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Yuma Okamura, Keisuke Maruyama, Shin Fukuda, Hiroshi Horikawa, Nobuyoshi Sasaki, Akio Noguchi, Motoo Nagane and Yoshiaki Shiokawa

C erebrospinal fluid (CSF) shunt surgeries play an essential role in the treatment of hydrocephalus of various etiologies. 25 Due to the implantation of foreign materials, shunt infections are among the most common surgical complications, frequently causing meningitis or peritoneal infections. 21 Once infections occur, they may result in shunt failure, subsequent disorders of higher cortical function, and more serious sequelae, including death. 11 , 17 The reported rate of infections is 5% to 17%, 3 , 15 , 16 , 20 , 28 and the use of a protocol to prevent

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Wesley A. King, Keith L. Black, Kiyonobu Ikezaki, Scott Conklin and Donald P. Becker

. Neurological Function The neurological function in the rat groups 10 days after tumor implantation is presented in Table 2 . Of the seven rats in the control group treated with vehicle only, two rats remained asymptomatic while the rest were moderately symptomatic or worse. Six rats were tested in each of the other treated groups. Methylprednisolone, U-74006F, and U-78517F significantly prevented neurological dysfunction compared to controls (p < 0.01 for methylprednisolone and U-74006F and p < 0.03 for U-78517F). All rats in the methylprednisolone group and those treated

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Evaluation of DuraGen in preventing peridural fibrosis in rabbits

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2005

Claudio E. Tatsui, Gonzalo Martinez, Xiuming Li, Pradip Pattany and Allan D. Levi

, 46 Although free fat grafts are commonly used for this purpose, their results are clinically inconsistent, 2 , 15 , 29 and some authors have reported nervous tissue compression presenting as radiculopathy and cauda equina syndrome due to remodeling and migration of the grafts. 4 , 29 , 30 , 45 The ideal material with which to prevent fibrosis should not impair dural healing so that it can be used in cases of primary dural closure, duraplasty, or incidental dural tears. Additionally local inflammatory reaction should be limited and the infection rate low

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Byron Young, Robert P. Rapp, J. A. Norton, Dennis Haack, Phillip A. Tibbs and James R. Bean

% (over 40,000) were hospitalized for 20 or more days. A survey of board-certified neurosurgeons in 1973 revealed that 60% used prophylactic anticonvulsant drugs in patients with severe head injury. 15 Several recent uncontrolled studies have supported this practice by indicating that posttraumatic seizures can be prevented by prophylactically administering anticonvulsant drugs. 13, 21, 22 We report the results of a randomized double-blind placebo-controlled study showing that the incidence of late posttraumatic epilepsy is not decreased by prophylactically

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Toshiaki Hayashi, Reizo Shirane, Takahiro Kato and Teiji Tominaga

believed to reduce bacteria from the air of the operating room and were recommended. To reduce the chances of bacterial contact with the patients' skin and shunt material, several practices such as the “no-touch” technique, 9 soaking instruments and gloves in iodine solution, 5 , 6 and intraoperative double-gloving strategy 15 , 19 were undertaken because they were believed to reduce implantation of bacteria on the shunt. Although not yet widely used, antibiotic-impregnated shunt systems have been introduced 1 , 11 and are believed to work by preventing proliferation

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Toshiaki Hayashi, Reizo Shirane, Michiko Yokosawa, Tomomi Kimiwada and Teiji Tominaga

contact. We consider our technique to be an efficient procedure for reducing local bacterial contamination. The irrigation also washes out CSF and blood clots that are considered to be an excellent growth medium for bacteria. There have been some reports in which saline wound irrigation diminished the infection rate by means of significant reduction of the bacterial inoculum present at the time of skin closure. 2 , 3 , 13 A previous report also demonstrated the effectiveness of irrigation with amikacin containing saline for preventing shunt infection. 10 Considering

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Susumu Oikawa, Masahiko Mizuno, Shinsuke Muraoka and Shigeaki Kobayashi

T emporalis muscle atrophy can be one of the cosmetic and functional complications of pterional craniotomy, which may cause delay in recovery or inability of patients to return to their previous occupations. The factors causing muscle atrophy are as follows: 1) denervation; 2) loss of blood supply; 3) inappropriate muscle tension; and 4) muscle fiber injury. 5 To prevent temporalis muscle atrophy, surgical procedures should preserve the deep temporal nerve and artery and reattach the muscle to an appropriate place without causing muscle damage. We describe a

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Garrett T. Venable, Nicholas B. Rossi, G. Morgan Jones, Nickalus R. Khan, Zachary S. Smalley, Mallory L. Roberts and Paul Klimo Jr.

year for patients with newly diagnosed hydrocephalus. This same group, as well as Dr. Goumnerova and colleagues at Boston Children's Hospital ( http://www.qualityforum.org/QPS/0713 ), have advocated the use of the 30-day shunt malfunction rate. 35 The purpose of this study was to analyze in detail the etiologies of early shunt failure (within the first 90 days) in our population of pediatric patients with hydrocephalus and to determine the proportion of shunt failures that potentially could have been prevented. We believe that such detailed analysis is a requisite

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Harold D. Portnoy, Rudolf R. Schulte, John L. Fox, Paul D. Croissant and Lucius Tripp

requires a similar positive pressure at the inlet to open the valve. With this valve an adult hydrocephalic patient with a V-P shunt whose distal catheter is 800 mm long would require an IVP of 800 mm H 2 O to overcome this siphon effect. To prevent such an increase in IVP, the area of the diaphragm under the inlet and outlet is adjusted to have a ratio of 8:1; thus, with 800 mm of distal catheter the valve opens at approximately 100 mm H 2 O (force = pressure × area). Fig. 2. Diagram of anti-siphon valve in open and closed positions. Note a slight offset

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Janusz A. Bonkowski, Robin D. Gibson and Leslie Snape

single suture was passed across the middle of the dural defect to prevent the fascia from prolapsing into the wound. A rectangle of corticocancellous bone, measuring 4 × 1 cm, was harvested from the inner iliac cortex and placed in the defect over the fascia. The upper and lower ends of the graft were thinned to leave cortex only and were wedged, above and below, behind the clivus and body of C-2, after an extradural pocket had been fashioned behind the clivus and a lower pocket between the posterior longitudinal ligament and the body of C-2 ( Fig. 2 ). Fig. 2