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October 28, 2016 - Physical therapy--with helmet therapy if needed--is the recommended treatment for most infants with position-related flattening of the skull (plagiocephaly), according to a new set of clinical guidelines in the November issue of Neurosurgery, official journal of the Congress of Neurological Surgeons (CNS). The journal is published by Wolters Kluwer. "Evidence-based guidelines for the treatment of positional plagiocephaly are necessary and important to deal with this common disorder," writes Dr. Ann Marie Flannery of Women's and Children's Hospital, Lafayette, La., and colleagues. An Executive Summary of the new guidelines is published in the November issue of Neurosurgery in addition to summaries of each individual chapter. The full-text versions of the guidelines are available on the Congress of Neurological Surgeons' Guidelines website. Evidence-Based Recommendations for Diagnosis and Treatment of Positional Plagiocephaly Positional plagiocephaly refers to flattening of one side of the head. It may occur in infants who always sleep in the same position, causing pressure on the same spot on the skull. This and other positional skull deformities have become more common since the recommendation to place babies on their backs to sleep. The "Back to Sleep" campaign (now called "Safe to Sleep") has been highly effective in lowering nationwide rates of sudden infant death syndrome (SIDS). A multidisciplinary task force complied of clinical experts was assigned to perform a comprehensive review and analysis of the research on diagnosis and treatment of positional plagiocephaly. Developed by the Congress of Neurological Surgeons, these guidelines are also endorsed by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, and the American Academy of Pediatrics. The new plagiocephaly guidelines include recommendations in the following areas: The recommendations in the new guidelines are rated according to the strength of the supporting research. The recommendation for physical therapy over repositioning aligns with the American Academy of Pediatrics' warning against the use of soft "positioning pillow" devices in the infants' sleeping environment. The new documents offer guidance to the many different healthcare professionals--including pediatricians, neurosurgeons, neurologists, plastic surgeons, and physical therapists--who evaluate children with positional plagiocephaly. The guideline also highlights the need for continued research in several key areas, including further high-quality studies on the effectiveness of physical therapy. Click here to read "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Management of Patients With Positional Plagiocephaly." Article: "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Management of Patients With Positional Plagiocephaly" (doi: 10.1227/NEU.0000000000001426) Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable. Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world. Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www. , follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Ryoo S.,Sungkyunkwan University | Cha J.,Neurosurgery | Kim S.J.,Sungkyunkwan University | Choi J.W.,Neurosurgery | And 6 more authors.
Stroke | Year: 2014

BACKGROUND AND PURPOSE - : Diagnosis of Moyamoya disease (MMD) is based on the characteristic angiographic findings. However, differentiating MMD from intracranial atherosclerotic disease (ICAD) is difficult. We compared vessel wall imaging findings on high-resolution magnetic resonance imaging between MMD and ICAD. METHODS - : High-resolution magnetic resonance imaging was performed on 32 patients with angiographically proven MMD and 16 patients with acute infarcts because of ICAD. Bilateral internal carotid arteries and steno-occlusive middle cerebral artery were analyzed for wall enhancement and remodeling. RESULTS - : Enhancement patterns and distribution were different. Most patients with MMD (90.6%) showed concentric enhancement on distal internal carotid arteries and middle cerebral arteries, whereas focal eccentric enhancement was observed on the symptomatic segment in ICAD. MMD was characterized by middle cerebral artery shrinkage; the remodeling index and wall area were lower in MMD than in ICAD (remodeling index, 0.19±0.11 versus 1.00±0.43; wall area, 0.32±0.22 versus 6.00±2.72; P<0.001). CONCLUSIONS - : MMD was characterized by concentric enhancement on bilateral distal internal carotid arteries and shrinkage of middle cerebral artery, regardless of symptoms. © 2014 American Heart Association, Inc.

News Article | November 22, 2016

Oxford University Press (OUP) is pleased to announce its new partnership with the Congress of Neurological Surgeons (CNS). Beginning in January 2017, OUP will publish Neurosurgery and Operative Neurosurgery (ONS). As a global leader in education and innovation, the CNS is dedicated to advancing the field of neurosurgery by inspiring and facilitating scientific discovery and its translation to members' clinical practice. The CNS chose to partner with OUP because of its outstanding reputation, established partnerships, and extensive experience co-publishing other scientific journals. "OUP is a great fit for us," said Alan M. Scarrow, MD, president of the CNS. "As one of the leading publishers in the world, OUP combines a rich research heritage with a unique ability to leverage today's digital technology. We are excited about their ability to provide creative and innovative solutions for us and look forward to forging a path of growth together." Featuring original, peer-reviewed articles, Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook. Neurosurgery attracts contributions from the most respected international authorities and presents the latest in clinical and experimental neurosurgery. Applicable to both researchers and practicing neurosurgeons, the journal includes a wealth of valuable, in-depth information that is applicable to researchers and practicing neurosurgeons alike. ONS is a unique publication focusing exclusively on surgical technique and devices, providing practical, cutting-edge, and skill-enhancing guidance to its readers. Complementing the clinical and research studies published in Neurosurgery, ONS brings the reader technical material that highlights operative procedures, anatomy, instrumentation, devices, and technology. "2016 has been a banner year for the journals, and as we all work to ensure continued success and innovation, I cannot think of a better partner than Oxford University Press," said Nelson M. Oyesiku, MD, editor in chief of Neurosurgery and Operative Neurosurgery. "We all look forward to a long and fruitful partnership." "We are very excited to be partnering with the Congress of Neurological Surgeons to publish Neurosurgery and Operative Neurosurgery. OUP shares the CNS's mission-driven approach and its goal to make Neurosurgery and Operative Neurosurgery the standout journals in their field," said Christopher Reid, senior publisher at Oxford University Press. Oxford Journals is a division of Oxford University Press, which publishes over 300 academic and research journals covering a broad range of subject areas, two thirds of which are published in collaboration with learned societies and other international organizations. Oxford Journals has been publishing journals for more than a century and, as part of the world's oldest and largest university press, has more than 500 years of publishing expertise behind it. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. OUP is the world's largest university press with the widest global presence. It currently publishes more than 6,000 new publications a year, has offices in around fifty countries, and employs more than 5,500 people worldwide. It has become familiar to millions through a diverse publishing program that includes scholarly works in all academic disciplines, bibles, music, school and college textbooks, business books, dictionaries and reference books, and academic journals. About the Congress of Neurological Surgeons The Congress of Neurological Surgeons (CNS) is the largest neurosurgical society in the world and the global leader in neurosurgical education, serving to promote health by advancing neurosurgery through innovation and excellence in education. The CNS provides leadership in neurosurgery by inspiring and facilitating scientific discovery and its translation into clinical practice. The CNS maintains the vitality of the profession through volunteer efforts of its members and the development of leadership in service to the public, to colleagues in other disciplines, and to neurosurgeons throughout the world in all stages of their professional lives. For more information, visit Neurosurgery, an official journal of the Congress of Neurological Surgeons, is the most complete window to the contemporary field of neurosurgery. Members of the CNS and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

Payer M.,Neurosurgery | Payer M.,University of Geneva | Bruhlhart K.,Trauma Center
Journal of Clinical Neuroscience | Year: 2011

Extradural arachnoid cysts of the spine are a rare cause of spinal cord and nerve root compression, usually in the mid to lower thoracic spine and at the thoraco-lumbar junction in a posterior position. Local pain and myelopathy occur predominantly in young adults, and MRI reveals a well-demarcated extradural lesion, iso-intense to cerebrospinal fluid. We report a 33-year-old woman with an extradural arachnoid cyst from T11 to L1 and review the surgical techniques reported in the literature. © 2010 Elsevier Ltd. All rights reserved.

Kowalski R.G.,Neurosurgery | Ziai W.C.,Neurosurgery | Rees R.N.,Neurosurgery | Werner J.K.,Johns Hopkins University | And 4 more authors.
Critical Care Medicine | Year: 2012

Objectives: To characterize associations between antiepileptic drugs with sedating or anesthetic effects (third-line antiepileptic drugs) vs. other antiepileptic agents, and short-term outcomes, in status epilepticus. Furthermore, to evaluate the role of adverse hemodynamic and respiratory effects of these agents in status epilepticus treatment. Design: Retrospective comparative analysis. Setting: Tertiary academic medical center with two emergency departments and two neurologic intensive care units. Patients: Adults admitted with a diagnosis of status epilepticus defined as seizures lasting continuously >5 mins, or for discrete periods in succession. Interventions: None. Measurements and Main Results: Of 126 patients with 144 separate status epilepticus admissions, 57 were female (45%) with mean age 54.7 ± 15.7 yrs. Status epilepticus was convulsive in 132 cases (92%). Status epilepticus etiologies included subtherapeutic antiepileptic drugs (43%), alcohol or other nonantiepileptic drug (13%), and acute central nervous system disease (12%). Third-line antiepileptic drugs were administered in 47 cases (33%). Seventy-eight status epilepticus episodes (54%) had good outcomes (Glasgow Outcome Score = 1, 2) at the time of hospital discharge. On univariate analysis, poor outcome (Glasgow Outcome Score > 2) was associated with older age (mean 59.8 ± 15.5 vs. 50.5 ± 13.8 yrs, p < .001), acute central nervous system disease (21% vs. 4%, p = .001), mechanical ventilation (76% vs. 53%, p = .004), longer duration of ventilation (median 10 days [range 1-56] vs. 2 days [range 1-10], p < .001), treatment with vasopressors (35% vs. 5%, p < .001), and treatment with third-line antiepileptic drugs (51% vs. 17%, p < .001). Death was associated with acute central nervous system disease, prolonged ventilation, treatment with vasopressors, and treatment with third-line antiepileptic drugs. Predictors of poor outcome among all status epilepticus episodes were older age (odds ratio 1.06; 95% confidence interval 1.03-1.09; p < .001), treatment with third-line antiepileptic therapy (odds ratio 5.64; 95% confidence interval 2.31-13.75; p < .001), and first episode of status epilepticus (odds ratio 3.73; 95% confidence interval 1.38-10.10; p = .010). Among status epilepticus episodes treated by third-line antiepileptic drugs, predictors of poor outcome were older age (odds ratio, 1.09; 95% confidence interval 1.01-1.18; p = .038) and longer ventilation (odds ratio, 1.47; 95% confidence interval 1.08-2.00; p = .015). Predictors of mortality among all status epilepticus episodes were treatment with third-line antiepileptic drugs (odds ratio, 12.08; 95% confidence interval 2.30-63.39; p = .003) and older age (odds ratio, 1.06; 95% confidence interval 1.00-1.12; p = .045). Conclusions: Third-line antiepileptic drug therapies with sedating or anesthetic effects predicted poor outcome and death in status epilepticus. Hypotension requiring vasopressor therapy and duration of mechanical ventilation induced by these agents may be contributing factors, especially when pentobarbital is used. These findings may inform decision making on drug therapy in status epilepticus and help develop safer and more effective treatment strategies to improve outcome. © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Gekht G.,Pain Management | Nottmeier E.W.,Neurosurgery | Lamer T.J.,Pain Medicine
Pain Medicine (United States) | Year: 2010

Objective: To report an unusual complication following lumbar facet radiofrequency denervation and describe a successful, minimally invasive treatment of a presumed medial branch neuroma. Summary of Background Data: Radiofrequency medial branch neurotomy is a common procedure for the treatment of mechanical back pain. Deafferentation injury and neuroma formation is well known and reported following chemical, surgical, and cryoablation neurolysis; however, it is thought to be rare with radiofrequency ablation. When this problem is encountered, treatment options appear to be limited. Further radiofrequency ablations may be ineffective and indeed may cause further injury. Methods: A 17-year-old male who sustained a traumatic fracture of the right L3-4 facet joint presented with increasing back pain after multiple radiofrequency ablations of the medial branches of the L2 and L3 dorsal rami. The description of the back pain, initially nociceptive in nature, had become progressively neuropathic with clear focal areas of allodynia and hyperesthesia. Further medial branch radiofrequency denervation was found to be ineffective. Results: Diagnostic block of the right medial branch of the L2 dorsal ramus provided the patient with total relief of pain. This was followed by a minimally invasive open surgical ablation of the L2 medial branch neuroma using three-dimensional, fluoroscopy-based image guidance. At 7 months of follow-up, the patient reported complete resolution of pain, discontinuation of all pain medications, and return to all previous physical activities.pme_851 1179.1182 Conclusion: Deafferentation injury is a rare but recognized complication of chemical, surgical, and thermal neuroablation. This case report presents a rare instance of presumed neuroma formation following multiple radiofrequency ablations for the treatment of facet-generated mechanical back pain. Open and minimally invasive medial branch neurectomy resulted in complete resolution of pain and return to baseline function.

Salunke P.,Neurosurgery | Sahoo S.,Neurosurgery | Khandelwal N.K.,Radiodiagnosis | Ghuman M.S.,Radiodiagnosis
Clinical Neurology and Neurosurgery | Year: 2015

Objective Apart from the commonly seen antero-posterior subluxation of C1 over C2, the dislocation may occur in vertical, lateral or rotational plane. Desired C1-2 realignment can be achieved by corrrecting its dislocation in all planes. We describe a technique for the same. Material and methods The clinical and radiological features of 16 patients (4 - traumatic and 12 - congenital) with irreducible atlantoaxial dislocation (AAD) admitted in the last 1.5 years were studied. Specific attention was paid to vertical dislocation with lateral and rotational components, apart from anterior-posterior subluxation. They were operated through direct posterior approach. The technique using a long rod holder as lever and screw head (tulip) as fulcrum was employed to achieve C1-2 realignment in all planes. The postoperative clinical and radiological data was analyzed and compared with preoperative data. Results Patients presented with progressive myelopathy and/or progressive worsening of neck pain. Vertical dislocation was seen in 11 patients with congenital AAD in addition to the antero-posterior subluxation seen in all. Three patients with traumatic AAD and 8 with congenital AAD had additional lateral dislocation or lateral tilt. Three patients with traumatic AAD and 7 with congenital AAD showed rotational component. Postoperatively, all patients showed clinical improvement. Conclusions The antero-posterior and vertical realignment could be achieved in all except one. Similarly, rotational and lateral components could be completely corrected in 8 out of 10 patients. The technique appears to realign the C1-2 in all planes and provides good anatomical restoration. © 2015 Elsevier B.V. All rights reserved.

Sahoo S.K.,Neurosurgery | Salunke P.,Neurosurgery
British Journal of Neurosurgery | Year: 2014

Charcot arthropathy of the elbow joint is occasionally seen with Chiari malformation with syringomyelia, but rarely as a presenting feature as in the reported case. The treatment is directed toward its underlying cause to halt its progression. Thus, it is important to diagnose the cause as early as possible. © 2014 The Neurosurgical Foundation.

Mindermann T.,Neurosurgery | Mendelowitsch A.,Neurosurgery
Acta Neurochirurgica | Year: 2016

We report the case of a patient in whom 8.8 years following the implantation of a bilateral deep brain stimulation (DBS) into the Vim, a high-grade glioma was diagnosed in close proximity to the two electrode leads. A possible relationship between the permanent DBS and the development of the brain tumour is discussed. © 2016, Springer-Verlag Wien.

Mindermann T.,Neurosurgery | Schlegel I.,Neurosurgery
Acta Neurochirurgica | Year: 2013

Background: Patients with vestibular schwannomas (VS) are either assigned to watchful waiting, microsurgical resection, or radiosurgery. Decision making on how to proceed is based on parameters such as age, tumor growth, loss of hearing, and the tumor's Koos grading. Methods: In order to correlate Koos grading with tumor volume, patient records of 235 patients with VS who underwent Gamma Knife radiosurgery (GKRS) were retrospectively reviewed. Results: From 1994 to 2009, 235 consecutive patients underwent GKRS for sporadic VS at the Zurich Gamma Knife Center. Median follow up was 62.8 ± 33.0 months. Of the 235 tumors, 32 (13.6 %) were graded Koos I with a volume of 0.25 ± 0.3 cc; 71 (30.2 %) were graded Koos II with a volume of 0.57 ± 0.54 cc; 70 (29.8 %) were graded Koos III with a volume of 1.82 ± 1.88 cc; and 62 (26.4 %) were graded Koos IV with a volume of 4.17 ± 2.75 cc. Tumor progression was defined as a volume increase > 20 % at 2 years or later following GKRS. Overall tumor progression occurred in 21/235 (8.9 %) patients at 3.4 ± 0.9 years. Tumor progression did not differ statistically significantly in the various Koos grades: 1/32 (3.1 %) patients with VS Koos Grade I, 7/71 (9.8 %) patients with VS Koos Grade II, 6/70 (8.6 %) patients with VS Koos Grade III, and 7/62 (11.3 %) patients with VS Koos Grade IV. Conclusion: To our knowledge, this is the first work correlating the various Koos grades of VS to their respective tumor volumes. In our patients, tumor volumes of VS Koos Grade IV were limited because all of our patients were eligible for radiosurgery. In our series, the outcome following GKRS for patients with VS Koos Grade IV tumors did not differ from patients with VS Koos Grades I-III. We therefore suggest to limit Koos Grade IV VS to tumor volumes < 6 cc that may be eligible for radiosurgery, and introduce an additional VS Grade V for large VS with tumor volumes of > 6 cc that may not be eligible for radiosurgery. © 2012 Springer-Verlag Wien.

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