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St Christopher\u27s Hospital for Children Memorial Tribute for Paul M. Glat, MD, FACS, 4 August 1962-22 May 2024.
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Surgical Technique for Repositioning Deep Brain Stimulation Electrodes.
No full textBACKGROUND AND OBJECTIVES: Accuracy in deep brain stimulation (DBS) surgery is critical. The literature lacks a systematic approach, including surgical technique, for repositioning DBS electrodes when first pass accuracy is suboptimal. This is especially true of asleep DBS surgery.
METHODS: A retrospective analysis was performed for DBS with an image-guided image-verified robotic technique performed from July 2018 to November 2024. Surgical technique for repositioning was based on the direction and magnitude of the first pass radial error. Radial error was measured as distance (mm) in the plane perpendicular to the planned trajectory from the center of the electrode on intraoperative O-arm computed tomography to the planned trajectory.
RESULTS: We analyzed 506 passes for 441 electrodes. Final radial error after repositioning (0.96 ± 0.38 mm) was comparable with previous reports (0.9 mm). An average 1.14 ± 0.51 passes per electrode was similar to literature values for asleep cases (1.4 passes). Average radial error from trajectory 1 to electrode 1 was 2.39 mm and for trajectory 2 to electrode 2 was 2.23 mm, with a significant correlation between the 2 passes (Pearson r = 0.68, P \u3c .001). Direction of radial error was identical from pass 1 to pass 2 in 71.74% of revisions. The relationship between the direction of the initial radial error and subsequent error was statistically significant (χ2 statistic 45.04, P \u3c .001). This did not differ with or without the use of a rigid cannula (U-statistic: 77.0, P = .46) and did not depend on the presence of pneumocephalus (Pearson correlation coefficient 0.008, P = .96).
CONCLUSION: For DBS electrodes placed with suboptimal radial error, direction and magnitude of that error can be reliably used to correct that error. This error is likely due to a reproducible systematic error influenced by both procedural variables and patient-specific anatomical factors
Long-term retinal outcomes in spontaneously regressed stage 3 retinopathy of prematurity
No full textHow do language barriers affect diagnosis and treatment of miscarriages in the Emergency Department?
No full textOutcomes of adjuvant radiation treatment following subtotal resection of world health organization grade II meningiomas.
No full textPURPOSE: Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients.
METHODS: A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS).
RESULTS: Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm
CONCLUSION: Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS
Postoperative Complication Risk in Idiopathic Intracranial Hypertension Patients Treated with Glucagon-Like Peptide-1 Receptor Agonists
No full textUpfront use of temporal myofascial flap for repair of traumatic injury and prevention of CSF leaks: illustrative cases.
No full textBACKGROUND: Traumatic brain injury involving destruction of the mastoid bone leading to a large defect in the middle fossa floor or posterior fossa dura can necessitate delayed or multistep repairs or reconstruction of the middle fossa floor because of a CSF leak and rhinorrhea. Delayed repair may be associated with CNS infection. Reconstruction using a temporalis myofascial flap has been described in delayed reconstruction cases with CSF leak. The authors report a novel concept of upfront repair.
OBSERVATIONS: Two patients with gunshot wound injuries involving the mastoid and middle fossa floor or posterior fossa dura underwent decompression and simultaneous early reconstruction with a temporalis myofascial flap sutured to the middle fossa dura. Both patients avoided prolonged CSF leak and had no complications from this approach.
LESSONS: Upfront repair of traumatic defects of the middle fossa floor or posterior fossa dura involving the mastoid air cells may avoid a prolonged CSF leak and its complications. https://thejns.org/doi/10.3171/CASE25412