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Emily L. Day and R. Michael Scott

S ince 2005, Boston Children’s Hospital’s Department of Neurosurgery has employed intraoperative MRI (ioMRI) using a 1.5T mobile magnet during brain tumor surgery (IMRIS). One of the goals of this technology is to guide and demonstrate the extent of tumor resection while the craniotomy flap is still open in the hope of avoiding a subsequent return to the operating room to remove resectable residual tumor detected on a postoperative scan. 5 , 8 , 9 , 19 Demonstrating the utility of this technology is an important issue, as there is a significant expense to

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Alexander F. C. Hulsbergen, Francesca Siddi, Malia McAvoy, Benjamin T. Lynch, Madeline B. Karsten, Brittany M. Stopa, Joanna Ashby, Jack McNulty, Marike L. D. Broekman, William B. Gormley, Scellig S. D. Stone, Benjamin C. Warf, and Mark R. Proctor

after surgery, with reported rates ranging from 12% to 24%. 6–10 For these reasons, our institution has moved away from shunt placement as the primary treatment for hydrocephalus in children, although shunt revisions remain common. Many institutions routinely perform postoperative imaging of the head to assess shunt location and ventricle size after revision surgery. While this practice has obvious benefits in the setting of persistent symptoms, its utility in asymptomatic, uncomplicated patients is questionable. This is reflected in the lack of clear guidelines

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Victoria Kuta, P. Daniel McNeely, Simon Walling, and Michael Bezuhly

sutures. 25 , 46 Although the disorder’s impact on neurocognitive development remains in question, children with sagittal craniosynostosis may be faced with social and psychological barriers that negatively impact their self-esteem and social function because of their scaphocephalic appearance. 31 , 41 Although reports have documented the psychosocial aspects of scaphocephaly, no study to date has quantified the perceived burden of sagittal craniosynostosis and scaphocephaly by using standardized methods of obtaining health utility scores. Utility scores such as the

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Jared D. Ament and Kee D. Kim

questionnaires asking about current symptoms and functioning, and responses are used to calculate scores. The most widely used generic health status instrument include the SF-36, SF-12 (12-Item Short-Form Health Survey), and more recently, the economic utility derivative, SF-6D (6-dimensional Short-Form Health Survey). 15 , 18 In contrast, preference-based QOL instruments elicit patients' valuations for their current health state. The instruments generate a single value expressed on a 0-to-1 scale, where 0 represents the value of death and 1 represents the value of perfect

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Ariana Adamski, Michael W. O’Brien, and Matthew A. Adamo

peritoneal cavity has a more robust or meager flow or only exits the tubing through one perforation. The cutoffs used during the procedure may also affect the utility of a shuntogram. A multicenter study involving 259 shuntograms in 227 patients revealed that shunt failure was lowest (37.5%) and specificity was highest (97.2%) when a normal (negative) shuntogram was defined by tracer movement within 45 minutes versus 15 minutes. 8 Perhaps the low sensitivity of the procedure is one reason shuntograms are not a universal practice among neurosurgeons. In our series, the

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Pirjo Räsänen, Juha Öhman, Harri Sintonen, Olli-Pekka Ryynänen, Anna-Maija Koivisto, Marja Blom, and Risto P. Roine

permanent disability. Many traditional medical outcomes offer a too limited view on what patients consider beneficial. This is especially true in cases involving disorders such as cervical or lumbar radicular pain in which the patient’s main complaint cannot be objectively measured. Furthermore, traditional medical outcome measures are usually disease specific and, consequently, do not allow comparison of treatment results across different medical specialties. We have been conducting a large trial to explore the feasibility of routine evaluation of cost–utility of

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Scellig S. D. Stone and James T. Rutka

localize language/sensorimotor cortex; in anesthetized craniotomies to localize motor cortex continuous train of 5 CST monitoring no no yes, if perirolandic yes, if perirolandic *CST = corticospinal tract; US = ultrasonography. Anatomical Guidance Defining one's location relative to surrounding neurovascular structures is imperative to performing safe and effective epilepsy surgery. The utility of preoperative neuronavigation in providing anatomical guidance can take many forms. For example, neuronavigation used preoperatively can assist with

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Grégoire P. Chatain, Nicholas Patronas, James G. Smirniotopoulos, Martin Piazza, Sarah Benzo, Abhik Ray-Chaudhury, Susmeeta Sharma, Maya Lodish, Lynnette Nieman, Constantine A. Stratakis, and Prashant Chittiboina

or the adenoma ( Fig. 1 ). We then tested the utility of FLAIR as a complementary tool to 3D-GRE. Interestingly, all 5 patients with negative 3D-GRE MRI displayed a distinct focus of FLAIR enhancement ( Fig. 2 ). Four of those 5 cases (80%) had location-concurrent positive histopathological findings and achieved postsurgical biochemical remission. The remaining patient did not achieve remission from CD despite subtotal hypophysectomy. No intraoperative tumor was found; therefore a subtotal hypophysectomy was performed that did not include the FLAIR hyperintensity

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Adham M. Khalafallah, Adrian E. Jimenez, Carlos G. Romo, David Olayinka Kamson, Lawrence Kleinberg, Jon Weingart, Henry Brem, Stuart A. Grossman, and Debraj Mukherjee

research has yet to directly measure the efficacy of MDTBs in positively influencing the diagnosis and treatment of patients with cancer affecting the nervous system. The purpose of the present study was to quantify the utility of a weekly neuro-oncology MDTB by determining to what extent these meetings influence diagnosis and treatment within this patient population. The primary outcome of interest was whether the MDTB discussion led to changes in patient treatment plans, such as the additions of referrals, recommendations for further diagnostic workups, and any

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an established procedure for the treatment of patients with transient ischemic attacks.” The authors do not give a single reference which challenges the utility of carotid endarterectomy, yet I am certain that they are aware of the existence of these. The study is retrospective and uncontrolled. They have reported patients with acute neurological deficits, the natural history of which, in most instances, would include some improvement over the next several days after onset; however, they attribute this improvement to the surgery. They clearly recognize that most