bluuebunny/crossref_metadata_2025 huggingface dataset:
A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus
Authors: Koueik Joyce , Kraemer Mark R. , Hsu David , Rizk Elias , Zea Ryan , Haldeman Clayton , Iskandar Bermans J.
Published: October 2019

OBJECTIVE

Recent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.

METHODS

A retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.

RESULTS

Seventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.

CONCLUSIONS

Using an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.
Assessment of craniocervical motion in Down syndrome: a pilot study of two measurement techniques
Authors: Martin Jonathan E. , Rocque Brandon G. , Jea Andrew , Anderson Richard C. E. , Pahys Joshua , Brockmeyer Douglas
Published: October 2019

OBJECTIVE

Hypermobility of the craniocervical junction (CCJ) in patients with Down syndrome (DS) is common. Whereas atlantoaxial (C1–2) hypermobility is well characterized, occipitoatlantal (Oc–C1) laxity is recognized but poorly defined. A clear understanding of the risks associated with DS-related hypermobility is lacking. Research efforts to address the topic of axial cervical spine instability in the patient with DS require a reliable and reproducible means of assessing CCJ mobility. The authors conducted a pilot study comparing two methods of quantifying motion of the CCJ on dynamic (flexion/extension) plain radiographs: the delta–condyle-axial interval (ΔCAI) and the delta–basion-axial interval (ΔBAI) methods.

METHODS

Dynamic radiographs from a cohort of 10 patients with DS were evaluated according to prescribed standards. Independent movement of Oc–C1, C1–2, and Oc–C2 was calculated. Interrater and intrarater reliability for CCJ mobility was then calculated for both techniques.

RESULTS

Measurement using the ΔCAI technique had excellent fidelity with intraclass correlation coefficients (ICCs) of 0.77, 0.71, and 0.80 for Oc–C1, C1–2, and Oc–C2, respectively. The ΔBAI technique had lower fidelity, yielding respective ICCs of 0.61, 0.65, and 0.50.

CONCLUSIONS

This pilot study suggests that ΔCAI is a superior measurement technique compared to ΔBAI and may provide reliable assessment of the mobility of the CCJ on dynamic radiographs in the pediatric patient with DS. The use of reliable and reproducible measurement techniques strengthens the validity of research derived from pooled database efforts.
Evaluation and treatment of children with radiation-induced cerebral vasculopathy
Authors: Hersh David S. , Moore Kenneth , Nguyen Vincent , Elijovich Lucas , Choudhri Asim F. , Lee-Diaz Jorge A. , Khan Raja B. , Vaughn Brandy , Klimo Paul
Published: October 2019

OBJECTIVE

Stenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.

METHODS

Eligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.

RESULTS

Thirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.

CONCLUSIONS

All children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.
The effect of hospital characteristics on pediatric neuromuscular scoliosis fusion cost
Authors: Dallas Jonathan , Shannon Chevis N. , Bonfield Christopher M.
Published: October 2019

OBJECTIVE

Spinal fusion is used in the treatment of pediatric neuromuscular scoliosis (NMS) to improve spine alignment and delay disease progression. However, patients with NMS are often medically complex and require a higher level of care than those with other types of scoliosis, leading to higher treatment costs. The purpose of this study was to 1) characterize the cost of pediatric NMS fusion in the US and 2) determine hospital characteristics associated with changes in overall cost.

METHODS

Patients were identified from the National Inpatient Sample (2012 to the first 3 quarters of 2015). Inclusion criteria selected for patients with NMS, spinal fusion of at least 4 vertebral levels, and elective hospitalization. Patients with no cost information were excluded. Sociodemographics, treating hospital characteristics, disease etiology/severity, comorbidities, length of stay, and hospital costs were collected. Univariable analysis and multivariable gamma log-link regression were used to determine hospital characteristics associated with changes in cost.

RESULTS

A total of 1780 weighted patients met inclusion criteria. The median cost was $68,815. Following multivariable regression, both small (+$11,580, p < 0.001) and medium (+$6329, p < 0.001) hospitals had higher costs than large hospitals. Rural hospitals had higher costs than urban teaching hospitals (+$32,438, p < 0.001). Nonprofit hospitals were more expensive than both government (–$4518, p = 0.030) and investor-owned (–$10,240, p = 0.001) hospitals. There was significant variability by US census division; compared with the South Atlantic, all other divisions except for the Middle Atlantic had significantly higher costs, most notably the West North Central (+$15,203, p < 0.001) and the Pacific (+$22,235, p < 0.001). Hospital fusion volume was not associated with total cost.

CONCLUSIONS

A number of hospital factors were associated with changes in fusion cost. Larger hospitals may be able to achieve decreased costs due to economies of scale. Regional differences could reflect uncontrolled-for variability in underlying patient populations or systems-level and policy differences. Overall, this analysis identified multiple systemic patterns that could be targets of further cost-related interventions.
Pediatric thoracolumbar spine surgery and return to athletics: a systematic review
Authors: Sellyn Georgina E. , Hale Andrew T. , Tang Alan R. , Waters Alaina , Shannon Chevis N. , Bonfield Christopher M.
Published: October 2019

OBJECTIVE

Spinal conditions and injuries in the pediatric population can necessitate surgical treatment. For many pediatric patients, a return to athletic activity after spinal surgery is a significant postoperative focus. However, there is a lack of standardized guidelines to determine criteria for safe return to play (RTP). To understand clinical criteria for patients to safely RTP, the authors conducted a systematic review of outcomes and the period of time before physicians recommend an RTP for pediatric patients undergoing spinal surgery.

METHODS

English-language publications were searched systematically in the PubMed electronic database, and a review was conducted in accordance with the PRISMA guidelines. Additional relevant studies found via a supplementary literature search were also included. Studies assessing return to athletic activity in a pediatric population after spinal surgery were included. Studies without an RTP, postsurgical activity outcomes, or surgical intervention were excluded.

RESULTS

A PubMed search identified 295 articles, with 29 included for the systematic review. In addition, 4 studies were included from a supplementary literature search. The majority of these studies were retrospective case series and cohort studies, and the remaining studies included questionnaire-based studies, prospective cohorts, and case-control studies. The most common spinal conditions or injuries included spondylolysis, and this was followed by adolescent idiopathic scoliosis. Overall, the most frequent recommendation for RTP for noncontact and contact sports was 6 months after surgery (range 1–12 months), and for collision sports it was 12 months after surgery. However, some physicians recommended never returning to collision sports after spinal intervention.

CONCLUSIONS

Most pediatric patients are able to return to some level of sports after spinal surgery. However, no standardized criteria have been proposed, and RTP recommendations vary according to the treating surgeon. In addition, limited data are published on the variation in timelines for RTP with regard to classifications of sports (noncontact, contact, and collision). Further analysis of specific spinal conditions and injuries with postoperative athletic recovery is needed.
Management of sterile abdominal pseudocysts related to ventriculoperitoneal shunts
Authors: Erwood Andrew , Rindler Rima S. , Motiwala Mustafa , Ajmera Sonia , Vaughn Brandy , Klimo Paul , Chern Joshua J.
Published: October 2019

OBJECTIVE

There are many known complications associated with CSF shunts. One of the more rare ones is a sterile abdominal pseudocyst due to decreased peritoneal absorption. This study was undertaken to detail the presentation, evaluation, and management of this unusual shunt-related event.

METHODS

Patients presenting with ventriculoperitoneal shunt (VPS)–related sterile abdominal pseudocysts treated at two institutions between 2013 and 2018 were included. Patients who had undergone abdominal surgery or shunt revisions within a 12-month period preceding presentation were excluded. Information was collected regarding clinical characteristics; hospital course, including surgical intervention(s); and any subsequent complications. Special attention was given to the eventual surgery after pseudocyst resolution, including the use of laparoscopy for peritoneal catheter placement, distal shunt conversion (i.e., in the atrium or pleural cavity), endoscopic third ventriculostomy, or shunt removal. The timing and nature of any subsequent shunt failures were also noted.

RESULTS

Twenty-eight patients met the study criteria, with a mean age of 10 years. The most common etiology of hydrocephalus was intraventricular hemorrhage of prematurity. All shunts were externalized at presentation. One shunt was removed without subsequent internalization. Distal catheters were re-internalized back into the peritoneal cavity in 11 patients (laparoscopy was used in 8 cases). Fourteen shunts were converted to a ventriculoatrial shunt (VAS), and two to a ventriculopleural (VPlS). Two VPSs failed due to a recurrent pseudocyst. The total all-cause failure rates at 1 year were as follows: 18% for VPSs and 50% for VASs.

CONCLUSIONS

Following treatment of a VPS-related sterile abdominal pseudocyst, laparoscopy-assisted placement of the distal catheter in the peritoneum is a viable and safe option for select patients, compared to a VAS or VPlS.
Salvage sacrococcygeal resection for yolk sac tumors after chemotherapy: report of 2 cases
Authors: Ravindra Vijay M. , Ruggieri Lucia , Vasudevan Sanjeev A. , Hicks M. John , Muscal Jodi A. , Quintanilla Norma M. , Schady Deborah A. , Aldave Guillermo
Published: October 2019

Pediatric germ cell tumors (GCTs) are neoplasms that originate from primordial germ cells and, according to their site of presentation, are classified as gonadal or extragonadal. The most common site of extragonadal GCTs in children is the sacrococcygeal region, and the standard management is multimodal with a focus on chemotherapy. In selected instances, sacrococcygeal resection is performed. Herein, the authors report on 2 patients who presented with presacral yolk sac tumors managed with multimodal treatment. Both patients underwent salvage sacrococcygeal resection for oncological control and surgical removal of the sacral vertebral elements: a 27-month-old girl with a recurrent sacrococcygeal yolk sac tumor following chemotherapy and initial resection and a 24-month-old boy in whom a primary sacrococcygeal yolk sac tumor was resected following chemotherapy. These 2 cases illustrate the complexity in the management of these unusual tumors and will help neurosurgeons with the understanding of yolk sac tumors in the sacrococcygeal region.
Detection of epileptogenic focus using advanced dynamic statistical parametric mapping with magnetoencephalography in a patient with MRI-negative focal cortical dysplasia type IIB
Authors: Chang Won Seok , Nakajima Midori , Ochi Ayako , Widjaja Elysa , Rutka James T. , Yau Ivanna , Baba Shiro , Otsubo Hiroshi
Published: October 2019

Advanced dynamic statistical parametric mapping (AdSPM) with magnetoencephalography (MEG) was used to identify MRI-negative epileptogenic lesions in this report. A 15-year-old girl had MRI-negative and pharmacology-resistant focal-onset epilepsy. She experienced two types of seizures. Type I consisted of her arousal from sleep, staring, and a forced head-turning movement to the left, followed by secondary generalization. Type II began with an aura of dizziness followed by staring and postictal headache with fatigue. Scalp video-electroencephalography (EEG) captured two type I seizures originating from the right frontocentral region. MEG showed scattered dipoles over the right frontal region. AdSPM identified the spike source at the bottom of the right inferior frontal sulcus. Intracranial video-EEG captured one type I seizure, which originated from the depth electrode at the bottom of the sulcus and correlated with the AdSPM spike source. Accordingly, the patient underwent resection of the middle and inferior frontal gyri, including the AdSPM-identified spike source. Histopathological examination revealed that the patient had focal cortical dysplasia type IIB. To date, the patient has been seizure free for 2 years while receiving topiramate treatment. This is the first preliminary report to identify MRI-negative epilepsy using AdSPM. Further investigation of AdSPM would be valuable for cases of MRI-negative focal epilepsy.
Incidence of nonaccidental head trauma in infants: a call to revisit prevention strategies
Authors: Thompson LaVerne W. , Bass Kathryn D. , Agyei Justice O. , Naseem Hibbut-Ur-Rauf , Borngraber Elizabeth , Wang Jiefei , Reynolds Renée M.
Published: October 2019

OBJECTIVE

Traumatic brain injury is a major sequela of nonaccidental trauma (NAT) that disproportionately affects young children and can have lasting sequelae. Considering the potentially devastating effects, many hospitals develop parent education programs to prevent NAT. Despite these efforts, NAT is still common in Western New York. The authors studied the incidence of NAT following the implementation of the Western New York Shaken Baby Syndrome Education Program in 1998.

METHODS

The authors performed a retrospective chart review of children admitted to our pediatric hospital between 1999 and 2016 with ICD-9-CM and ICD-10-CM codes for types of child abuse and intracranial hemorrhage. Data were also provided by the Safe Babies New York program, which tracks NAT in Western New York. Children with a diagnosis of abuse at 0–24 months old were included in the study. Children who suffered a genuine accidental trauma or those with insufficient corroborating evidence to support the NAT diagnosis were excluded.

RESULTS

A total of 107 children were included in the study. There was a statistically significant rise in both the incidence of NAT (p = 0.0086) and the incidence rate of NAT (p = 0.0235) during the study period. There was no significant difference in trendlines for annual NAT incidence between sexes (y-intercept p = 0.5270, slope p = 0.5263). When stratified by age and sex, each age group had a distinct and statistically significant incidence of NAT (y-intercept p = 0.0069, slope p = 0.0374).

CONCLUSIONS

Despite educational interventions targeted at preventing NAT, there is a significant rise in the trend of newly reported cases of NAT, indicating a great need for better injury prevention programming.
Pediatric ganglioglioma of the brainstem and cervicomedullary junction: a retrospective cohort study
Authors: Oushy Soliman , Perry Avital , Graffeo Christopher S. , Raghunathan Aditya , Carlstrom Lucas P. , Daniels David J.
Published: October 2019

OBJECTIVE

Ganglioglioma is a low-grade central nervous system neoplasm with a pediatric predominance, accounting for 10% of all brain tumors in children. Gangliogliomas of the cervicomedullary junction (GGCMJs) and brainstem (GGBSs) present a host of management challenges, including a significant risk of surgical morbidity. At present, understanding of the prognostic factors—including BRAF V600E status—is incomplete. Here, the authors report a single-institution GGCMJ and GGBS experience and review the pertinent literature.

METHODS

A prospectively maintained neurosurgical database at a large tertiary care academic referral center was retrospectively queried for cases of GGCMJ pathologically confirmed in the period from 1995 to 2015; appropriate cases were defined by diagnosis codes and keywords. Secondary supplemental chart review was conducted to confirm or capture relevant data. The primary study outcome was treatment failure as defined by evidence of radiographic recurrence or progression and/or clinical or functional decline. A review of the literature was conducted as well.

RESULTS

Five neurosurgically managed GGBS patients were identified, and the neoplasms in 4 were classified as GGCMJ. All 5 patients were younger than 18 years old (median 15 years, range 4–16 years) and 3 (60%) were female. One patient underwent gross-total resection, 2 underwent aggressive subtotal resection (STR), and 2 underwent stereotactic biopsy only. All patients who had undergone STR or biopsy required repeat resection for tumor control or progression. Progressive disease was treated with radiotherapy in 2 patients, chemotherapy in 2, and chemoradiotherapy alone in 1. Immunostaining for BRAF V600E was positive in 3 patients (60%). All 5 patients experienced at least one major complication, including wound infection, foot drop, hemiparesis, quadriparesis, cranial neuropathy, C2–3 subluxation, syringomyelia, hydrocephalus, aspiration, and coma. Overall mortality was 20%, with 1 death observed over 11 years of follow-up.

CONCLUSIONS

GGBS and GGCMJ are rare, benign posterior fossa tumors that carry significant perioperative morbidity. Contemporary management strategies are heterogeneous and include combinations of resection, radiotherapy, and chemotherapy. The BRAF V600E mutation is frequently observed in GGBS and GGCMJ and appears to have both prognostic and therapeutic significance with targeted biological agents.
Antiangiogenic agent as a novel treatment for pediatric intracranial arteriovenous malformations: case report
Authors: Maynard Ken , LoPresti Melissa , Iacobas Ionela , Kan Peter , Lam Sandi
Published: October 2019

Intracerebral arteriovenous malformations (AVMs) are high-flow collections of abnormal vessels and a common cause of pediatric intracranial hemorrhage. There are few treatment options available for AVMs not amenable to surgical resection, endovascular embolization, radiosurgery, or multimodality treatment. The authors sought to review the molecular and genetic pathways that have been implicated in the formation of AVMs, focusing on the possibility of medically targeting these pathways in the treatment of AVMs. In the novel case presented here, a pediatric patient who was diagnosed with an intracranial AVM unamenable to conventional treatments underwent alternative treatment with molecular pathway inhibitors.
Analysis of adjacent-segment cervical kinematics: the role of construct length and the dorsal ligamentous complex
Authors: Lubelski Daniel , Healy Andrew T. , Mageswaran Prasath , Colbrunn Robb , Schlenk Richard P.
Published: October 2019

OBJECTIVE

Lateral mass fixation stabilizes the cervical spine while causing minimal morbidity and resulting in high fusion rates. Still, with 2 years of follow-up, approximately 6% of patients who have undergone posterior cervical fusion have worsening kyphosis or symptomatic adjacent-segment disease. Based on the length of the construct, the question of whether to extend the fixation system to undisrupted levels has not been answered for the cervical spine. The authors conducted a study to quantify the role of construct length and the terminal dorsal ligamentous complex in the adjacent-segment kinematics of the subaxial cervical spine.

METHODS

In vitro flexibility testing was performed using 6 human cadaveric specimens (C2–T8), with the upper thoracic rib cage and osseous and ligamentous integrity intact. An industrial robot was used to apply pure moments and to measure segmental motion at each level. The authors tested the intact state, followed by 9 postsurgical permutations of laminectomy and lateral mass fixation spanning C2 to C7.

RESULTS

Constructs spanning a single level exerted no significant effects on immediate adjacent-segment motion. The addition of a second immobilized segment, however, created significant changes in flexion-extension range of motion at the supradjacent level (+164%). Regardless of construct length, resection of the terminal dorsal ligaments did not greatly affect adjacent-level motion except at C2–3 and C7–T1 (increasing by +794% and +607%, respectively).

CONCLUSIONS

Dorsal ligamentous support was found to contribute significant stability to the C2–3 and C7–T1 segments only. Construct length was found to play a significant role when fixating two or more segments. The addition of a fused segment to support an undisrupted cervical level is not suggested by the present data, except potentially at C2–3 and C7–T1. The study findings emphasize the importance of the C2–3 segment and its dorsal support.
Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity
Authors: Lau Darryl , DiGiorgio Anthony M. , Chan Andrew K. , Dalle Ore Cecilia L. , Virk Michael S. , Chou Dean , Bisson Erica F. , Mummaneni Praveen V.
Published: October 2019

OBJECTIVE

Understanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.

METHODS

Consecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.

RESULTS

A total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.

CONCLUSIONS

ACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.
Spinal dural resection for oncological purposes: a systematic analysis of risks and outcomes in patients with malignant spinal tumors
Authors: Barber Sean M. , Konakondla Sanjay , Nakhla Jonathan , Fridley Jared S. , Xia Jimmy , Oyelese Adetokunbo A. , Telfeian Albert E. , Gokaslan Ziya L.
Published: October 2019

OBJECTIVE

Oncological outcomes for many malignant primary spinal tumors and isolated spinal metastases have been shown to correlate with extent of resection. For tumors with dural involvement, some authors have described spinal dural resection at the time of tumor resection in the interest of improving oncological outcomes. The complication profile associated with resection of the spinal dura for oncological purposes, however, and the relative influence of resecting tumor-involved dura on progression-free survival are not well defined. The authors performed a systematic review of the literature and identified cases in which the spinal dura was resected for oncological purposes in the interest of better understanding the associated risks and outcomes of this technique.

METHODS

Electronic databases (PubMed/MEDLINE, Scopus) were systematically searched to identify studies that reported clinical and/or oncological outcomes of patients with malignant spinal neoplasms undergoing resection of tumor-involved dura at the time of surgical intervention.

RESULTS

Ten articles describing 15 patients were included in the analysis. The most common tumor histologies were chordoma (3/15, 20%), giant cell tumor (3/15, 20%), epithelioid sarcoma (2/15, 13.3%), osteosarcoma (2/15, 13.3%), and metastasis (2/15, 13.3%). Procedure-related complications were reported in 40% of patients. A trend was seen toward an increased complication rate in redo (66.7%) versus index (16.7%) operations, but this trend did not reach statistical significance (p = 0.24). New, unexpected postoperative neurological deficits were seen in 3 patients (of 14 reporting, 21.4%). A single patient experienced a profound, unexpected neurological deterioration (paraparesis/paraplegia) after surgery, which reportedly improved considerably at latest follow-up. Tumor recurrence was seen in 3 cases (of 12 reporting, 25%) at a mean of 28.34 ± 21.1 months postoperatively. The overall mean radiographic follow-up period was 49.6 ± 36.5 months.

CONCLUSIONS

Resection of the spinal dura for oncological purposes is rarely performed, although a limited number of reports and small series have demonstrated that it is feasible. Spinal dural resection is primarily performed in patients with isolated, primary spinal neoplasms with an intent to cure. The risk associated with spinal dura resection is nontrivial and the complication profile is significant. The influence of dural resection on oncological outcomes is not well defined, and further study is needed before definitive conclusions may be drawn regarding the oncological benefit of dural resection for any particular patient or pathology.
Long-term outcomes of high-dose single-fraction radiosurgery for chordomas of the spine and sacrum
Authors: Jin Chunzi Jenny , Berry-Candelario John , Reiner Anne S. , Laufer Ilya , Higginson Daniel S. , Schmitt Adam M. , Lis Eric , Barzilai Ori , Boland Patrick , Yamada Yoshiya , Bilsky Mark H.
Published: October 2019

OBJECTIVE

The current treatment of chordomas is associated with significant morbidity, high rates of local recurrence, and the potential for metastases. Stereotactic radiosurgery (SRS) as a primary treatment could reduce the need for en bloc resection to achieve wide or marginal margins. Spinal SRS outcomes support the exploration of SRS’s role in the durable control of these conventionally radioresistant tumors. The goal of the study was to evaluate outcomes of patients with primary chordomas treated with spinal SRS alone or in combination with surgery.

METHODS

Clinical records were reviewed for outcomes of patients with primary chordomas of the mobile spine and sacrum who underwent single-fraction SRS between 2006 and 2017. Radiographic local recurrence-free survival (LRFS), overall survival (OS), symptom response, and toxicity were assessed in relation to the extent of surgery.

RESULTS

In total, 35 patients with de novo chordomas of the mobile spine (n = 17) and sacrum (n = 18) received SRS and had a median post-SRS follow-up duration of 38.8 months (range 2.0–122.9 months). The median planning target volume dose was a 24-Gy single fraction (range 18–24 Gy). Overall, 12 patients (34%) underwent definitive SRS and 23 patients (66%) underwent surgery and either neoadjuvant or postoperative adjuvant SRS. Definitive SRS was selectively used to treat both sacral (n = 7) and mobile spine (n = 5) chordomas. Surgical strategies for the mobile spine were either intralesional, gross-total resection (n = 5) or separation surgery (n = 7) and for the sacrum en bloc sacrectomy (n = 11). The 3- and 5-year LRFS rates were 86.2% and 80.5%, respectively. Among 32 patients (91%) receiving 24-Gy radiation doses, the 3- and 5-year LRFS rates were 96.3% and 89.9%, respectively. The 3- and 5-year OS rates were 90.0% and 84.3%, respectively. The symptom response rate to treatment was 88% for pain and radiculopathy. The extent or type of surgery was not associated with LRFS, OS, or symptom response rates (p > 0.05), but en bloc resection was associated with higher surgical toxicity, as measured using the Common Terminology Criteria for Adverse Events (version 5.0) classification tool, than epidural decompression and curettage/intralesional resection (p = 0.03). The long-term rate of toxicity ≥ grade 2 was 31%, including 20% grade 3 tissue necrosis, recurrent laryngeal nerve palsy, myelopathy, fracture, and secondary malignancy.

CONCLUSIONS

High-dose spinal SRS offers the chance for durable radiological control and effective symptom relief with acceptable toxicity in patients with primary chordomas as either a definitive or adjuvant therapy.
Repair of a large primary subtemporal encephalocele in a 3-year-old child: case report
Authors: Thatikunta Meena , Bumpous Jeffrey , Little Jarrod , Karia Samir , Herring Nicole R. , Nuru Mohammed , Engineer Nitin , Mutchnick Ian
Published: October 2019

Primary encephaloceles (PEs) present only rarely in the temporal region; in the rare instance that they project through the floor of the middle fossa they are secondary. In this case report the authors report on the management of a giant PE extending through the floor of the middle fossa.

An 8-month-old boy presented to the authors’ service with a large PE projecting into his neck through a missing left middle fossa floor; the lesion was causing significant meta-, dys-, and hypoplasia of the structures of the anterolateral neck on that side. Surgical goals for this patient included the following: 1) removal of potentially epileptogenic and dysfunctional tissue; 2) preservation of cranial nerves; 3) prevention of cognitive decline or iatrogenic deficit; 4) prevention of CSF leak; 5) reconstruction of skull base; 6) prevention of airway and swallowing compromise; and 7) cosmesis. After a multidisciplinary evaluation with ENT, plastic surgery, and neurology, an operation was performed using a preauricular infratemporal approach when the patient was 3 years old. Gliotic tissue was resected and amygdala, hippocampus, and middle cerebral artery were preserved.

The immediate results of the operation showed good immediate outcome. Seizure freedom and neurodevelopment outcomes remain to be seen at follow-up.
Interrater reliability of a method to assess hypothalamic involvement in pediatric adamantinomatous craniopharyngioma
Authors: Whelan Ros , Prince Eric , Mirsky David M. , Naftel Robert , Bhatia Aashim , Pettorini Benedetta , Avula Shivaram , Staulcup Susan , Alexander Allyson L. , Meier Maxene , Hankinson Todd C.
Published: October 2019

OBJECTIVE

Pediatric adamantinomatous craniopharyngiomas (ACPs) are histologically benign brain tumors that confer significant neuroendocrine morbidity. Previous studies have demonstrated that injury to the hypothalamus is associated with worsened quality of life and a shorter lifespan. This insight helps many surgeons define the goals of surgery for patients with ACP. Puget and colleagues proposed a 3-tiered preoperative and postoperative grading system based on the degree of hypothalamic involvement identified on MRI. In a prospective cohort from their institution, the authors found that use of the system to guide operative goals was associated with decreased morbidity. To date, however, the Puget system has not been externally validated. Here, the authors present an interrater reliability study that assesses the generalizability of this system for surgeons planning initial operative intervention for children with craniopharyngiomas.

METHODS

A panel of 6 experts, consisting of pediatric neurosurgeons and pediatric neuroradiologists, graded 30 preoperative and postoperative MRI scans according to the Puget system. Interrater reliability was calculated using Fleiss’ κ and Krippendorff’s α statistics.

RESULTS

Interrater reliability in the preoperative context demonstrated moderate agreement (κ = 0.50, α = 0.51). Interrater reliability in the postoperative context was 0.27 for both methods of statistical evaluation.

CONCLUSIONS

Interrater reliability for the system as defined is moderate. Slight refinements of the Puget MRI grading system, such as collapsing the 3 grades into 2, may improve its reliability, making the system more generalizable.
Perineural Invasion and Its Interrelationship with Neural Repair: A Review
Authors: Som P.M. , Miles B. , Bakst R.
Published: October 2019

The impact of perineural invasion and perineural spread on survival and the MR imaging of this tumor spread have been well documented in the literature. What has not been addressed in the radiology literature is the mechanics that are behind perineural invasion. Perineural invasion
is not the result of a passive invasion of a nerve by tumor, a common misconception. Because there are no lymphatics within a nerve, perineural invasion is not mediated by a direct lymphatic extension. Rather, perineural invasion is the result of complex molecular interactions between a nerve
and an adjacent cancer. Once the cancer has entered a nerve, it can travel in the spaces between fascicles, which explains how such perineural invasion can appear at great distances from the primary tumor. This article reviews the current concepts regarding the mechanisms of perineural invasion
and the relationship to peripheral nerve regeneration. Perineural invasion is diagnosed by histology, whereas perineural spread can be identified on imaging.Learning Objective: The reader will learn the intimate relationship between a tumor and its adjacent nerves that lead to perineural
invasion. This process is the result of a series of molecular pathways, in part related to nerve regeneration.
The Added Value of 18F-FDOPA PET/CT in the Work-Up of Patients with Movement Disorders
Authors: Khamis K. , Giladi N. , Levine C. , Kesler M. , Kuten J. , Lerman H. , Even-Sapir E.
Published: October 2019

Movement disorders represent a common clinical feature in many different neurologic diseases. However, although the clinical features are often similar, there are many different possible etiologies of these movement disorders, which represent a valid diagnostic challenge. Management
of these patients is dependent on an accurate diagnosis of the underlying etiology because the clinical course and treatment may vary significantly. 18F-Fluor-l-dopa has been used as a positron-emitting compound for PET evaluation of patients with movement disorders and parkinsonism.
To emphasize the diagnostic value of combining both morphologic and functional imaging in 18F-Fluor-l-dopa PET/CT, we describe the clinical history and 18F-Fluor-l-dopa PET/CT imaging findings of 5 patients in whom the cause of movement impairment was unclear.
MR Imaging of Meningioangiomatosis in a Pediatric Population
Authors: Bhatia A. , Saade-Lemus S. , Ndolo J.M. , Chow W. , Schwartz E.S.
Published: October 2019

Meningioangiomatosis (MA) is a rare intracranial hamartomatous lesion. We retrospectively reviewed the MRIs in 6 pediatric patients with a histopathologic diagnosis of MA. Patients with MA demonstrated a solitary lesion in the frontotemporal regions, with FLAIR hyperintensity and leptomeningeal
enhancement. A solitary brain lesion in the frontotemporal lobes associated with leptomeningeal enhancement and T2/FLAIR hyperintensity should include the possibility of MA in a pediatric patient who presents with seizures or headaches.
Stuck in the Middle: Nervus Intermedius‐Related Neuropathologic Imaging Spectrum
Authors: Elakkad S.E. , Yetto J.M. , Landon M.D. , Cathey M.R.
Published: October 2019

The nervus intermedius is a complex nerve that traverses the cerebellopontine angle and is associated with a wide range of pathologies for which imaging plays a crucial diagnostic role. Cerebellopontine angle masses or neurovascular compression may directly involve the nervus intermedius.
Alternatively, pathologies that involve branches of the nervus intermedius may present with symptoms referable to the nervus intermedius, including sinonasal tumors, perineural tumor spread, or viral reactivation such as in Ramsay Hunt syndrome. Overlapping innervation with branches of the
trigeminal, glossopharyngeal, and vagus nerves can confound diagnosis and/or lead to mislocalization, which may result in delayed diagnosis or inappropriate therapy. This review article provides an in-depth overview of nervus intermedius anatomy and physiology, and the wide spectrum of pathologies
that can involve the nervus intermedius or its branches, with an emphasis on clinical relevance.Learning Objective: To understand the normal anatomy and physiology of the nervus intermedius as well as the clinical relevance and imaging findings of the neuropathologic spectrum of disease
referable to the nervus intermedius and its branches: the greater superficial petrosal nerve, the chorda tympani, and the sensory auricular branch.
Primary Leptomeningeal Medulloblastoma: Desmoplastic/Nodular Medulloblastoma without a Discrete Parenchymal Mass
Authors: Hanna M.H. , Hanna M.G. , Rosenblum M.K. , Fowkes M.E. , Belani P.
Published: October 2019

Medulloblastoma is one of the most common pediatric CNS malignancies and the most common primary tumor of the posterior fossa in children. Medulloblastoma can present with leptomeningeal seeding in up to 33% of patients at presentation. Primary leptomeningeal medulloblastoma without
a discrete parenchymal mass has been reported 6 times in the literature to date, in both the pediatric and adult populations. This report aims to review the literature of these rare cases and present the first case of a primary leptomeningeal medulloblastoma with a desmoplastic/nodular subtype.
SOSIALISASI PENGGUNAAN INVERTER BERBASIS SOLAR SEL DI LAYANAN KESEHATAN CUMA-CUMA (LKC) DOMPET DUAFA PALEMBANG SEBAGAI UPAYA PENINGKATAN KUALITAS LAYANAN KESEHATAN
Authors: Apriani Yosi , Anwar Wiwin Oktaviani , Rasyad Ade Arinia
Published: October 2019

Abstrak: Kegiatan pengabdian ini bertujuan meningkatkan pelayanan kesehatan oleh mitra kepada masyarakat yang kurang mampu (kaum dhuafa). Mitra yang dipilih adalah sebuah lembaga yang sangat memperhatikan kondisi masyarakat yang miskin (kaum dhuafa), Layanan Kesehatan Cuma-Cuma ini sebuah lembaga nirlaba yang merupakan salah satu unit dari Dompet Dhuafa Palembang. Staf dan karyawan di LKC berjumlah 15 orang, dan hampir semuanya belum memahami pentingnya penggunaan inverter sebagai penghemat daya di klinik LKC. Permasalahan di klinik LKC DD Sumsel adalah belum memiliki peralatan penghemat daya berupa inverter berbasis solar sel yang aman terhadap lingkungan, sedangkan perlatan kesehatan di LKC banyak yang menggunakan listrik. Berdasarkan kondisi tersebut tim pengabdian berinisiatif mengadakan sosialisasi penggunaan inverter sebagai penghemat daya yang benar dan tepat, serta sosialisasi pemeliharaan instalasi listrik yang benar. Setelah sosialisasi terjadi peningkatan pemahaman pemakaian peralatan inverter sebesar 75%, dari 25%, sehingga terjadi peningkatan kualitas pelayanan kesehatan.Abstract: This service activity aims to improve health services by partners to disadvantaged communities (the poor). The partner chosen is an institution that is very concerned about the conditions of the poor (poor), Free Medical Services is a non-profit organization which is a unit of the Dompet Dhuafa Palembang. The staff and employees at LKC are 15 people, and almost all of them do not yet understand the importance of using an inverter as a power saver at LKC clinics. The problem at the LKC DD Sumsel clinic is that it does not yet have power-saving equipment in the form of solar cell-based inverters that are safe for the environment, while many health equipment in LKC uses electricity. Based on these conditions the dedication team took the initiative to conduct socialization of the use of inverters as a true and right power saver, as well as a socialization of the maintenance of the correct electrical installations. After the socialization, there was an increase in understanding of the use of inverter equipment by 75%, from 25%, resulting in an increase in the quality of health services.
Religious network of Ukraine 2018 at the beginning of 2019
Authors: Kolodnyi Anatolii M.
Published: October 2019

The article presents the digital indicators of the religious network of Ukraine in 2018. The statistics are compiled by the Department of Nationalities and Religion of the Ministry of Culture of Ukraine (DNR MCU), which collects data annually from the relevant oblast departments in an approved form. On the basis of officially presented figures, the general tendencies of changes in the religious network of years of independence of Ukraine are analyzed.
Akuntansi Keberlanjutan Dan Pengukuran Kinerja Keberlanjutan Universitas
Authors: Kurniawan Putu Sukma , Wahyuni Made Arie
Published: October 2019

This analysis proposes to know the ability of non-business organizations to implement the concept of sustainability accounting and measure organizational sustainability performance at higher education institutions and conduct analysis on measuring sustainability performance at universities. The method used is a qualitative paradigm and to analyze sustainability performance, this research uses the GASU and STARS System methods. The result found that the University of Education Ganesha has a high capability in social performance. The results of this study also found that University of Education Ganesha can apply the concept of sustainability accounting and higher education institutions have very high capability to implement the concept of sustainability accounting.
Analisis Abnormal Return Disekitar Tanggal Pengumuman Stock Split
Authors: Yunawati Sri
Published: October 2019

The purpose of this study is to prove how the effect of the stock split on abnormal returns and whether there are differences in average abnormal returns before and after the stock split. This research was conducted at a company that conducted a stock split which was listed on the Indonesia Stock Exchange in 2017. The method used by a statistical test is one sample t-test (t-test for one sample) at a significance level of a = 5%. Research results show that there is no significant abnormal return when the stock split. And the tests performed on abnormal return averages before and after the stock split using paired sample t-test (t-test for two paired samples) showed that there were no significant differences in the average abnormal return before and after the stock split. Tujuan penelitian ini adalah untuk membuktikan bagaimana pengaruh stock split terhadap abnormal return dan apakah terdapat perbedaan rata-rata abnormal return sebelum dan setelah stock split. Penelitian ini dilakukan pada perusahaan yang melakukan pemecahan saham yang terdaftar di Bursa Efek Indonesia tahun 2017. Metode yang digunakan dengan uji statistik one sampel t-test (uji t untuk satu sampel) pada tingkat signifikansi a =5%. Hasil Penelitian menunjukkan bahwa tidak terdapat abnormal retum yang signifikan pada saat stock split. Dan pengujian yang dilakukan terhadap rata-rata abnormal retun sebelum dan setelah stock split dengan menggunakan paired sample t test (uji t untuk dua sampel berpasangan) diperoleh hasil bahwa tidak terdapat perbedaan yang signifikan pada rata-rata abnormal return sebelum dan sesudah stock split.