Endoscopic-assisted craniosynostosis surgery.

Over the last decade, endoscopy has been increasingly utilized in craniosynostosis surgery. In 2006, the author added endoscopy followed by helmet therapy to the treatment of young craniosynostosis patients. Since then, 73 children have been successfully treated utilizing endoscopic techniques with a transfusion rate of 23%. Most children are discharged on the first postoperative day; helmet therapy begins one week later. A helmet is worn for 4 to 6 months with one helmet replacement. Complications were limited to three reoperations to address suboptimal results, and one reoperation for a persisting skull defect. One sagittal sinus injury was addressed successfully, with resolution of a small intrasinus thrombus and no adverse brain sequelae. Although not applicable to every craniosynostosis patient, properly applied endoscopic-assisted craniosynostosis surgery is safe and effective, adding another option to the treatment armamentarium for craniosynostosis.

Preservation of a subcutaneous pocket for vagus nerve stimulation pulse generator during magnetoencephalography. Technical note.

Patients with epilepsy and an implanted vagus nerve stimulation (VNS) device who are referred for consideration of definitive epilepsy surgery (removal of the epileptogenic cortex) may require magnetoencephalography (MEG), a study requiring explantation of the pulse generator, as part of their evaluation. Nonetheless, these patients may not wish to abandon palliative VNS therapy should definitive surgery prove unsuccessful or impossible. To avoid obliteration of the pocket by scar tissue after the pulse generator is explanted, the authors have preserved the dead space in several patients with insertion of a similarly sized silicone block. This block is easily replaced with the pulse generator if continued VNS therapy is appropriate, and is left in place in patients who appear to no longer require VNS therapy. Upon completion of MEG, if pulse generator replacement proves desirable, atraumatic retrieval of the electrode connector pin and body is easy. Silicone block implantation during what may prove to be temporary device explantation facilitates reuse of the original pulse generator implantation site and atraumatic distal electrode wire retrieval.

Cervical ventral epidural pressure response to graded spinal canal compromise and spinal motion.

STUDY DESIGN: A laboratory investigation using a feline model of graded ventral spinal canal compromise was performed. OBJECTIVE: To quantify the effects of graded ventral spinal canal compromise, both in the static condition and in combination with passive spinal motion, on cervical ventral epidural pressure (CVEP). The CVEP effects of laminectomy are also investigated. SUMMARY OF BACKGROUND DATA: Spinal canal compromise, both in the static condition and in combination with passive spinal motion, has been implicated as a cause of spinal cord dysfunction. METHODS: Seventeen cats underwent anterior corpectomy of C3 and placement of a flexible ventral graded compression device incorporating a pressure transducer. Ten animals also underwent laminectomy of C3. The implant was advanced stepwise into the spinal canal. CVEP was measured, at each degree of canal compromise, in the flexed, extended, and neutral positions, as well as during neck movement. RESULTS: CVEP rose as a function of spinal canal compromise. In animals without laminectomy, mean CVEP was higher in the extended position and lower in the flexed position than in the neutral position. Mean CVEP during continuous passive neck movement was found to be higher than mean CVEP in the neutral position. Laminectomy was found to lower CVEP during all conditions examined, although substantial rises in CVEP were still observed in the presence of a residual ventral mass. All reported differences were statistically significant (P < 0.05). CONCLUSIONS: CVEP is elevated by both spinal canal compromise and spinal motion.