorby and Verity Grinnell

of a patient who had been treated with a high-flow CCA—IICA saphenous vein interposition bypass graft for a traumatic pseudoaneurysm of the intracavernous ICA, and who suffered an initial stenosis of the graft caused by intimal hyperplasia that recurred after revision surgery. This was successfully treated with endovascular stent placement in the vein graft. Case Report First Operation This 39-year-old woman underwent bilateral nasal antrostomies and ethmoidectomy for chronic sinusitis complicated by massive bleeding from the region of the superolateral sphenoid

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Daniel J. Tomes, Leslie C. Hellbusch and L. Russell Alberts

; pedi = pediatric-sized catheter; ref = reference; reg = regular- or adult-sized catheter. † Newer version. Used Tubing Silastic shunt tubing obtained in patients in the course of CSF shunt revision surgery was tested to compare the stretching and breaking characteristics of new with patient-used tubing. The model number and manufacturer of the retrieved (used) silastic shunt tubing were identified by reviewing the operative reports on the patients and by visual identification. A retrospective chart review also allowed us to identify various

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L. Fernando Gonzalez, Louis Kim, Harold L. Rekate, Cameron G. Mcdougall and Felipe C. Albuquerque

C erebrospinal fluid diversion procedures are associated with a high incidence of malfunction. Once the peritoneum becomes scarred, finding a new distal end for the catheter to prevent CSF absorption is challenging. Revision surgeries involving ventriculoatrial shunts are especially complicated because of scarring in the neck and the likelihood that there has been a previous thrombosis. We present a technique that facilitates localization of the internal jugular vein and simultaneously rules out thrombosis. Clinical Material and Methods Patient

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Peter T. Frame and Robert L. McLaurin

means of CSF pressure release while the infection is being treated. The second management strategy is to attempt sterilization of the CSF shunt while the mechanism remains in place, without any surgery directed at the infection. If a shunt malfunction is present, shunt revision is performed and if new shunt hardware is required it is replaced at the time of revision surgery. At this institution, management plans consistent with the latter philosophy have been followed with considerable success. 6, 14, 18 In our more recent cases we have been investigating antibiotic

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Lorenzo Rinaldo, Desmond Brown, Giuseppe Lanzino and Ian F. Parney

the risk of complications after shunting, particularly the risk of subsequent revision surgery, is not well-defined in this clinical context. The standard of care for high-grade gliomas currently includes both adjuvant radio- and chemotherapy. 16 In addition, novel antiangiogenic agents, such as bevacizumab, are sometimes used as salvage chemotherapy for progressive disease. 5 , 8 It is also not known whether these treatment modalities affect the risks of shunting. Herein, we reviewed the clinical outcomes of patients with WHO grade III or IV gliomas who developed

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Valérie Decrouy-Duruz, Thierry Christen and Wassim Raffoul

an anesthetic local nerve block, whereas others were selected after clinical examination only. Preoperative nerve blocks were performed in a minority of patients; therefore, their efficiency as a predictor of favorable outcome was not assessed. All operations were performed by the senior author. The following parameters were recorded for each patient: history, location, duration, and severity of the pain (VAS Score 0–10) and details of nerve revision surgery. Neuromas were classified as a terminal neuroma or a neuroma-in-continuity; the latter category included

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Daniel M. Sciubba, Joseph C. Noggle, Neena I. Marupudi, Carlos A. Bagley, Markus J. Bookland, Benjamin S. Carson Sr., Michael C. Ain and George I. Jallo

11 location of initial procedure (%)  thoracolumbar 32 (65.3)  lumbar 10 (20.4)  cervical 4 (8)  cervicothoracic 2 (4)  thoracic 1 (2) fusion procedures w/ internal fixation 43 nonfusion procedures 17 mean follow up (mos) * 34 (range 8–93) reasons for revision surgery  progressive deformity in nonfused spine 5  decompression of junctional stenosis 5  repeat decompression at same levels 1 complications (%) 7 (11.6)  durotomy 4  wound breakdown/infection 2  instrumentation

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Kimitoshi Sato, Satoru Shimizu, Satoshi Utsuki, Sachio Suzuki, Hidehiro Oka and Kiyotaka Fujii

system in detail radiographically, but failed. There is no established method for verifying the opening pressure in vivo. In patients whose history is difficult to ascertain and especially in children, the possibility of damage to the valve spring and the need for prompt revision surgery should be considered. In addition, the placement of the CHPV system may be contraindicated in patients with a known habit of head banging. Acknowledgments We thank Johnson & Johnson K. K. Codman Mitek Division for technical assistance and information about the product

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John R. W. Kestle and Marion L. Walker

2 (Adjunct). Surgical Procedures The primary study end point was shunt revision surgery. This was defined in four categories: obstruction, overdrainage, loculated compartments, or infection. These definitions are the same as those used in previous hydrocephalus trials, including the SDT and the Endoscopic Shunt Insertion Trial. 1, 3 This was done to strenghten the comparison between the current study and the historical literature. In all of the surgeries (shunt insertion or revision), the Strata valve was placed; other flow-control devices were

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John R. W. Kestle and Marion L. Walker

2 (Adjunct). Surgical Procedures The primary study end point was shunt revision surgery. This was defined in four categories: obstruction, overdrainage, loculated compartments, or infection. These definitions are the same as those used in previous hydrocephalus trials, including the SDT and the Endoscopic Shunt Insertion Trial. 1, 3 This was done to strenghten the comparison between the current study and the historical literature. In all of the surgeries (shunt insertion or revision), the Strata valve was placed; other flow-control devices were