Surgeons
14 years of experience
Video profile
Accepting new patients
34 N 34th St
Philadelphia, PA 19104
Locations and availability (5)

Education ?

Medical School Score Rankings
Johns Hopkins University (1996)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Patients' Choice Award (2010 - 2011)
Compassionate Doctor Recognition (2010 - 2011)
Associations
American Board of Neurological Surgery

Affiliations ?

Dr. Storm is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • Good Samaritan Hospital
    5601 Loch Raven Blvd, Baltimore, MD 21239
    • Currently 3 of 4 crosses
    Top 50%
  • Children's Hospital of Philadelphia
    324 S 34th St, Philadelphia, PA 19104
    • Currently 2 of 4 crosses
  • Chop Clinical Associates
  • Publications & Research

    Dr. Storm has contributed to 51 publications.
    Title Pulmonary Edema and Cardiac Dysfunction After Resection of a Fourth Ventricle Tumor in a Toddler: Case Report.
    Date February 2012
    Journal Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
    Title Use of the Vascularized Free Fibula Graft with an Arteriovenous Loop for Fusion of Cervical and Thoracic Spinal Defects in Previously Irradiated Pediatric Patients.
    Date July 2011
    Journal Plastic and Reconstructive Surgery
    Excerpt

    Extensive spinal neoplasms are difficult to manage. Following resection, arthrodesis of the spine can be performed with instrumentation, but this often fails in the setting of radiation therapy. Use of the free fibula flap for anterior spinal fusion to correct deformities has been described in multiple studies, but its use for posterior spinal fusion has been limited. In addition, its use in the pediatric population for this purpose has not been reported.

    Title Use of Occipital Bone Graft in Pediatric Posterior Cervical Fusion: an Alternative Paramedian Technique and Review of the Literature.
    Date June 2011
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    An alternative method of bone grafting for pediatric posterior cervical and occipitocervical fixation is presented in detail. Full-thickness autografts from small craniectomies of the occipital bone are used to augment posterior segmental fusion in pediatric patients. Twelve patients have been treated successfully without bone graft donor site complications. The technical differences from previously reported uses of calvarial autograft in spine fusion are reviewed.

    Title Treatment of a Malignant Peripheral Nerve Sheath Tumor and Its Complications Through a Multidisciplinary Approach.
    Date June 2011
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    The authors report the case of a 14-year-old girl with a residual malignant peripheral nerve sheath tumor after thoracotomy, chemotherapy, and radiation therapy. The residual tumor, which involved the intercostal muscles, aorta, and neural foramina of T4-10, was completely resected through a costotransversectomy and multiple hemilaminotomies with the patient in the prone position and was stabilized using a T1-12 pedicle screw fusion. Postoperatively, the patient developed several infections requiring multiple washouts and prolonged antibiotics. Thirty months after surgery, she developed a bronchocutaneous fistula. The hardware was removed, and a vascularized latissimus dorsi free flap was placed over the lung. She continued to have an air leak and presented 3 weeks later with a 40° left thoracic curve. She returned to the operating room for a T2-L2 fusion with a vascularized fibular graft. On postoperative Day 1, she underwent a bronchoscopy and had her left lower lobe airways occluded with multiple novel one-way endobronchial valves. She is now 5 years out from her tumor resection and 3 years out from her definitive fusion. She has no evidence of residual tumor, infection, or pseudarthrosis and continues to remain asymptomatic.

    Title Morphometric Analysis of Posterior Fossa After in Utero Myelomeningocele Repair.
    Date May 2011
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    Myelomeningocele (MMC) is characterized by a defect in caudal neurulation and appears at birth with a constellation of neuroanatomical abnormalities, including Chiari malformation Type II. The authors investigated the effects of antenatal versus postnatal repair of MMC through a quantitative analysis of morphometric changes in the posterior fossa (PF).

    Title Fluoroscopically Guided, Transoral, Closed Reduction, and Halo Vest Immobilization for an Atypical C-1 Fracture.
    Date May 2011
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    Fractures through the ring of the C-1 vertebrae are very rare in the pediatric patient population. In this report, the authors describe the case of a widely displaced fracture of the C-1 anterior arch in a 6-year-old boy. The fracture was initially treated using a fluoroscopy-guided, transoral, closed reduction with subsequent halo vest immobilization. Although conservative management of C-1 fractures is generally adequate and efficacious in the pediatric population, mechanistic and anatomical considerations in this case were concerning for potential instability in extension, and prompted an unusual method of closed reduction followed by treatment in a halo vest.

    Title The Genetic Landscape of the Childhood Cancer Medulloblastoma.
    Date February 2011
    Journal Science (new York, N.y.)
    Excerpt

    Medulloblastoma (MB) is the most common malignant brain tumor of children. To identify the genetic alterations in this tumor type, we searched for copy number alterations using high-density microarrays and sequenced all known protein-coding genes and microRNA genes using Sanger sequencing in a set of 22 MBs. We found that, on average, each tumor had 11 gene alterations, fewer by a factor of 5 to 10 than in the adult solid tumors that have been sequenced to date. In addition to alterations in the Hedgehog and Wnt pathways, our analysis led to the discovery of genes not previously known to be altered in MBs. Most notably, inactivating mutations of the histone-lysine N-methyltransferase genes MLL2 or MLL3 were identified in 16% of MB patients. These results demonstrate key differences between the genetic landscapes of adult and childhood cancers, highlight dysregulation of developmental pathways as an important mechanism underlying MBs, and identify a role for a specific type of histone methylation in human tumorigenesis.

    Title Penile Blood Pressure Monitoring for a Pediatric Patient with Hypomelia.
    Date November 2010
    Journal Anesthesia and Analgesia
    Title Diagnosis and Treatment of Vein of Galen Aneurysmal Malformations.
    Date September 2010
    Journal Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
    Excerpt

    Vein of Galen aneurysmal malformations (VGAM) are rare but clinically significant intracranial arteriovenous shunt lesions that most often present in neonates and infants.

    Title Early Progenitor Cell Marker Expression Distinguishes Type Ii from Type I Focal Cortical Dysplasias.
    Date August 2010
    Journal Journal of Neuropathology and Experimental Neurology
    Excerpt

    Type I and type II focal cortical dysplasias (FCDs) exhibit distinct histopathologic features that suggest different pathogenic mechanisms. Type I FCDs are characterized by mild laminar disorganization and hypertrophic neurons, whereas type II FCDs exhibit dramatic laminar disorganization and cytomegalic cells (balloon cells). Both FCD types are associated with intractable epilepsy; therefore, identifying cellular or molecular differences between these lesion types that explains the histologic differences could provide new diagnostic and therapeutic insights. Type II FCDs express nestin, a neuroglial progenitor protein that is modulated in vitro by the stem cell proteins c-Myc, sex-determining region Y-box 2 (SOX2), and Octamer-4 (Oct-4) after activation of mammalian target of rapamycin complex 1 (mTORC1). Because mTORC1 activation has been demonstrated in type II FCDs, we hypothesized that c-Myc, SOX2, and Oct-4 expression would distinguish type II from type I FCDs. In addition, we assayed the expression of progenitor cell proteins forkhead box G1 (FOXG1), Kruppel-like factor 4 (KLF4), Nanog, and SOX3. Differential expression of 7 stem cellproteins and aberrant phosphorylation of2mTORC1 substrates, S6 andS6 kinase 1 proteins, clearly distinguished type II from type I FCDs(n = 10 each). Our results demonstrate new potential pathogenic pathways in type II FCDs and suggest biomarkers for diagnostic pathology in resected epilepsy specimens.

    Title Pedicle Subtraction Osteotomies for the Correction of Post-traumatic Thoracolumbar Kyphosis.
    Date June 2010
    Journal Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
    Excerpt

    Traumatic compression fractures are usually treated non-surgically. In most patients without osteoporosis, such fractures heal without any sequelae. However, some patients develop a post-traumatic kyphosis that can lead to severe pain and disability, refractory to non-surgical management. In such patients, correction of the kyphosis ultimately may be the only definitive treatment. Pedicle subtraction osteotomies have been used in non-traumatic settings to correct kyphotic deformities or restore lordosis in patients in symptomatic positive sagittal balance. We apply this technique in the setting of post-traumatic kyphosis, and we performed the osteotomies at the level of the compression fracture.

    Title Interictal Eeg Spikes Identify the Region of Electrographic Seizure Onset in Some, but Not All, Pediatric Epilepsy Patients.
    Date May 2010
    Journal Epilepsia
    Excerpt

    The role of sharps and spikes, interictal epileptiform discharges (IEDs), in guiding epilepsy surgery in children remains controversial, particularly with intracranial electroencephalography (IEEG). Although ictal recording is the mainstay of localizing epileptic networks for surgical resection, current practice dictates removing regions generating frequent IEDs if they are near the ictal onset zone. Indeed, past studies suggest an inconsistent relationship between IED and seizure-onset location, although these studies were based upon relatively short EEG epochs.

    Title Abc/xyz Estimates Intracerebral Hemorrhage Volume As a Percent of Total Brain Volume in Children.
    Date May 2010
    Journal Stroke; a Journal of Cerebral Circulation
    Excerpt

    Intracerebral hemorrhage volume (ICHV) as a percentage of total brain volume (TBV) is a strong predictor of outcome in childhood intracerebral hemorrhage with ICHV/TBV >2% associated with functional impairment. We aimed to determine whether easily performed approximations of intracerebral hemorrhage and brain volume can accurately and reliably stratify intracerebral hemorrhage by size.

    Title Predictors of Outcome in Childhood Intracerebral Hemorrhage: a Prospective Consecutive Cohort Study.
    Date February 2010
    Journal Stroke; a Journal of Cerebral Circulation
    Excerpt

    The purposes of this study were to describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study.

    Title Surgical Treatment of a Clival-c2 Atypical Teratoid/rhabdoid Tumor.
    Date January 2010
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    The authors present the case of en bloc resection of a clival-C2 atypical teratoid/rhabdoid tumor. These aggressive lesions of early childhood generally occur in the cerebellum or cerebral hemispheres. This 7-year-old boy presented with pain on turning his head and was found to have a clival-C2 mass. A metastatic workup was negative for disseminated disease. A transoral biopsy procedure revealed an atypical teratoid/rhabdoid tumor on histological examination. The tumor was resected via a transoral approach, and the patient's spine was stabilized with posterior instrumented fusion from the occiput to C-5. Postoperatively, the patient underwent 16 months of chemotherapy along with 6 weeks of overlapping radiation therapy. Twenty-seven months after the initial surgery he presented with leg pain and was found to have a solitary metastatic lesion at the conus medullaris. There was no local recurrence at the clivus. The conus tumor was resected and found to be consistent with the primary tumor. Several months later the patient presented with disseminated intrathecal disease and ultimately died 42 months after the initial resection.

    Title Duplication of 7q34 in Pediatric Low-grade Astrocytomas Detected by High-density Single-nucleotide Polymorphism-based Genotype Arrays Results in a Novel Braf Fusion Gene.
    Date September 2009
    Journal Brain Pathology (zurich, Switzerland)
    Excerpt

    In the present study, DNA from 28 pediatric low-grade astrocytomas was analyzed using Illumina HumanHap550K single-nucleotide polymorphism oligonucleotide arrays. A novel duplication in chromosome band 7q34 was identified in 17 of 22 juvenile pilocytic astrocytomas and three of six fibrillary astrocytomas. The 7q34 duplication spans 2.6 Mb of genomic sequence and contains approximately 20 genes, including two candidate tumor genes, HIPK2 and BRAF. There were no abnormalities in HIPK2, and analysis of two mutation hot-spots in BRAF revealed a V600E mutation in only one tumor without the duplication. Fluorescence in situ hybridization confirmed the 7q34 copy number change and was suggestive of a tandem duplication. Reverse transcription polymerase chain reaction-based sequencing revealed a fusion product between KIAA1549 and BRAF. The predicted fusion product includes the BRAF kinase domain and lacks the auto-inhibitory N-terminus. Western blot analysis revealed phosphorylated mitogen-activated protein kinase (MAPK) protein in tumors with the duplication, consistent with BRAF-induced activation of the pathway. Further studies are required to determine the role of this fusion gene in downstream MAPK signaling and its role in development of pediatric low-grade astrocytomas.

    Title Treatment of Pediatric Atlantoaxial Instability with Traditional and Modified Goel-harms Fusion Constructs.
    Date September 2009
    Journal European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
    Excerpt

    There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a Goel-Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005-2007). Six patients were treated using Goel-Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3-4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.

    Title Endovascular and Surgical Treatment of Ruptured Cerebral Aneurysms in Pediatric Patients.
    Date December 2008
    Journal Neurosurgery
    Excerpt

    OBJECTIVE: Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms. METHODS: Pediatric patients aged 16 years and younger who were admitted with a diagnosis of aneurysmal subarachnoid hemorrhage and treated at the Children's Hospital of Philadelphia were included in this analysis. RESULTS: Twelve patients with 13 aneurysms (4 male patients and 8 female patients; age range, 4 months-16 years; mean age, 5.1 years), were admitted with subarachnoid hemorrhage during the past 12 years. The majority of patients were admitted in good clinical condition; 31% were in Hunt and Hess Grade II, and 31% were in Hunt and Hess Grade III. The remaining patients were in poor clinical condition and were in Hunt and Hess Grade IV (23%) or Grade V (15%). Computed tomography revealed that 15% of the patients were in Fisher Grade 2, 23% were in Fisher Grade 3, and 62% were in Fisher Grade 4. Endovascular techniques were used in the treatment of 5 aneurysms, and microsurgery was used in the treatment of 8 aneurysms. In the endovascular group, aneurysm sizes ranged from 2 to 35 mm (mean, 12.6 mm); 3 aneurysms were in the anterior circulation, and 2 were in the posterior circulation. In the microsurgery group, 6 aneurysms were in the anterior circulation, and 2 were in the posterior circulation; sizes ranged from 3 to 15 mm (mean, 6.8 mm). Sixty-nine percent of the patients were independent at follow-up. CONCLUSION: Contemporary endovascular and microsurgical techniques can be used effectively to treat ruptured cerebral aneurysms in pediatric patients. In the time period studied, the techniques were equally effective when used in the appropriate patients.

    Title Anatomic Hemispherectomy for Intractable Epilepsy in a Patient with Unilateral Schizencephaly.
    Date October 2008
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    Schizencephaly is a rare congenital cortical brain malformation defined by unilateral or bilateral clefts of the cerebral hemispheres. These malformations are often associated with medically intractable epilepsy. Surgical solutions include lesionectomy, lobectomy, or hemispherectomy. The authors describe the case of an anatomic hemispherectomy for medically intractable epilepsy in an 8-year-old boy with a large schizencephalic cleft. Seven years prior to his epilepsy surgery, the patient underwent placement of a ventriculoperitoneal shunt for communicating hydrocephalus that resulted in severe left-to-right shift. Subsequently, medically refractory epilepsy developed and the patient underwent an anatomic hemispherectomy for seizure control. The preoperative brain shift remained after the surgery, although the patient tolerated the procedure well and was seizure free postoperatively. Anatomic hemispherectomy is a viable option for treating medically intractable epilepsy in a schizencephalic pediatric patient-even one with considerable brain shift.

    Title Magnetoencephalography for Pediatric Epilepsy: How We Do It.
    Date June 2008
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Magnetoencephalography (MEG) is increasingly being used in the preoperative evaluation of pediatric patients with epilepsy. The ability to noninvasively localize ictal onset zones (IOZ) and their relationships to eloquent functional cortex allows the pediatric epilepsy team to more accurately assess the likelihood of postoperative seizure freedom, while more precisely prognosticating the potential functional deficits that may be expected from resective surgery. Confirmation of clinically suggested multifocality may result in a recommendation against resective surgery because the probability of seizure freedom will be low. Current paradigms for motor and somatosensory testing are robust. Paradigms allowing localization of those regions necessary for competent language function, though promising, are under continuous optimization. MR imaging white matter trajectory data, created from diffusion tensor imaging obtained in the same setting as the localization brain MR imaging, provide ancillary information regarding connectivity of the IOZ to sites of rapid secondary spread and the spatial relationship of the IOZ to functionally important white matter bundles, such as the corticospinal tracts. A collaborative effort between neuroradiology, neurology, neurosurgery, neuropsychology, technology, and physics ensures successful implementation of MEG within a pediatric epilepsy program.

    Title Cranial Fetus in Fetu. Case Illustration.
    Date May 2008
    Journal Journal of Neurosurgery. Pediatrics
    Title Multiple Ruptured Cerebral Aneurysms in a Child with Takayasu Arteritis.
    Date April 2008
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

    Title Lumbar Puncture and Surgical Intervention in a Child with Undiagnosed Fibrodysplasia Ossificans Progressiva.
    Date April 2008
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    Fibrodysplasia ossificans progressiva (FOP) is a rare, autosomal dominant disorder characterized by congenital malformation of the great toes and episodes of soft tissue swelling that lead to progressive heterotopic ossification. The genetic cause of FOP was recently discovered to be a recurrent missense activating mutation in the activin A type I receptor, a bone morphogenetic protein type I receptor in all classically affected individuals worldwide. The authors present a child with the classic features of previously undiagnosed FOP who developed a paraspinal soft-tissue mass after a lumbar puncture for a fever workup. Excision of the mass resulted in a massive inflammatory response leading to progression of heterotopic ossification. Awareness of the classic clinical features of FOP prior to the appearance of heterotopic ossification can prompt early clinical diagnosis and confirmation through genetic testing, thus avoiding interventions that lead to irreversible iatrogenic harm.

    Title Surgical Management of Pediatric Brain Tumors.
    Date February 2008
    Journal Expert Review of Anticancer Therapy
    Excerpt

    Brain tumors are the most common cause of cancer-related death and the second most common form of cancer in pediatric patients. Many of these tumors are treated primarily with surgery, either alone or in combination with radiation or chemotherapy. Recent advances have lead to greater survival and decreased morbidities in childhood brain tumor patients. A full understanding of the biology and primary treatment modalities for the particular tumor are essential for any professional treating these patients, including the neurosurgeon. Each tumor type has features in common with, and unique from, other tumors that need to be understood prior to undertaking a rational treatment plan. This article summarizes some of these features.

    Title Atypical Teratoid/rhabdoid Tumor in a Patient with Beckwith-wiedemann Syndrome.
    Date January 2008
    Journal American Journal of Medical Genetics. Part A
    Excerpt

    Beckwith-Wiedemann syndrome (BWS) is a genetic disorder associated with an increased risk of childhood tumors. Here we describe a patient with BWS who developed a central nervous system atypical teratoid/rhabdoid tumor (AT/RT). To our knowledge, despite the known cancer predisposition, this patient is the first described with BWS to develop an AT/RT. Due to the high propensity of these patients to develop childhood tumors, in addition to routine diagnostic tests, analysis of the tumor DNA using the Illumina Infinium whole-genome genotyping 550K Beadchip was performed to investigate a possible common underlying mechanism for his BWS and AT/RT. The only alteration detected was monosomy 22, which was accompanied by a somatic mutation in the INI1 rhabdoid tumor gene. These results suggest that, despite an underlying cancer predisposition, the occurrence of BWS and AT/RT in this patient may be unrelated.

    Title Comparison of Novel Computer Detectors and Human Performance for Spike Detection in Intracranial Eeg.
    Date September 2007
    Journal Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
    Excerpt

    OBJECTIVE: Interictal spikes in intracranial EEG (iEEG) may correlate with epileptogenic cortex, but review of interictal iEEG is labor intensive. Accurate automated spike detectors are necessary for understanding the role of spikes in epileptogenesis. METHODS: The sensitivity, accuracy and reproducibility of three automated iEEG spike detectors were compared against two human EEG readers using iEEG segments from eight patients. A consensus set of detections was generated for detector calibration. Spike verification was calculated after both human EEG readers independently reviewed all detections. RESULTS: Humans and two of the three automated detectors demonstrated comparable accuracy. In four patients, automated spike detection sensitivity was >70% and accuracy was >50%. In the remaining four patients, EEG background morphology resulted in poorer performance. Blinded human verification accuracy was 76.7+/-6.6% for computer-detected spikes, and 84.5+/-4.1% for human-detected spikes. CONCLUSIONS: Automated iEEG spike detectors perform comparably to humans, but sensitivity and accuracy are patient dependent. Humans verified the majority of computer-detected spikes. SIGNIFICANCE: In some patients automated detectors may be used for mapping spike occurrences in epileptic networks. This may reveal associations between spike distribution, seizure onset, and pathology.

    Title Dislocation of the Mandible into the Middle Cranial Fossa. Case Report.
    Date August 2007
    Journal Journal of Neurosurgery
    Excerpt

    Dislocation of the mandibular condyle into the middle cranial fossa is a rare event due to anatomical and biomechanical factors. The authors report the case of a 12-year-old girl who presented with this condition after colliding with a classmate. One day after her injury, the patient demonstrated an inability to close her mouth completely, and she had minor tenderness to palpation anterior to the tragus, without neurological deficits. Imaging studies demonstrated a fractured glenoid fossa with intrusion of the mandible into the cranial cavity. Open reduction of the mandibular condyle was performed, and the glenoid fossa was reconstructed with a split-thickness bone graft and titanium screws. Several dural tears noted at the time of surgery were repaired primarily. Mandibular condyle dislocation into the middle cranial fossa is often misdiagnosed initially because of its low incidence and nonspecific symptoms. Computed tomography scanning is the most sensitive diagnostic study for detecting this injury. Closed reduction after induction of general anesthesia has been recommended in recently suffered injuries without neurological deficits, but this approach may overlook damage to intracranial structures. Surgical repair is recommended if neurological injury is suspected. Treatment options should be tailored to the individual factors of each case.

    Title Successful Microsurgical Extraction of a Migrated Coil in a Pediatric Patient After Failed Endovascular Closure of a Blalock-taussig Shunt. Case Report.
    Date July 2007
    Journal Journal of Neurosurgery
    Excerpt

    Coil migration is a rare but potentially serious complication of endovascular procedures. Occasionally coils can be retrieved via endovascular techniques. The authors describe the microsurgical management of a case in which endovascular techniques failed. A 2-year-old girl with pulmonary atresia and a Blalock-Taussig shunt underwent attempted endovascular closure of the shunt with Gianturco steel coils. During deployment, a coil was lost in the aorta and an angiogram showed that it had lodged in the proximal M1 segment of the middle cerebral artery. The coil could not be retrieved by endovascular techniques, and the patient was taken to the operating room to undergo a craniotomy. After the sylvian fissure was split, the coil was visible through the vessel wall. Temporary clips were placed on the proximal M1 and the proximal M2 segments, trapping the coil. A small arteriotomy was performed, the coil was removed, and the arteriotomy was closed. A cerebral angiogram showed excellent perfusion with no dissections. The patient's motor examination demonstrated a mild hemiparesis on the left with no tremulousness. Coil migration can be treated by microsurgical techniques in pediatric patients with a good clinical outcome.

    Title Other Causes of Pediatric Deformity.
    Date June 2007
    Journal Neurosurgery Clinics of North America
    Excerpt

    Pediatric spine deformity can result from a variety of conditions. The etiologies include idiopathic, congenital, neuromuscular, traumatic, iatrogenic, and radiation-induced spine deformities. The spine deformity may manifest as scoliosis, kyphosis, lordosis, or a mixed deformity. In this article, the authors discuss the classification, natural history, and management of congenital scoliosis. They conclude with a discussion of the various etiologies for neuromuscular scoliosis.

    Title Cervical Chordoma in a Patient with Tuberous Sclerosis Presenting with Shoulder Pain.
    Date May 2007
    Journal Pediatric Neurosurgery
    Title Brain Tissue Oxygen Monitoring in Pediatric Patients with Severe Traumatic Brain Injury.
    Date March 2007
    Journal Journal of Neurosurgery
    Excerpt

    OBJECT: Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring are fundamental to the management of severe traumatic brain injury (TBI). In adults, brain tissue oxygen monitoring (specifically PO2) and treatment have been shown to be safe additions to conventional neurocritical care and are associated with improved outcome. Brain tissue oxygen monitoring, however, has not been described in pediatric patients with TBI. In this report, the authors present preliminary experience with the use of ICP and PO2 monitoring in this population. METHODS: Pediatric patients (age <18 years) with severe TBI (Glasgow Coma Scale score <8) admitted to a Level 1 trauma center who underwent ICP and PO2 monitoring were evaluated. Therapy was directed at maintaining ICP below 20 mm Hg and age-appropriate CPP (> or =40 mm Hg). Data obtained in six patients (two girls and four boys ranging in age from 6-16 years) were analyzed. Brain tissue oxygen levels were significantly higher (p < 0.01) at an ICP of less than 20 mm Hg (PO2 29.29 +/- 7.17 mm Hg) than at an ICP of greater than or equal to 20 mm Hg (PO2 22.83 +/- 13.85 mm Hg). Significant differences (p < 0.01) were also measured when CPP was less than 40 mm Hg (PO2 2.53 +/- 7.98 mm Hg) and greater than or equal to 40 mm Hg (PO2 28.97 +/- 7.85 mm Hg). CONCLUSIONS. Brain tissue oxygen monitoring may be a safe and useful addition to ICP monitoring in the treatment of pediatric patients with severe TBI.

    Title Surgical Clipping of a Pica Aneurysm in a 6-month-old Child.
    Date January 2007
    Journal Pediatric Neurosurgery
    Title Ventriculoperitoneal Shunt Malfunction Presenting with Pleuritic Chest Pain.
    Date July 2006
    Journal Pediatric Emergency Care
    Excerpt

    BACKGROUND: Ventriculoperitoneal (VP) shunts are widely used for treating hydrocephalus. These devices are prone to malfunction with up to 70% requiring revision. Shunt infection and obstruction comprise the majority of malfunctions and usually present dramatically. However, rare presentations occur. METHODS/RESULTS: We report a rare case of VP shunt malfunction presenting with pleuritic chest pain. A 13-year-old girl with a VP shunt placed at birth for congenital hydrocephalus presented on multiple occasions with pleuritic chest pain, cough, and fever. She was diagnosed with an upper respiratory tract infection and discharged home. She returned with respiratory compromise, and chest x-ray depicted the shunt catheter in the pleural space with an associated pleural effusion and infiltrate. The patient fully recovered with intravenous antibiotics, thoracentesis, and placement of a new shunt system. CONCLUSIONS: VP shunt malfunction usually presents with signs and symptoms of increased intracranial pressure and/or infection. However, unusual presentations of malfunction may occur with signs and symptoms which appear unrelated to the shunt. Thus, all patients with VP shunts warrant a comprehensive evaluation.

    Title Use of Allogeneic Skin Graft for the Closure of Large Meningomyeloceles: Technical Case Report.
    Date May 2006
    Journal Neurosurgery
    Excerpt

    OBJECTIVE AND IMPORTANCE: To describe an alternative approach to the operative management of large meningomyeloceles, in which primary closure is not possible. CLINICAL PRESENTATION: Two full-term infants presented with very large meningomyeloceles for closure after an uncomplicated delivery. TECHNIQUE: An allogeneic skin graft was used in both cases to approximate the skin defect that remained after removal of the large meningomyelocele sacs. The surgical site was treated with dressing changes only during the postoperative period. CONCLUSION: The independent use of allogeneic skin grafts can lead to a successful cosmetic result for the treatment of large meningomyeloceles without the use of complicated skin incisions or flap advancements.

    Title In Vivo Release from a Drug Delivery Mems Device.
    Date March 2005
    Journal Journal of Controlled Release : Official Journal of the Controlled Release Society
    Excerpt

    A drug delivery microelectromechanical systems (MEMS) device was designed to release complex profiles of multiple substances in order to maximize the effectiveness of drug therapies. The device is based on micro-reservoirs etched into a silicon substrate that contain individual doses of drug. Each dose is released by the electrochemical dissolution of the gold membrane that covers the reservoir. The first in vivo operation of this device was reported in this study. Subcutaneous release was demonstrated in rats using two tracer molecules, fluorescein dye and radiolabeled mannitol, and one radiolabeled chemotherapeutic agent, carmustine (BCNU). BCNU was chosen because of the need to improve the direct delivery of chemotherapy to malignant tumors. The spatial profile of fluorescein dye release from the drug delivery device was evaluated by fluorimetry, the temporal profile of 14C labeled mannitol release was evaluated by liquid scintillation counting, and the temporal profile of 14C labeled BCNU release was evaluated by accelerator mass spectrometry (AMS). Release profiles obtained from injected controls were compared with those from activated devices. The in vivo dye release results showed high concentration of fluorescein in the flank tissue surrounding the devices 1 h after activation. The 14C labeled mannitol released from the drug delivery devices was rapidly cleared (1 day) from the rat urine. In vivo release of 14C labeled BCNU from activated devices showed slightly slower kinetics than the injected and in vitro controls, and the time to reach the steady-state plasma 14C concentration was on the order of 1 h. All these results demonstrated the capability of this drug delivery device to achieve localized delivery of various compounds with well-defined temporal profiles.

    Title Systemic Bcnu Enhances the Efficacy of Local Delivery of a Topoisomerase I Inhibitor Against Malignant Glioma.
    Date October 2004
    Journal Cancer Chemotherapy and Pharmacology
    Excerpt

    PURPOSE: To investigate the ability of systemically delivered BCNU to enhance the activity of either systemically delivered irinotecan (CPT-11) or locally delivered camptothecin from a biodegradable polymer for treatment of an intracranial 9L gliosarcoma. METHODS: We used a single systemic dose of BCNU on treatment day 1 in combination with systemic doses of CPT-11 on treatment days 1-5 and 8-12 against an intracranial rat 9L gliosarcoma model implanted into female Fischer 344 rats. We also used the same systemic dose of BCNU given on treatment day 1, followed by a local dose of a 20% loaded camptothecin biodegradable polymer implanted on the same day. RESULTS: Two doses of CPT-11 (10 and 60 mg/kg) were delivered systemically against intracranial 9L. Neither dose showed an increase in survival compared to controls ( P>0.2 for 10 mg/kg and P=0.17 for 60 mg/kg). Systemic delivery of CPT-11 (10 mg/kg per day) in combination with systemic BCNU (15 mg/kg) did not show a significant effect on survival compared to systemic BCNU alone ( P>0.2), even at the maximally tolerated systemic dose of CPT-11 (60 mg/kg per day; P=0.06). The combination of systemic BCNU (15 mg/kg) and intracranial delivery of camptothecin (20% loaded polymer), however, significantly extended survival compared to systemic BCNU alone ( P<0.001) and compared to intracranial delivery of camptothecin alone ( P=0.01). CONCLUSIONS: In a 9L gliosarcoma model, systemic delivery of CPT-11 showed no benefit in survival when delivered alone or in combination with systemic BCNU, because CPT-11 is unable to cross the blood-brain barrier in cytotoxic levels. When cytotoxic levels of a topoisomerase I inhibitor are delivered directly to the brain tumor via a biodegradable polymer, however, the systemic delivery of the alkylating agent BCNU significantly enhances the antitumor effects of camptothecin in a 9L gliosarcoma model.

    Title Surgical Repair of Brachial Plexus Injury: a Multinational Survey of Experienced Peripheral Nerve Surgeons.
    Date September 2004
    Journal Journal of Neurosurgery
    Excerpt

    OBJECT: Brachial plexus injuries (BPIs) are often devastating events that lead to upper-extremity paralysis, rendering the limb a painful extraneous appendage. Fortunately, there are several nerve repair techniques that provide restoration of some function. Although there is general agreement in the medical community concerning which patients may benefit from surgical intervention, the actual repair technique for a given lesion is less clear. The authors sought to identify and better define areas of agreement and disagreement among experienced peripheral nerve surgeons as to the management of BPIs. METHODS: The authors developed a detailed survey in two parts: one part addressing general issues related to BPI and the other presenting four clinical cases. The survey was mailed to 126 experienced peripheral nerve physicians and 49 (39%) participated in the study. The respondents represent 22 different countries and multiple surgical subspecialties. They performed a mean of 33 brachial plexus reconstructions annually. Areas of significant disagreement included the timing and indications for surgical intervention in birth-related palsy, treatment of neuroma-in-continuity, the best transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for motor neurotization, and the use of distal or proximal coaptation during nerve transfer. CONCLUSIONS: Experienced peripheral nerve surgeons disagree in important ways as to the management of BPI. The decisions made by the various treating physicians underscore the many areas of disagreement regarding the treatment of BPI, including the diagnostic approach to defining the injury, timing of and indications for surgical intervention in birth-related palsy, the treatment of neuroma-in-continuity, the choice of nerve transfers to achieve elbow flexion and shoulder abduction, the use of intra- or extraplexal donors for neurotization, and the use of distal or proximal coaptation during nerve transfer.

    Title Vulnerability of the Subcostal Nerve to Injury During Bone Graft Harvesting from the Iliac Crest.
    Date August 2004
    Journal Journal of Neurosurgery. Spine
    Excerpt

    Autologous bone graft harvesting from the iliac crest remains the gold standard for fusion surgery. One disadvantage of autologous bone harvesting is the patient's enduring postoperative pain at the donor site. Nerve injury is one of the postulated mechanisms that may account for this pain. The object of this study was to determine whether the lateral cutaneous branch of the subcostal nerve is vulnerable to injury in the process of obtaining grafts from the anterior iliac crest.

    Title A Surgical Technique for Safely Placing a Drug Delivery Catheter into the Pons of Primates: Preliminary Results of Carboplatin Infusion.
    Date June 2003
    Journal Neurosurgery
    Excerpt

    OBJECTIVE: We sought to develop a neurosurgical procedure to access the pons with a drug delivery device for chronic therapy and collect preliminary data on the toxicity of direct infusions of carboplatin in primates. METHODS: We made midline incisions on five cynomolgus monkeys, identified the inion, made a burr hole 2.5 cm below the inion, and inserted a catheter through the cerebellum into the roof of the pons. Pumps that infused saline for 90 days or carboplatin solutions for 30 to 35 days at 10 microl/d were placed subcutaneously in the low cervical/high thoracic region. Monkeys were assessed by computed tomography and magnetic resonance imaging, laboratory studies, daily neurological observation, postmortem examinations, and histopathology. RESULTS: Monkeys infused with saline and 82 microg of carboplatin remained neurologically intact throughout the infusion periods. Serial imaging showed that the catheter tip was in the pons and revealed no evidence of hemorrhage, edema, or migration. Two monkeys infused with up to 850 microg of carboplatin showed hyperintense magnetic resonance imaging signals at Days 15 and 18 and neurological deficits at approximately Week 3. Platinum levels greater than 10 ng/mg tissue were detected over a distance of 1 cm in tissue slices. Histopathology demonstrated significant tissue necrosis around the tip of the catheter. CONCLUSION: The pons of monkeys is safely accessed with a catheter for drug delivery by using a posterior midline approach. Clinical observations, radiographic imaging, and laboratory tests of animals infused with saline for 3 months or 0.26 mg/ml of carboplatin for 1 month were unremarkable. Neurotoxicity was seen with dose levels of 2.6 mg/ml of drug for 1 month. This procedure offers opportunities for examining the toxicity of brainstem antitumor therapy in primates.

    Title Lumbar Spinal Stenosis, Cauda Equina Syndrome, and Multiple Lumbosacral Radiculopathies.
    Date February 2003
    Journal Physical Medicine and Rehabilitation Clinics of North America
    Excerpt

    Narrowing of the vertebral canal, the lateral recess, or the neural foramina causes lumbar spinal stenosis. Stenosis results from degenerative changes that usually are superimposed on a congenitally narrowed spinal canal and can result in significant pain and disability, especially in the elderly. Signs and symptoms are related to the compression of neural and vascular elements from the limited canal space. The article reviews the anatomy and pathophysiology, clinical syndrome, diagnostic workup, and natural history of lumbar spinal stenosis to aid in proper diagnosis and treatment.

    Title Surgical Management of Cervical and Lumbosacral Radiculopathies: Indications and Outcomes.
    Date February 2003
    Journal Physical Medicine and Rehabilitation Clinics of North America
    Excerpt

    The most common indication for the surgical management of compressive cervical and lumbar radiculopathies is a herniated disc in a patient who has not improved with conservative management. Even though a herniated disk is a common condition, it is paramount that the examining physician considers an extensive differential diagnosis when evaluating radiculopathies, especially in patients with a history of cancer, multiple medical illnesses, secondary gain, or advanced age. This consideration has become even more important as imaging studies have improved, because previously undetected degenerative changes are now clearly visualized on MRI and CT scans. These improved studies, however, do not replace a thorough history and physical examination, because a patient's signs and symptoms may not correlate with the radiographic findings. The authors have presented a series of surgical techniques used to manage cervical and lumbar discectomies to the most recent "minimally invasive" percutaneous techniques. Much debate and controversy surround these more recent techniques. There is no controversy, however, in stating that achieving good outcomes, regardless of technique, is predicated on proper patient selection. Because patient selection is the most important predictor of outcome and because serious complications have been reported with "minimally invasive" percutaneous procedures, the authors continue to advocate the proven traditional surgical approaches until prospective, randomized studies demonstrate a clear benefit to using alternative techniques.

    Title Polymer Delivery of Camptothecin Against 9l Gliosarcoma: Release, Distribution, and Efficacy.
    Date December 2002
    Journal Journal of Neuro-oncology
    Excerpt

    Camptothecin is a potent antineoplastic agent that has shown efficacy against multiple tumor lines in vitro; unfortunately, systemic toxicity has limited its in vivo efficacy. This is the first study to investigate the release, biodistribution, and efficacy of camptothecin from a biodegradable polyanhydride polymer. Tritiated camptothecin was incorporated into biodegradable polymers that were implanted intracranially in 16 male Fischer 344 rats and the animals were followed up to 21 days post-implant. A concentration of 11-45 microg of camptothecin-sodium/mg brain tissue was within a 3 mm radius of the polymer disc, with levels of 0.1 microg at the outermost margin of the rat brain, 7 mm from the site of implantation. These tissue concentrations are within the therapeutic ranges for human and rat glioma lines tested against camptothecin-sodium in vitro. The in vivo efficacy of camptothecin-sodium was evaluated with male Fischer 344 rats implanted intracranially with 9L gliosarcoma and compared with the efficacy of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). The animals were divided into four groups. Group 1 (control) had a median survival of 17 days. Group 2 (3.8% BCNU polymer) had a median survival of 23 days (P = 0.006). Group 3 (20% camptothecin polymer) had a median survival of 25 days (P = 0.023). Group 4 (50% camptothecin polymer) had a median survival of 69 days (P < 0.001). Drug loadings of 20% and 50% camptothecin released intact camptothecin for up to 1000 h in vitro. We conclude that the biodegradable polymer p(CPP: SA) releases camptothecin-sodium, produces tumoricidal tissue levels, results in little or no systemic toxicity, and prolongs survival in a rat glioma model.

    Title Udp-glucuronate Decarboxylase, a Key Enzyme in Proteoglycan Synthesis: Cloning, Characterization, and Localization.
    Date June 2002
    Journal The Journal of Biological Chemistry
    Excerpt

    UDP-glucuronate decarboxylase (UGD) catalyzes the formation of UDP-xylose from UDP-glucuronate. UDP-xylose is then used to initiate glycosaminoglycan biosynthesis on the core protein of proteoglycans. In a yeast two-hybrid screen with the protein kinase Akt (protein kinase B), we detected interactions with a novel sequence, which we cloned and expressed. The expressed protein displayed UGD activity but did not display the activities of homologous nucleotide sugar epimerases or dehydratases. We did not detect phosphorylation of UGD by Akt nor did we detect any influence of Akt on UGD activity. Effects of UGD on Akt kinase activity were also absent. Northern blot and Western blot analyses revealed the presence of UGD in multiple tissues and brain regions. Subcellular studies and histochemistry localized UGD protein to the perinuclear Golgi where xylosylation of proteoglycan core proteins is known to occur.

    Title Reversible Posterior Leukoencephalopathy Occurring During Resection of a Posterior Fossa Tumor: Case Report and Review of the Literature.
    Date March 2002
    Journal Neurosurgery
    Excerpt

    OBJECTIVE AND IMPORTANCE: Our goal was to present a clinically and radiographically documented case of reversible posterior leukoencephalopathy (RPL) that occurred during resection of a posterior fossa tumor. Although RPL has been previously described in multiple nonsurgical settings, we hope that this case description makes RPL more clinically and radiographically recognizable to neurosurgeons. CLINICAL PRESENTATION: RPL is the clinical syndrome of headaches, altered mental status, seizures, and visual loss, with radiographic findings of reversible parieto-occipital changes on cerebral computed tomographic and magnetic resonance imaging scans. It has been previously reported in the settings of malignant hypertension, renal disease, eclampsia, and immunosuppression. To our knowledge, the patient presented represents the first clinically and radiographically documented case of RPL occurring during resection of a posterior fossa tumor. The patient intraoperatively exhibited wide fluctuations in blood pressure and awoke with clinical and radiographic findings consistent with RPL. INTERVENTION: Aggressive intraoperative and postoperative management of the patient's blood pressure, supportive intensive care, rehabilitation, and close radiographic follow-up were performed. CONCLUSION: RPL can occur as a result of intraoperative variations in blood pressure, even among young, previously healthy individuals. With the aforementioned interventions, the patient experienced significant clinical and radiographic recovery.

    Title Human "memories" Can Be Evoked by Stimulation of the Lateral Temporal Cortex After Ipsilateral Medial Temporal Lobe Resection.
    Date December 2001
    Journal Journal of Neurology, Neurosurgery, and Psychiatry
    Excerpt

    A patient with medically intractable seizures and mesial temporal sclerosis underwent a left anterior temporal lobectomy and amygdalohippocampectomy. After 4 months, his seizures recurred and a left temporal, subdural grid of electrodes was placed to localise his seizure focus. Stimulation through the grid evoked four distinct "memories", or experiential phenomena, despite absence of the ipsilateral medial temporal lobe. To our knowledge, this is the first documented case of experiential phenomena evoked by cortical stimulation in the absence of the ipsilateral medial temporal lobe.

    Title Gravity Detection Through Bifurcation.
    Date March 1996
    Journal Advances in Space Research : the Official Journal of the Committee on Space Research (cospar)
    Excerpt

    Bifurcation is a phenomenon in which a physical system is forced to make a choice between one of the several possible states to which it can evolve. In this process the system can become extremely sensitive to very small influences--smaller than the size of the fluctuations--that favor one of the states. A general theory of this sensitivity and a simple model for gravity detection is presented. The difference between systems in thermodynamic equilibrium and those that are far from equilibrium is also discussed.

    Title Non-specific Granulomatous Ureteritis.
    Date August 1977
    Journal The Journal of Urology
    Title Mediastinal Choriocarcinoma in a Chromatin-positive Boy.
    Date February 1977
    Journal The Journal of Urology
    Excerpt

    A case of primary mediastinal choriocarcinoma in a chromatin-positive boy is reported. The incidence of neoplasms in patients with so-called Klinefelter's syndrome is discussed as well as embryogenesis and diagnostic evaluation in patients presenting with this tumor.

    Title Treatment of Osteoblastoma at C7: a Multidisciplinary Approach. A Case Report and Review of the Literature.
    Date
    Journal European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
    Excerpt

    Osteoblastoma is a rare benign bone tumor that presents with back pain and occurs in the spine approximately 40% of the time. The time from onset of symptoms to diagnosis is typically several months because it is a rare entity and radiographic studies are often negative early in the course of the disease. These highly vascular and locally aggressive tumors require complete and precise resection. The patient presented is a 15-year-old boy with a 14-month history of right-sided neck and shoulder pain. Computerized tomography and magnetic resonance imaging demonstrated a lesion in the posterior elements of C7 which extended through the pedicle and into the body. Preoperative angiography confirmed a hypervascular lesion which was successfully embolized. He subsequently underwent piecemeal tumor resection and instrumented fusion. Immediate postoperative imaging demonstrated complete resection. At 18 months follow up the patient has maintained resolution of preoperative symptoms and demonstrates evidence of solid fusion on CT. This multidisciplinary approach markedly decreased blood loss and improved visualization to help achieve complete surgical resection and resolution of clinical symptoms.

    Title Activating Mutations in Braf Characterize a Spectrum of Pediatric Low-grade Gliomas.
    Date
    Journal Neuro-oncology
    Excerpt

    In the present study, DNA from 27 grade I and grade II pediatric gliomas, including ganglioglioma, desmoplastic infantile ganglioglioma, dysembryoplastic neuroepithelial tumor, and pleomorphic xanthoastrocytoma was analyzed using the Illumina 610K Beadchip SNP-based oligonucleotide array. Several consistent abnormalities, including gain of chromosome 7 and loss of 9p21 were observed. Based on our previous studies, in which we demonstrated BRAF mutations in 3 gangliogliomas, 31 tumors were screened for activating mutations in exons 11 and 15 of the BRAF oncogene or a KIAA1549-BRAF fusion product. There were no cases with a KIAA1549-BRAF fusion. A BRAF V600E mutation was detected in 14 of 31 tumors, which was not correlated with any consistent pattern of aberrations detected by the SNP array analysis. Tumors were also screened for mutations in codon 132 in exon 4 of IDH1, exons 2 and 3 of KRAS, and exons 2-9 of TP53. No mutations in KRAS or TP53 were identified in any of the samples, and there was only 1 IDH1 R132H mutation detected among the sample set. BRAF mutations constitute a major genetic alteration in this histologic group of pediatric brain tumors and may serve as a molecular target for biologically based inhibitors.

    Title Decompressive Hemicraniectomy for Pediatric Traumatic Brain Injury: Long-term Outcome Based on Quality of Life.
    Date
    Journal Pediatric Neurosurgery
    Excerpt

    The impact of decompressive hemicraniectomy (DCH) on the overall outcome of pediatric brain injury patients has not been fully determined. In this paper, the authors performed a systematic review of patient outcome based on quality of life following DCH in a pediatric population.


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