bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventriculopleural shunts in a pediatric population: a review of 170 consecutive patients
Authors: Christian Eisha A. , Quezada Jeffrey J. , Melamed Edward F. , Lai Carolyn , McComb J. Gordon 
Published: August 2021

OBJECTIVE
The authors sought to determine the outcome of using the pleural space as the terminus for ventricular CSF-diverting shunts in a pediatric population.

METHODS
All ventriculopleural (VPl) shunt insertions or revisions done between 1978 and 2018 in patients at Children’s Hospital Los Angeles were identified. Data recorded for analysis were age, sex, weight, etiology of hydrocephalus, previous shunt history, reason for VPl shunt insertion or conversion from a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt, valve type, nature of malfunction, presence of shunt infection or pleural effusion, and conversion to a different distal site.

RESULTS
A total of 170 patients (mean age 14 ± 4 years) with a VPl shunt who were followed up for a mean of 57 ± 53 months were identified. The reasons for conversion to a VPl shunt for 167 patients were previous shunt infection in 57 (34%), multiple abdominal procedures in 44 (26%), inadequate absorption of CSF in 34 (20%), abdominal pseudocyst in 25 (15%), and obesity in 7 (4%). No VPl revisions were required in 97 (57%) patients. Of the 73 (43%) patients who did require revision, the most common reason was proximal obstruction in 32 (44%). The next most frequent complication was pleural effusion in 22 (30%) and included 3 patients with shunt infection. All 22 patients with a clinically significant pleural effusion required changing the distal end of the shunt from the pleural space. Pleural effusion was more likely to occur in VPl shunts without an antisiphon valve. Of the 29 children < 10 years old, 7 (24%) developed a pleural effusion requiring a revision of the distal catheter to outside the pleural space compared with 15 (11%) who were older (p = 0.049). There were 14 shunt infections with a rate of 4.2% per procedure and 8.2% per patient.

CONCLUSIONS
VPl shunts in children younger than 10 years of age have a significantly higher rate of symptomatic pleural effusion, requiring revision of the shunt’s terminus to a different location. VPl shunt complication rates are similar to those of VP shunts. The technical difficulty of inserting a VPl shunt is comparable to that of a VP shunt. In a patient older than 10 years, all else being equal, the authors recommend that the distal end of a shunt be placed into the pleural space rather than the right atrium if the peritoneal cavity is not suitable.
Ventriculomegaly and postoperative lateral/third ventricular blood as predictors of cerebrospinal fluid diversion following posterior fossa tumor resection
Authors: Park Christine , Liu Beiyu , Harward Stephen C. , Zhang Anru R. , Gloria Jared , Lee Hui-Jie , Fuchs Herbert E. , Muh Carrie R. , Hodges Sarah E. , Thompson Eric M. 
Published: August 2021

OBJECTIVE
Postoperative hydrocephalus occurs in one-third of children after posterior fossa tumor resection. Although models to predict the need for CSF diversion after resection exist for preoperative variables, it is unknown which postoperative variables predict the need for CSF diversion. In this study, the authors sought to determine the clinical and radiographic predictors for CSF diversion in children following posterior fossa tumor resection.

METHODS
This was a retrospective cohort study involving patients ≤ 18 years of age who underwent resection of a primary posterior fossa tumor between 2000 and 2018. The primary outcome was the need for CSF diversion 6 months after surgery. Candidate predictors for CSF diversion including age, race, sex, frontal occipital horn ratio (FOHR), tumor type, tumor volume and location, transependymal edema, papilledema, presence of postoperative intraventricular blood, and residual tumor were evaluated using a best subset selection method with logistic regression.

RESULTS
Of the 63 included patients, 26 (41.3%) had CSF diversion at 6 months. Patients who required CSF diversion had a higher median FOHR (0.5 vs 0.4) and a higher percentage of postoperative intraventricular blood (30.8% vs 2.7%) compared with those who did not. A 0.1-unit increase in FOHR or intraventricular blood was associated with increased odds of CSF diversion (OR 2.9 [95% CI 1.3–7.8], p = 0.02 and OR 20.2 [95% CI 2.9–423.1], p = 0.01, respectively) with an overfitting-corrected concordance index of 0.68 (95% CI 0.56–0.80).

CONCLUSIONS
The preoperative FOHR and postoperative intraventricular blood were significant predictors of the need for permanent CSF diversion within 6 months after posterior fossa tumor resection in children.
Standardizing postoperative care for pediatric intradural Chiari decompressions to decrease length of stay
Authors: Mazur-Hart David J. , Bowden Stephen G. , Pang Brandi W. , Yaghi Nasser K. , Nugent Joseph G. , Yablon Laurie D. , Domreis Wendy O. , Ohm Erika T. , Sayama Christina M. 
Published: August 2021

OBJECTIVE
Amid national and local budget crises, cutting costs while maintaining quality care is a top priority. Chiari malformation is a relatively common pediatric neurosurgical pathology, and postoperative care varies widely. The postoperative course can be complicated by pain and nausea, which can extend the hospital stay. In this study, the authors aimed to examine whether instituting a standardized postoperative care protocol would decrease overall patient hospital length of stay (LOS) as well as cost to families and the hospital system.

METHODS
A retrospective study of pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty at a single institution from January 2016 to September 2019 was performed. A standardized postoperative care protocol was instituted on May 17, 2018. Pre- and postprotocol groups were primarily analyzed for demographics, LOS, and the estimated financial expense of the hospital stay. Secondary analysis included readmissions, opioid consumption, and follow-up.

RESULTS
The analysis included 132 pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty. The preprotocol group included 97 patients and the postprotocol group included 35 patients. Patient age ranged from 0.5 to 26 years (mean 9.5 years). The mean LOS preprotocol was 55.48 hours (range 25.90–127.77 hours), and the mean postprotocol LOS was 46.39 hours (range 27.58–77.38 hours). The comparison between means showed a statistically significant decrease following protocol initiation (95% CI 1.87–16.31 hours, p = 0.014). In the preprotocol group, 21 of 97 patients (22%) were discharged the first day after surgery compared with 14 of 35 patients (40%) in the postprotocol group (p = 0.045). The estimated cost of one night on the pediatric neurosurgical intermediate ward was approximately $4500, which gives overall cost estimates for 100 theoretical cases of $927,800 for the preprotocol group and $732,900 for the postprotocol group.

CONCLUSIONS
By instituting a Chiari protocol, postoperative LOS was significantly decreased, which resulted in decreased healthcare costs while maintaining high-quality and safe care.
Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship
Authors: Can Dang Do Thanh , Lepard Jacob R. , Anh Nguyen Minh , Tuan Pham Anh , Tuan Tran Diep , Son Vo Tan , Grant John H. , Johnston James M. 
Published: August 2021

OBJECTIVE
There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction.

METHODS
A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019.

RESULTS
A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively.

CONCLUSIONS
Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.
Categorizing cortical dysplasia lesions for surgical outcome using network functional connectivity
Authors: Bdaiwi Abdullah S. , Greiner Hansel M. , Leach James , Mangano Francesco T. , DiFrancesco Mark W. 
Published: August 2021

OBJECTIVE
Focal cortical dysplasia (FCD) is often associated with drug-resistant epilepsy, leading to a recommendation to surgically remove the seizure focus. Predicting outcome for resection of FCD is challenging, requiring a new approach. Lesion-symptom mapping is a powerful and broadly applicable method for linking neurological symptoms or outcomes to damage to particular brain regions. In this work, the authors applied lesion network mapping, an expansion of the traditional approach, to search for the association of lesion network connectivity with surgical outcomes. They hypothesized that connectivity of lesion volumes, preoperatively identified by MRI, would associate with seizure outcomes after surgery in a pediatric cohort with FCD.

METHODS
This retrospective study included 21 patients spanning the ages of 3 months to 17.7 years with FCD lesions who underwent surgery for drug-resistant epilepsy. The mean brain-wide functional connectivity map of each lesion volume was assessed across a database of resting-state functional MRI data from healthy children (spanning approximately 2.9 to 18.9 years old) compiled at the authors’ institution. Lesion connectivity maps were averaged across age and sex groupings from the database and matched to each patient. The authors sought to associate voxel-wise differences in these maps with subject-specific surgical outcome (seizure free vs persistent seizures).

RESULTS
Lesion volumes with persistent seizures after surgery tended to have stronger connectivity to attention and motor networks and weaker connectivity to the default mode network compared with lesion volumes with seizure-free surgical outcome.

CONCLUSIONS
Network connectivity–based lesion-outcome mapping may offer new insight for determining the impact of lesion volumes discerned according to both size and specific location. The results of this pilot study could be validated with a larger set of data, with the ultimate goal of allowing examination of lesions in patients with FCD and predicting their surgical outcomes.
Social-emotional functioning in pediatric hydrocephalus: comparison of the Hydrocephalus Outcome Questionnaire to the Behavior Assessment System for Children
Authors: Wall Vanessa L. , Kestle John R. W. , Fulton John B. , Gale Shawn D. 
Published: August 2021

OBJECTIVE
Hydrocephalus can impact all areas of health, including physical, cognitive, and social-emotional functioning. The social-emotional health of children who have had surgery for hydrocephalus is not well characterized. In this study, the authors sought to examine social-emotional functioning using the Behavior Assessment System for Children, Third Edition (BASC-3) and the Hydrocephalus Outcome Questionnaire (HOQ) in 66 children aged 5 to 17 years.

METHODS
Caregivers of pediatric patients with hydrocephalus completed the BASC-3 and the HOQ. BASC-3 internalizing, externalizing, and executive functioning caregiver-reported scores were compared with the BASC-3 normative sample using one-sample t-tests to evaluate overall social-emotional functioning. BASC-3 scores were correlated with the social-emotional domain of the HOQ using Pearson’s r to determine if the HOQ accurately captured the social-emotional functioning of children with hydrocephalus in a neurosurgery setting. BASC-3 and HOQ scores of children with different etiologies of hydrocephalus were compared using the Kruskal-Wallis one-way analysis of variance to determine if differences existed between the following etiologies: intraventricular hemorrhage secondary to prematurity, myelomeningocele, communicating congenital hydrocephalus, aqueductal stenosis, or other.

RESULTS
Children with hydrocephalus of all etiologies had more difficulties with social-emotional functioning compared with normative populations. Children with different hydrocephalus etiologies differed in executive functioning and overall HOQ scores but not in internalizing symptoms, externalizing symptoms, or social-emotional HOQ scores. The social-emotional domain of the HOQ correlated more strongly with the BASC-3 than did the physical and cognitive domains.

CONCLUSIONS
These results have provided evidence that children who have had surgery for hydrocephalus may be at increased risk of social-emotional and behavioral difficulties, but etiology may not be particularly helpful in predicting what kinds or degree of difficulty. The results of this study also support the convergent and divergent validity of the social-emotional domain of the HOQ.
Sudden-onset paraplegia in a 72-year-old male with a spinal dural arteriovenous fistula: illustrative case
Authors: Ogbu Ikenna I. , Tzerakis Nikolaos , Al-Shamary Zaineb 
Published: August 2021

BACKGROUND
Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations of the spine but account for up to 80% of all vascular malformations involving the spine. Few case reports of SDAVFs have been reported in the literature, and even fewer have been described with sudden onset of symptoms.

OBSERVATIONS
The authors described the case of a 72-year-old male with sudden-onset bilateral paraplegia and sensory loss with subsequent inability to bear weight and an initial suspicion of cauda equina syndrome, which was eventually diagnosed as an SDAVF using magnetic resonance imaging. During open surgery, it was difficult to identify the feeder vessels. A postoperative scan showed persistence of the fistula, and the patient had to receive redo ligation with good postoperative status.

LESSONS
Sudden-onset paraplegia is not the typical presentation of SDAVF. All doctors need to be aware of the possibility of an acute presentation with SDAVF, especially with the high likelihood of misdiagnosis and resultant worse outcome due to treatment delays. A high index of suspicion is required to ensure early recognition as well as initiation of treatment.
Mechanical thrombectomy and carotid artery stenting for stenosis of the internal carotid artery with free-floating thrombosis: illustrative case
Authors: Tomoyose Ryuta , Tsumoto Tomoyuki , Hara Kenta , Miyazaki Yuichi , Tokunaga So , Yasaka Masahiro , Okada Yasushi 
Published: August 2021

BACKGROUND
The authors report a case in which mechanical thrombectomy and carotid artery stenting (CAS) were performed for acute cerebral infarction with free-floating thrombosis (FFT) in left internal carotid artery (ICA) stenosis. Good results were obtained.

OBSERVATIONS
A 63-year-old man developed sudden disturbance of consciousness and right hemiplegia. He was transported to the authors’ hospital by an emergency vehicle. Head magnetic resonance imaging showed acute cerebral infarction in the left middle cerebral artery region, and magnetic resonance angiography showed poor vascular flow beyond the left ICA. Emergency angiography revealed severe stenosis at the origin of the left ICA and a free-floating thrombus attached to the stenosis and extending to the peripheral side. Percutaneous transluminal angioplasty (PTA) was performed on the stenosis with proximal protection, the thrombus was aspirated under reversal flow, and CAS was performed without exacerbation of clinical symptoms.

LESSONS
PTA, thrombus aspiration, and CAS under reversal flow may be effective treatments for FFT caused by ICA stenosis.
Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case
Authors: Takarada Ayako , Yanaka Kiyoyuki , Onuma Kuniyuki , Nakamura Kazuhiro , Takahashi Nobuyuki , Ishikawa Eiichi 
Published: August 2021

BACKGROUND
Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a congenital MCA anomaly. It may present with symptoms of both hemorrhage and ischemia, similar to moyamoya disease, and hemodynamic stress may play an essential role in the development of symptoms in both clinical entities. The optimal treatment remains controversial in symptomatic patients with Ap/T-MCA. This report discussed the treatment method for a patient with Ap/T-MCA with unruptured aneurysms who presented with intraventricular hemorrhage (IVH) treated by aneurysm clipping and bypass surgery.

OBSERVATIONS
In a 46-year-old woman with a sudden headache, computed tomography showed left IVH. Magnetic resonance angiography showed a left MCA aneurysm and MCA trunk stenosis. Three-dimensional angiography demonstrated a plexiform arterial network and multiple aneurysms arising from the MCA and in the plexiform network, leading to the diagnosis of Ap/T-MCA harboring unruptured aneurysms. The patient was successfully treated by craniotomy with aneurysm clipping and bypass surgery to prevent further intracranial hemorrhages and/or aneurysm rupture.

LESSONS
Especially in cases such as Ap/T-MCA, in which hemodynamic stress has a significant effect, the optimal treatment method should be based on vascular morphology and the impact of hemodynamic stress.
Appraisal of Seasonal Rainfall Prediction and Utilization: A Case Study of Kano State, Nigeria
Authors: Alapata Ahmed Yusuf , Ismaila Aliyu , Maigeri Mustapha Ibrahim 
Published: August 2021

This work evaluates the accuracy of seasonal rainfall prediction by the Nigerian Meteorological Agency by comparing it with the actual amount of rainfall received. It also measures the perception of the farmers regarding such prediction in the case of Kano State using data collected for the years 2009-2015. A total of eighty structured questionnaires were administered to the respondents in selected areas including Mariri, Hotoro, Zaria road and Gwarzo using purposive and snowball sampling techniques. When comparison between the predicted and the observed amount of rainfall received in the study area was made, the outcome showed a high level of variation throughout the years under study. The results further revealed that the majority of the respondents were not aware of convectional rainfall levels or assumed that the modern prediction method is unreliable. The current study recommends massive sensitization of farmers about the modern rainfall prediction methods considering the erratic nature of the weather and the changing climate, particularly in this era of global climate change.
Rendészeti tisztképzés a Rendőrtiszti Főiskolán (1996–2005)
Authors: Blaskó Béla 
Published: August 2021

A szerző a 20. század utolsó öt, valamint a 21. század első öt éve között eltelt időszakot átölelően nyújt képet a Rendőrtiszti Főiskola (RTF) életéről, amelynek 1997 és 2005 között a főigazgatója volt. Korábban maga is nappali tagozatos hallgatója volt az intézménynek, kitüntetéses, úgynevezett „vörös diplomával” végzett. Az RTF-en, illetve a jogutód Nemzeti Közszolgálati Egyetem Rendészettudományi Karán (RTK) évtizedekig látott el tanszék-, illetve intézetvezetői feladatokat, 2012–2015 között pedig az RTK oktatási dékánhelyetteseként tevékenykedett. Írásában érinti az intézmény első – egyben sikeres – akkreditációs megmérettetéséhez vezető út főbb állomásait, amelyeket bejárva az RTF a magyar felsőoktatási rendszer hivatalosan is elismert, integráns részévé válhatott. A terjedelmi korlátok adta lehetőségek figyelembevételével szó esik a Magyar Rendészettudományi Társaságot a megalakulásakor gesztorként befogadó főiskola életében történt egyéb kiemelésre érdemes folyamatról, valamint a korábbi időszakokhoz képest történő változásokról.
Szakmai követelmények a rendészeti felsőoktatásban
Authors: Boda József 
Published: August 2021

2019. augusztus 1-jétőlképviselem a Belügyminisztériumot (BM) a Nemzeti Közszolgálati Egyetem Tanácsadó Testületében (NKE TT). Ebben a beosztásban tolmácsolom a belügyi vezetés szakmai elvárásait az NKE és Rendészettudományi Karának (RTK) vezetői, tanárai és diákjai felé. Ez a munka természetesen különböző formában és intenzitással folyt korábban is, a Rendőrtiszti Főiskola működése idején és az NKE RTK megalakulása után is. Az NKE RTK megalakulása utáni első belügyminiszteri oktatási-képzési értekezletre és a miniszteri ajánlások megfogalmazására 2012. október 26-án, a BM-benkerült sor, ahová az NKE Rektora, az RTK teljes oktatói kara meghívást kapott, és jelen voltak a BM, valamint a rendvédelmi szervek vezetői is. A feladatok és követelmények rövid és hosszú távon is meghatározták az RTK-n dolgozó munkatársak tevékenységét. Ezeket azután évente áttekintették és pontosították.