Neurosurgery
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The past decade has witnessed the increasing application of robotics in surgery, yet there is no existing system that combines stereotaxy and microsurgery in an imaging environment. To fulfill this niche, we have designed and manufactured an image-guided robotic system that is compatible with magnetic resonance imaging. ⋯ We are providing technology to advance and transform surgery with the potential to improve patient outcome.
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We report the youngest known case of a prepontine intradural chordoma. These tumors are exceedingly rare. Unlike their more common extradural counterparts, no recurrence of an intradural chordoma has been reported. ⋯ By using an endoscopic-assisted procedure, we achieved complete resection of an intradural chordoma offering a potential for surgical cure. Resection is particularly advantageous because it spares the young child the need for radiation treatment. Close follow-up is warranted because we postulate that this tumor exists in a biological continuum between benign notochordal hamartomatous remnants and typical invasive chordomas.
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Infection involving the cerebrum is a true neurosurgical emergency that requires rapid diagnosis and appropriate surgical and medical intervention to achieve good clinical outcome. ⋯ Combining advanced imaging and surgical techniques in the form of intraoperative magnetic resonance image-guided neurosurgery may further enhance clinical outcomes in these once uniformly fatal diseases.
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We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). ⋯ Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.
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Multicenter Study
A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children.
To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children. ⋯ Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.