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Bermans J. Iskandar, Benjamin B. Fulmer, Mark N. Hadley and W. Jerry Oakes

undiagnosed, despite obvious cutaneous anomalies or orthopedic deformities. The development of new symptoms (especially pain) or the progression of previously inconspicuous established deficits brings these patients to medical attention. Other authors have carefully described the clinical and radiographic features of adult patients who presented with congenital tethered cord syndrome, as well as the results of surgery in this group. 5, 7, 8, 10–13, 15–17 The aim of this paper is to describe the results of surgery performed in a group of adult patients with occult spinal

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Raita Fukaya, Kazunari Yoshida, Takenori Akiyama and Takeshi Kawase

I t is generally believed that moyamoya disease advances in angiographically visible stages, that the angiographic features are constructed in a short period between childhood and adolescence, and that subsequently the disease remains almost stabilized between adolescence and adulthood. 2 , 6 Rare have been the cases in which the progression of moyamoya disease in adults could be followed on angiographic or MR angiographic studies. 1 , 7 , 10–12 , 14 Recently, however, a long-term follow-up study has shown that the incidence of moyamoya disease progression

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Giannina L. Garcés-Ambrossi, Matthew J. McGirt, Roger Samuels, Daniel M. Sciubba, Ali Bydon, Ziya L. Gokaslan and George I. Jallo

A dult TCS remains an incompletely understood clinicopathological entity. Adult TCS may arise from many underlying causes, including fatty filum, lipomyelomeningocele, spinal neoplasms, and arachnoid scarring, among others. 6 , 11 The authors of several published series have demonstrated a high incidence of neurological improvement after surgical tethered cord release in adults; 1–4 , 6 , 8–12 however, the time course of neurological improvement and the symptomatic presentations most likely to experience improvement are not yet well-defined. Furthermore

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John A. Jane Jr., Erin Kiehna, Spencer C. Payne, Stephen V. Early and Edward R. Laws Jr.

because the expanded sella provides a widened aperture to the suprasellar compartment and also diaphragmatic protection from pial invasion. 11 , 19 Although there is limited experience using the transsphenoidal approach for suprasellar tumors, 1 , 2 , 5 , 6 endoscopic transsphenoidal approaches introduced over the past decade are being increasingly used. 3 , 4 , 8–10 , 23 We describe our experience using the endoscopic transsphenoidal technique for adults with craniopharyngiomas and describe the neurological, endocrinological, and visual outcomes. Methods

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Korak Sarkar, Krista Keachie, UyenThao Nguyen, J. Paul Muizelaar, Marike Zwienenberg-Lee and Kiarash Shahlaie

T raumatic brain injury (TBI) is a leading cause of death and disability among pediatric patients worldwide. In the US alone, over 475,000 children and adolescents sustain a TBI each year, resulting in 37,000 hospital admissions, 2600 deaths, and over $20 billion in health care costs. 2 , 14 , 18 , 31 Despite its significant impact, pediatric TBI is frequently excluded completely or grouped with adult TBI without an adequate understanding of the differences between these distinct patient populations. Although specific guidelines for the neurocritical

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Matthew C. Davis, Betsy D. Hopson, Jeffrey P. Blount, Rachel Carroll, Tracey S. Wilson, Danielle K. Powell, Amie B. Jackson McLain and Brandon G. Rocque

S pinal dysraphism is the most common congenital abnormality of the spinal cord and the most complex congenital condition with high rates of survival into adulthood. 6 While 75% of these individuals can expect to reach adulthood, 6 , 10 there is great variability in the range and degree of disability, 21 and multiple medical and psychosocial limitations pose challenges to full community engagement. Results of studies on the impact of medical factors on quality of life and employment status among adults with spina bifida are conflicting. 2 , 8 , 10 , 31

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Ian A. Anderson, Louise F. Saukila, James M. W. Robins, Christopher Y. Akhunbay-Fudge, John R. Goodden, Atul K. Tyagi, Nick Phillips and Paul D. Chumas

group from our institution (Al-Tamimi et al.) proposed that a 30-day shunt failure rate represents a reasonable and valid barometer of surgical outcomes (and therefore of relatively avoidable shunt failures) and that this should be used as a separate outcome measure in future shunt trials. 2 To validate the data produced in future trials (and in the Al-Tamimi et al. paper) it is important that sufficient background data be published with which others can compare their results. In this study we present a single-center experience of all adult and pediatric VP shunts

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Courtney M. Schusse, Kris Smith and Cornelia Drees

approaches that similarly aim to transect all crucial interhemispheric connections while minimizing brain removal. 17 Since then, functional hemispherectomy or hemispherotomy has remained an invaluable tool in treating focal or hemispheric epilepsy due to various etiologies (vascular insults, hemimegalencephaly, Rasmussen encephalitis). However, its use remains primarily in the pediatric population. The reason for the hesitation to use it in adult patients is not entirely clear, but concerns have generally been related to potentially irreversible damage to adult brains

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Tomohito Hishikawa, Koji Tokunaga, Kenji Sugiu and Isao Date

included in the diagnostic criteria of MMD. However, PCAs are often involved after progression of ICA lesions, and the clinical significance of steno-occlusive PCA lesions in MMD has been demonstrated. 4 , 5 , 7 , 9–12 , 15 The clinical characteristics of pediatric patients with MMD are quite different from those of adult patients. Most pediatric patients with MMD develop ischemic complications, and approximately half of adult patients suffer intracranial hemorrhage and half suffer ischemic complications. 6 Understanding the difference in angioarchitecture of MMD

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Timothy M. George and Lisa H. Fagan

T he tethered spinal cord in adult patients was initially recognized more than 100 years ago. 21 Despite this early observation, investigators have focused on the effects of tethering in the pediatric populations with spinal dysraphism. 16, 39 As many as two thirds of all procedures for tethered cord in pediatric patients are performed to treat postrepair myelomeningocele. 15 Adults with tethering lesions of various origins have been the subject of several series; 17, 18, 35, 54 however, the frequency of postrepair myelomeningocele tethered cord is only