Ahead of Print: Insurance and Pediatric Epilepsy Surgery

Background: It is unclear if socio-economic factors like type of insurance influence time to referral and developmental outcomes for pediatric epilepsy surgery patients.

Objective: This study determined if private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric epilepsy surgery patients.

Methods: A consecutive cohort (n=420) of pediatric epilepsy surgery patients were retrospectively categorized into those with Medicaid (California Children’s Services; n=91) or private (PPO, HMO, Indemnity; n=329) insurance. Intervals from seizure-onset to referral and surgery, and Vineland developmental assessments were compared by insurance type using log-rank tests.

Ahead of Print: The Frontotemporal Approach

The frontotemporal, so-called “pterional” approach has evolved with the contribution of many neurosurgeons over the past century. It has stood the test of time and been the most commonly used transcranial approach in neurosurgery. In its current form, drilling the sphenoid wing as far down as the superior orbital fissure with or without the removal of the anterior clinoid, thinning the orbital roof, and opening the Sylvian fissure and basal cisterns are the hallmarks of this approach.

Ahead of Print: Direct Cavernous Sinus DAVF Embolization

Background and Importance: Dural arteriovenous fistulas (dAVF) represent 10-15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished using transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible using transcranial cannulation of a cortical draining vein.

Clinical Presentation: An 82 year old woman presented with diplopia, left sixth cranial nerve palsy, intraocular hypertension and bilateral chemosis. Angiography revealed a complex cavernous dAVF with cortical venous reflux, supplied by both external carotid arteries and the left meningohypophyseal trunk. Percutaneous transvenous access failed, and only partial occlusion was achieved by transarterial embolization. A frontotemporal craniotomy was performed to access the superficial middle cerebral vein in the left Sylvian fissure. Under fluoroscopic guidance, a microcatheter was advanced through this vein to the floor of the middle cranial fossa and into the dAVF, permitting coil occlusion.

Ahead of Print: Surgical Mortality and Selected Complications in 273 Consecutive Craniotomies for Intracranial Tumors in Pediatric Patients

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

BACKGROUND: In order to weigh the risks of surgery against the presumed advantages, it is important to have specific knowledge about complication rates. Contemporary reports on complications following craniotomy for tumor resection in pediatric patients are scarce.

OBJECTIVE: To study the surgical mortality and rate of hematomas, infections, meningitis, infarctions, and CSF leaks, as well as neurological morbidity, after craniotomy for pediatric brain tumors in a large, contemporary, single-institution consecutive series.

METHODS: All pediatric patients (<18 years) from a well-defined population of 3.0 million inhabitants who underwent craniotomies for intracranial tumors at Oslo University Hospital, Rikshospitalet, during 2003 to 2009 were included. The patients were identified from our prospectively collected database, and all charts were reviewed to validate the database entries.

Ahead of Print: Immediate Titanium Cranioplasty after Debridement and Craniectomy for Post-Craniotomy Surgical Site Infection

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

BACKGROUND: For post-craniotomy surgical site infection (SSI) involving the bone, typical management involves craniectomy, debridement and delayed cranioplasty. Disadvantages to delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, and risks and costs associated with an additional operation. Many authors have attempted bone flap salvage using various techniques.

OBJECTIVE: We evaluate our experience with immediate titanium mesh cranioplasty at the time of craniectomy and debridement.

METHODS: We retrospectively reviewed SSIs in patients that underwent craniotomy for treatment of a brain tumor. These patients were treated with craniectomy, debridement, and immediate titanium mesh cranioplasty followed by antibiotics. Primary outcome was recurrent infection.