Neurosurgical Operative Atlas Second Edition Pediatric Neurosurgery American Association of Neurosurgeons • Rolling Meadows, Illinois Neurosurgical Operative Atlas Second Edition Pediatric Neurosurgery James Tait Goodrich, MD, PhD, DSci (Honoris Causa) Professor of Clinical Neurological Surgery, Pediatrics, Plastic and Reconstructive Surgery Albert Einstein College of Medicine Director, Division of Pediatric Neurosurgery Center for Craniofacial Disorders Children’s Hospital at Montefiore Bronx, New York Thieme New York • Stuttgart American Association of Neurosurgeons Rolling Meadows, Illinois Thieme Medical Publishers, Inc 333 Seventh Ave New York, NY 10001 American Association of Neurosurgeons (AANS)* 5550 Meadowbrook Drive Rolling Meadows, Illinois 60008-3852 *The acronym AANS refers to both the American Association of Neurological Surgeons and the American Association of Neurosurgeons Associate Editor: Birgitta Brandenburg Assistant Editor: Ivy Ip Vice President, Production and Electronic Publishing: Anne T Vinnicombe Production Editor: Print Matters, Inc Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial Officer: Peter van Woerden President: Brian D Scanlan Cover illustration: Anita Impagliazzo Compositor: Compset, Inc Printer: Everbest Printing Company Library of Congress Cataloging-in-Publication Data Neurosurgical operative atlas Pediatric neurosurgery / [edited by] James Tait Goodrich p ; cm Includes bibliographical references and index ISBN 978-1-58890-510-9 (alk paper) Nervous system—Surgery—Atlases Children—Surgery—Atlases Pediatric neurology—Atlases I Goodrich, James T [DNLM: Nervous System Diseases—surgery—Atlases Child Infant Neurosurgical Procedures—methods—Atlases WL 17 P371 2008] RD593.P3822 2008 618.92’8—dc22 2007048827 Copyright © 2008 by Thieme Medical Publishers, Inc., and the American Association of Neurosurgeons (AANS) This book, including all parts thereof, is legally protected by copyright Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage Important note: Medical knowledge is ever-changing As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information Readers are encouraged to confirm the information contained herein with other sources For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain Printed in China 54321 ISBN 978-1-58890-510-9 To Setti S Rengachary, MD, and Robert H Wilkins, MD When the first edition of this remarkable atlas came out in early 1990s, it was an instant and powerful success in the neurosurgical literature Drs Rengachary and Wilkins recognized the power of the illustrated text and in this case designed a work that was clearly visual with the text being secondary As neurosurgeons are visual animals, this was a successful design Drs Rengachary and Wilkins’ contributions to neurosurgery have been enormous It is a true pleasure to help bring this remarkable atlas back in a second edition However, it must be remembered that their original editorship led to this most elegant and influential series of operative chapters In acknowledgment of their insights, their educational leadership, and, most importantly, their longstanding contributions to neurosurgery, I dedicate this work to these two scholars and superb neurosurgeons v Contents Continuing Medical Education Credit Information and Objectives xi Continuing Medical Education Disclosure xii Series Foreword Robert Maciunas xiii Foreword Richard D Hayward xv Preface xvii Contributors xix Chapter Fibrous Dysplasia Involving the Craniofacial Skeleton James Tait Goodrich Chapter Chiari Malformations and Syringohydromyelia Elizabeth C Tyler-Kabara and W Jerry Oakes Chapter Unilateral and Bicoronal Craniosynostosis 13 Kant Y K Lin, John A Jane Jr., and John A Jane Sr Chapter Transoral Surgery for Craniovertebral Junction Abnormalities 20 Arnold H Menezes Chapter Malposition of the Orbits 27 John A Persing and Bianca I Knoll Chapter Ventriculoatrial Shunting 34 John Drygas and Stephen J Haines Chapter Repair of “Growing” Skull Fracture 40 Tadanori Tomita Chapter Occipital Encephaloceles 43 William O Bell Chapter Surgical Management of Pansynostosis (Craniosynostosis) 50 James Tait Goodrich and David L Staffenberg Chapter 10 Tethered Spinal Cord, Intramedullary Spinal Lipomas, and Lipomyelomeningoceles 62 Elizabeth C Tyler-Kabara and W Jerry Oakes Chapter 11 Encephaloceles of the Anterior Cranial Base 69 Jonathan P Miller and Alan R Cohen Chapter 12 Exorbitism 76 Constance M Barone, David F Jimenez, and James Tait Goodrich Chapter 13 Depressed Skull Fracture in Infants 83 Marion L Walker Chapter 14 Orbital Hypertelorism and Orbital Dystopia 88 Constance M Barone, David F Jimenez, and James Tait Goodrich vii viii Contents Chapter 15 Closure of the Myelomeningocele 96 David G McLone Chapter 16 Dandy-Walker Malformation 104 Arthur E Marlin and Sarah J Gaskill Chapter 17 Surgical Management of Chiari I Malformations and Syringomyelia 111 Elizabeth C Tyler-Kabara, Richard B Morawetz, and W Jerry Oakes Chapter 18 Split Cord Malformations 116 Dachling Pang Chapter 19 Tethered Cord Syndrome Secondary to Previous Repair of a Myelomeningocele 129 Timothy A Strait Chapter 20 Sectioning of the Filum Terminale 136 Frederick B Harris, Naina L Gross, and Frederick A Boop Chapter 21 Diastematomyelia 142 Frederick B Harris, Naina L Gross, and Frederick A Boop Chapter 22 Lipomyelomeningoceles 147 Frederick B Harris, Naina L Gross, and Frederick A Boop Chapter 23 Untethering of the Spinal Cord after a Previous Myelomeningocele Repair 152 Frederick B Harris, Naina L Gross, and Frederick A Boop Chapter 24 Brain Abscesses 157 Darric E Baty, Eli M Baron, and Christopher M Loftus Chapter 25 Unilateral Coronal Synostosis (Plagiocephaly) 165 James Tait Goodrich and David L Staffenberg Chapter 26 Moyamoya Syndrome in Children with Pial Synangiosis 171 R Michael Scott and Edward R Smith Chapter 27 Selective Dorsal Rhizotomy for Spastic Cerebral Palsy 177 Tae Sung Park and James M Johnston Chapter 28 Treatment of Lambdoidal Synostosis with Calvarial Reconstructive Techniques 184 David F Jimenez, Constance M Barone, and James Tait Goodrich Chapter 29 Early Treatment of Lambdoid Synostosis with Endoscopic-Assisted Craniectomy 190 David F Jimenez and Constance M Barone Chapter 30 Posterior Plagiocephaly 194 Richard G Ellenbogen, Sudesh J Ebenezer, and Richard Hopper Chapter 31 Sagittal Synostosis 203 Larry A Sargent and Timothy A Strait Chapter 32 The Separation of Craniopagus Twins 209 Sami Khoshyomn and James T Rutka Chapter 33 Endoscopic Approaches to the Ventricular System 215 David F Jimenez Chapter 34 Intraventricular Endoscopy 227 Jonathan P Miller and Alan R Cohen Chapter 35 Infected Ventriculoperitoneal Shunts 233 Keyne K Thomas, Sohaib A Kureshi, and Timothy M George Chapter 36 Combined Fronto-Orbital and Occipital Advancement for Total Calvarial Reconstruction 241 Ian F Pollack Chapter 37 Lumbosacral Meningoceles 251 Ciaran J Powers, Eric M Gabriel, and Timothy M George Contents ix Chapter 38 Surgical Correction of Unilateral and Bilateral Coronal Synostoses 256 Jack Chungkai Yu and Ann Marie Flannery Chapter 39 Myelomeningoceles, Split Cord Malformations, and Filum Terminale Dysgenesis 262 Robert F Keating Chapter 40 Lipomyelomeningoceles 269 James Tait Goodrich Chapter 41 Brain Stem Gliomas 275 Darlene A Lobel and Mark R Lee Chapter 42 Posterior Fossa Decompression without Dural Opening for the Treatment of Chiari I Malformation 281 Jonathan D Sherman, Jeffery J Larson, and Kerry R Crone Chapter 43 Metopic Synostosis 286 Kant Y K Lin, John A Jane Jr., and John A Jane Sr Chapter 44 Total Cranial Vault Repair for Sagittal Craniosynostosis 291 John A Jane Jr., Kant Y K Lin, Tord D Alden, and John A Jane Sr Chapter 45 Metopic Craniosynostosis 296 Paul C Francel and Jayesh Panchal Chapter 46 Unicoronal Synostosis 304 Jayesh Panchal and Paul C Francel Index 313 316 Index Coronal synostosis, (continued) etiology of, 304 genetics of, 13, 256, 261, 305 individualized treatment for, 241 multidisciplinary approach to, 241–242 ophthalmologic exam in, 13 plate-and-screw fixation in, 17, 17f, 19, 167–170, 167f, 169f, 261, 308–310 postoperative management of, 19, 170, 261, 310–311 radiologic findings of, 165, 241–242, 242f, 256–257, 305–306, 305f–308f, 310–311 recurrence or relapse of, 17, 19 surgery for, 13–19, 165–170, 256–261, 304–311 See also specific procedures blood loss in, 13–14, 19, 166, 170, 249, 257–258, 308 closure in, 19, 168–170, 260–261 complications of, 19, 170, 261, 310–311 craniotomy in, 167–168, 167f–168f, 259, 259f flap elevation in, 14–15, 166–167 follow-up in, 311 indications for, 13 osteotomies in, 15–16, 16f, 167, 168f, 259, 308, 309f–310f outcome of, 307f patient positioning for, 14, 17, 17f, 166, 258, 308 patient selection for, 13, 165, 256–257, 304 preoperative preparation for, 13–14, 165–166, 257 procedure for, 14–19, 166–170, 258–261, 308–310 risks of, 257 skin incision in, 14–15, 166–167, 258, 258f, 308 specialized instrumentation in, 19, 170, 261 supraorbital bar advancement in, 306, 308–310, 311f timing of, 13, 165, 241, 249–250, 304–305 syndromic vs nonsyndromic, 13, 304 total calvarial reconstruction for, 241–250 anesthesia for, 242 blood loss in, 249 closure in, 246–247 complications of, 249 draping in, 244, 245f exposure in, 244, 245f final recontouring in, 246, 248f height reduction in, 246, 248f intraoperative monitoring in, 242, 247 occipital advancement in, 246, 247f orbital advancement in, 244–246, 246f outcome of, 249 patient positioning for, 243–244, 243f patient selection for, 241 postoperative management of, 249 preoperative preparation for, 242 skin incision in, 244, 245f specialized instrumentation for, 247–249 timing of, 241, 249–250 turricephaly with, 13, 241, 242f, 249, 256 unilateral, 13, 14f, 165–170, 256, 304–311, 304f–305f craniofacial reconstruction in, 15–16, 16f, 167–168, 167f– 169f, 259–261, 306–310 craniotomy in, 15–17, 16f, 167–168, 167f–168f Corticectomy, for brain abscess, 161, 162f–163f Costochondral bone graft, for hypercanthorum, 28, 31f Cranial base encephaloceles, 69 anterior, 69–75 differential diagnosis of, 70–71 postoperative management of, 73–74 radiologic findings of, 71 surgery for closure in, 72–73 complications of, 73–74 craniotomy in, 71–72, 71f extradural approach in, 71–73, 72f–73f intradural approach in, 71, 73, 75f isolation, ligation, and transection in, 72, 73f–74f outcome of, 74 patient positioning for, 71, 71f preoperative preparation for, 70–71 14535IDX.indd 316 procedure for, 71–73 skin incision in, 71, 71f transcranial approach in, 71 transnasal approach in, 71 transnasal removal in, 72, 75f Cranial vault encephaloceles, 69 Cranial vault reconstruction, total, 204–208, 291–295 anesthesia for, 204 blood loss in, 204, 206, 208, 292, 294–295 bone plate recontouring in, 206, 207f closure in, 293–294 complications of, 208, 294–295 craniofacial reconstruction in, 204–208, 207f, 293, 293f–294f craniotomy in, 204–205, 205f, 293, 293f–294f draping for, 204 flap elevation in, 293 indications for, 292 outcome of, 207f, 208 patient positioning for, 204, 204f, 292–293 patient selection for, 203, 291–292 preoperative preparation for, 204, 292 procedure for, 204–208, 292–294 skin incision for, 204, 204f, 293 surgical setup for, 292–293 timing of, 203, 292 Craniectomy, endoscopic-assisted, for lambdoid synostosis, 190–192 closure in, 191–192 complications of, 192 helmet use after, 192, 192f metallic markers for, 190, 190f operative technique for, 191–192, 191f–192f outcome of, 193f patient positioning for, 190, 190f patient selection for, 190 postoperative management of, 192 preoperative preparation for, 190 procedure for, 190–192 skin incision for, 190–191, 191f Craniofacial complex, fibrous dysplasia of, 1–6 Craniofacial reconstruction See also specific procedures in coronal synostosis bilateral, 17–18, 18f, 241–250, 259–261 unilateral, 15–16, 16f, 167–168, 167f–169f, 259–261, 306–310 in craniopagus twins, 210, 211f, 212, 213f in fibrous dysplasia, 5, 5f–6f in metopic synostosis, 287–288, 288f, 299–302, 301f–303f in pansynostosis, 52f, 53–57, 54f–56f, 58f–60f in plagiocephaly, 167–168, 167f–169f in sagittal synostosis, 204–208, 207f, 293, 293f–294f Craniopagus twins classification of, 209 epidemiology of, 209 frontal, 209 occipital, 209 parietal, 209 photograph of, 209f radiologic studies of, 209, 210f–211f separation of, 209–214 challenge of, 214 closure in, 212, 213f complications of, 213 craniofacial reconstruction in, 210, 211f, 212, 213f craniotomy in, 212, 212f dural graft in, 212, 212f dural opening in, 212 main questions in, 209 mortality and morbidity in, 209, 214 outcome of, 214, 214f patient positioning for, 210 patient selection for, 209 plate-and-screw fixation in, 212, 213f postoperative management of, 213 preoperative embolization for, 209 preoperative preparation for, 209–210 4/23/08 3:14:08 PM Index 317 preoperative tissue expanders for, 210, 211f procedure for, 210–212 skin incision for, 210, 211f–212f shared sagittal sinus in, 209, 210f– 212f, 212–214 shared vascular anatomy of, 209–210, 210f–211f temporoparietal, 209 vertical, 209 Craniosynostosis See also specific types coronal, 13–19, 165–170, 256–261, 304–311 artist’s rendering of, 166f bilateral, 13, 15f, 256 brachycephaly with, 13, 241, 242f, 249, 256 compensatory growth in, 13, 14f–15f, 165, 166f, 241, 256, 304 definition of, 13 diagnosis of, 305 differential diagnosis of, 256 etiology of, 304 genetics of, 13, 256, 261, 305 genetic testing in, 13 individualized treatment for, 241 multidisciplinary approach to, 241–242 ophthalmologic exam in, 13 plate-and-screw fixation in, 17, 17f, 19, 167–170, 167f, 169f, 261, 308–310 postoperative management of, 19, 170, 261, 310–311 radiologic findings of, 165, 241–242, 242f, 256–257, 305–306, 305f–308f, 310–311 recurrence or relapse of, 17, 19 surgery for, 13–19, 165–170, 256–261 syndromic vs nonsyndromic, 13, 304 total calvarial reconstruction for, 241–250 turricephaly with, 13, 241, 242f, 249, 256 unilateral, 13, 14f, 165–170, 256, 304–311, 304f–305f lambdoid calvarial reconstruction for, 184–189 deformity with, 184, 184f–185f endoscopic assisted craniectomy for, 190–192 vs nonsynostotic plagiocephaly, 184, 194, 197 posterior plagiocephaly with, 194–202 metopic, 286–290, 296–303 cognitive impairment with, 286 compensatory growth in, 286, 288f, 296 definition of, 286 diagnosis of, 286, 296–297, 297f etiology of, 296, 298 multidisciplinary approach to, 297–298 ophthalmologic exam in, 286, 297–298 postoperative management of, 289–290, 302–303 radiologic findings of, 286, 296–297, 296f–297f, 298, 302, 302f referring pediatrician and, 298 relapse or recurrence of, 290 skull deformity in, 286, 288f, 296–297, 296f–297f multiple suture (pansynostosis), 50–61 clinical signs of, 50 hydrocephalus with, 50, 61 postoperative management of, 57–61 radiologic findings in, 50 “thumbprinting” appearance of, 50, 52f, 53, 54f sagittal, 203–208, 291–295 compensatory growth in, 291, 291f, 292, 295 definition of, 203 diagnosis of, 291 intracranial hypertension with, 291–292 intraoperative photograph of, 206f in males vs females, 203 multidisciplinary approach in, 204 vs positional deformity, 203 postoperative management of, 208, 294–295 radiologic findings of, 203–204, 291 relapse of, 295 skull deformity in, 203, 291, 291f, 295 Craniotomy See also specific procedures and disorders for anterior cranial base encephalocele, 71–72, 71f 14535IDX.indd 317 for brain stem glioma, 277, 277f for coronal synostosis, 167–168, 167f–168f bilateral, 17–18, 18f unilateral, 15–17, 16f for craniopagus twin separation, 212, 212f for exorbitism, 78, 79f for fibrous dysplasia, 3–5, 4f for growing skull fracture, 41, 41f for hypertelorism, 28, 29f, 90–91, 91f–93f for lambdoid synostosis, 186–187, 186f–188f for metopic synostosis, 287, 288f, 299, 299f for orbital dystopia, 90–91, 91f–93f for orbital malposition, 28, 29f for plagiocephaly, 167–168, 167f–168f, 199–201, 200f for posterior fossa decompression, 281, 283f for sagittal synostosis, 204–205, 205f, 293, 293f–294f for telorbitism, 32, 33f Craniovertebral junction abnormalities cerebrospinal fluid leak with, 25 co-morbidity assessment in, 20–21 direction of encroachment in, 20 intradural extension of tumor with, 25 magnetic resonance imaging of, 20, 21f, 26 postoperative management of, 25–26 radiologic findings of, 20 reducible vs irreducible, 20 transoral surgery for, 20–26, 22f cervical traction for, 21–22, 25–26 delayed complications of, 26 dental hygiene and, 20 endotracheal intubation in, 21–22, 25 nasogastric feeding tube in, 24–25, 25f nutritional status and, 20 oral cavity entrance and, 21 oropharyngeal/nasal cultures before, 21 patient positioning for, 21–22 patient selection for, 20 perioperative complications of, 26 preoperative preparation for, 20 procedure for, 21–25 special circumstances in, 24–25 tracheostomy in, 20–21 transpalatal route in, 24–25 C-reactive protein, brain abscess and, 159 Credé maneuver, for ventriculoperitoneal shunting, 105 Crouzon’s syndrome, 13, 76, 81f, 82, 256 Cruciate ligament, in transoral surgery, 24, 24f CT See Computed tomography Currarino’s triad, 251 Cystolipomyelomeningocele, 68f D Dandy, Walter Edward, 227 Dandy-Walker malformation, 104–110 artist’s depiction of, 105f characteristics of, 104 meningocele with, 251 radiologic findings of, 104, 106f shunt for vs reestablishment of patency, 104 ventriculoatrial, 104 ventriculoperitoneal, 104–110 complications of, 109–110 connections of, 107, 108f CSF leakage around, 110 intra-abdominal injury with, 110 operative procedure for, 105–109 patient positioning for, 105, 107f patient selection for, 104 peritoneal catheter placement in, 108–109 positioning of, 106f postoperative management of, 109–110 preoperative preparation for, 104–105 selection of equipment, 104 skin closure in, 109 4/23/08 3:14:08 PM 318 Index Dandy-Walker malformation, (continued) skin incision for, 106, 107f surgical isolation bubble for, 106–107, 107f surgical technique for, 106–109 ventricular catheter placement in, 106–108, 109f Dead space, pansynostosis surgery and, 61 Dental abscess, brain abscess with, 157, 160f Dental guards, in transoral surgery, 22, 25 Dental hygiene, and transoral approach, 20 Depressed skull fractures, in infants, 83–87 conservative approach to, 83 vs in older age groups, 83 “Ping-Pong” appearance of, 83, 84f postoperative management of, 87 surgery for anesthetic considerations in, 83 patient positioning for, 83, 84f patient selection for, 83 periosteal elevator use in, 83, 85f–86f preoperative preparation for, 83 procedure for, 83–85 risks of, 83, 87 skin incision for, 83, 85f Depth perception, orbital malposition and, 27 Dermal sinus tract, with split cord malformation, 126, 127f Dermoid cyst, with split cord malformation, 126, 127f Dermoid tumor, inclusion, with myelomeningocele, 97, 99f, 100 Diastematomyelia, 97, 100f, 116 See also Split cord malformations Diffusion-weighted imaging (DWI), of brain abscess, 159 Dingman mouth retractor, in transoral surgery, 22, 23f–24f Diplomyelia, 116 See also Split cord malformations Diplopia fibrous dysplasia and, orbital malposition and, 27 Distraction osteogenesis, for exorbitism, 81–82, 81f Dorsal rhizotomy, selective, 177–183 cauda equina localization in, 179, 179f complications of, 183 conus medullaris localization in, 177–180, 179f dorsal root identification in, 181 dorsal root sectioning in, 181–183, 182f dorsal root separation in, 180f, 181 electromyography in, 177–178, 178f, 180–183, 182f, 183t indications for, 177t laminectomy in, 177–180, 180f patient positioning for, 178, 178f patient selection for, 177–178 postoperative management of, 183 preoperative preparation for, 178 procedure for, 178–183 skin incision in, 179 standard technique for, 177 ultrasound guidance in, 179, 179f Dystopia, orbital, 88–95, 89f anteroposterior, 27 definition of, 88 postoperative management of, 93–94 radiologic findings of, 88, 88f rotatory, 27 surgery for, 88–95 blood loss in, 89 closure in, 92 complications of, 93–94 craniofacial osteotomies in, 90–91, 91f–93f draping for, 89 flap elevation in, 89–90, 90f patient positioning for, 89 preoperative evaluation for, 88–89 preoperative preparation for, 89 procedure for, 89–95 skin incisions for, 89 vertical, 27 E Electrocardiogram (EKG), in ventriculoatrial shunting, 35, 37–39 14535IDX.indd 318 Electromyography (EMG) in selective dorsal rhizotomy, 177–178, 178f, 180–183, 182f, 183t in split cord malformations, 119, 148 in tethered cord surgery, 263 Encephaloceles basal, 69–75, 70f clinical presentation of, 70 operative procedure for, 71–73 contents of sac, 69 cranial base, 69 cranial base, anterior, 69–75 differential diagnosis of, 70–71 postoperative management of, 73–74 radiologic findings of, 71 surgery for closure in, 72–73 complications of, 73–74 craniotomy in, 71–72, 71f extradural approach in, 71–73, 72f–73f intradural approach in, 71, 73, 75f isolation, ligation, and transection in, 72, 73f–74f outcome of, 74 patient positioning for, 71, 71f preoperative preparation for, 70–71 procedure for, 71–73 skin incision in, 71, 71f transcranial approach in, 71 transnasal approach in, 71 transnasal removal in, 72, 75f cranial vault, 69 definition of, 69 derivation of term, 69 frontoethmoidal, 69–75, 70f clinical presentation of, 70 operative procedure for, 71––73 types of, 69 nasoethmoidal, 69, 70f nasofrontal, 69, 70f naso-orbital, 69, 70f occipital, 43–49, 69 location of, 43 postoperative management of, 48–49 size range of, 43 skin coverage of, 43 surgery for anesthetic technique for, 43 complications of, 48–49 draping in, 44 dural/periosteal closure in, 45–46, 47f forceps use in, 44, 45f neural tissue management in, 44–45, 46f orbit protection in, 43, 44f patient positioning for, 43, 44f patient selection for, 43 preoperative preparation for, 43 procedure for, 43–48 scissor use in, 44, 45f skin closure in, 46–47, 48f–49f timing of, 43 sphenoethmoidal, 69 sphenomaxillary, 69 spheno-orbital, 69 sphenopharyngeal, 69 terminology describing, 69 transethmoidal, 69 Encephaloduroarteriosynangiosis (EDAS), 171 Encephalomalacia, with growing skull fracture, 40–41 Endocarditis, brain abscess with, 157 Endoscopic-assisted craniectomy, for lambdoid synostosis, 190–192 closure in, 191–192 complications of, 192 helmet use after, 192, 192f metallic markers for, 190, 190f 4/23/08 3:14:09 PM Index 319 operative technique for, 191–192, 191f–192f outcome of, 193f patient positioning for, 190, 190f patient selection for, 190 postoperative management of, 192 preoperative preparation for, 190 procedure for, 190–192 skin incision for, 190–191, 191f Endoscopic third ventriculostomy, 230, 230f, 232 Endoscopy, ventricular, 227–232 for adherent catheters, 231, 237, 238f anesthesia for, 216, 229 approaches in, 215–226 to anterior third ventricle, 217–218, 219f–220f to foramen of Monro, 217, 217f–218f to frontal horn, 222–223, 222f–223f to occipital horn, 223–224, 224f–225f to posterior fossa, 224–225, 225f to posterior third ventricle, 218–220, 220f–221f to temporal horn, 223, 223f–224f for biopsy and treatment of tumors, 231–232 bleeding in, 225 for colloid cyst, 217, 218f, 222–223, 231–232, 231f complications of, 225–226, 232 corporate interest in, 215 CSF analysis in, 216–217 flexible, 216, 227–229, 228f general principles of, 216–217 history of, 227 for hydrocephalus, 215, 230–231, 230f imaging studies for, 215, 230 instrumentation for, 215, 227–229, 228f–229f irrigation for, 215–216, 229 lasers used in, 223, 229 learning curve for, 225 patient positioning for, 217, 222f, 223, 224f, 229 pneumatic systems in, 216, 217f postoperative management in, 225–226, 232 preoperative preparation for, 215–216, 229 procedure for, 216–225, 229–232 rigid, 216, 227–229, 228f for shunt infection, 237–238, 238f, 240 skin incision for, 216, 229 for suprachiasmatic cyst, 217, 217f, 218, 220f surgeon disorientation in, 232 surgical suite organization for, 215 training for, 215, 225, 232 Enophthalmos, orbital malposition and, 27, 32 Enterococcus, and shunt infection, 235, 235t Epidermoid tumor, inclusion, with myelomeningocele, 97, 99f, 100 Erythrocyte sedimentation rate (ESR), brain abscess and, 159 Escherichia coli, and shunt infection, 235t Exophthalmos See Proptosis Exorbitism postoperative management of, 81–82 radiologic findings of, 77 surgical correction of, 32, 76–82 blood loss in, 77, 81 calvarial bone graft for, 76, 78, 80f closure in, 80–81 complications of, 81 craniofacial osteotomies in, 78, 79f distraction osteogenesis with, 81–82, 81f draping for, 77 flap elevation in, 77–78 fronto-orbital advancement for, 76 midface advancement for, 76 monoblock advancement for, 76 patient positioning for, 77 patient selection for, 76–77 preoperative evaluation for, 76–77 preoperative preparation for, 77 procedure for, 77–81 results of, 81, 81f 14535IDX.indd 319 rib graft for, 78, 80f skin incisions in, 77–78 views of patient with, 76f External ventricular drain (EVD), in shunt infection, 235–238, 236f–237f, 240 Extraocular muscles, orbital malposition and, 27, 32 Eyeballs, displacement of See Exorbitism; Proptosis Eyelid swelling with coronal synostosis surgery, 19 with sagittal synostosis surgery, 294 F Facial vein, common, open access for ventriculoatrial shunt, 36–37, 37f False aneurysm, postoperative, in craniovertebral junction abnormalities, 26 FBN mutations, 256 FGFR mutations, 256, 261 Fibrous dysplasia, of craniofacial complex, 1–6 clinical presentation of, 1, 1f monostotic, pathology of, polyostotic, postoperative management of, radiologic findings of, 1–2 surgery for blood loss in, calvarial bone graft in, 1–2, 5, 5f–6f closure in, complications of, craniofacial reconstruction in, 5, 5f–6f craniotomy in, 3–5, 4f draping in, dysplastic bone removal in, 1, 3–4, 4f dysplastic bone reuse in, flap elevation in, frontal sinus repair in, 5–6 helpful hints for, 4–5 implant avoidance in, optic nerve decompression in, patient evaluation for, patient positioning for, 2–3, 2f pericranial tissue repair in, 5–6 preoperative preparation for, principles of, procedure for, 2–6 skin incision in, temporalis muscle in, 3, visual testing in, “worst case scenario,” Filum terminale dysgenesis of, 262, 267–268 sectioning of, 136–141, 254f, 255, 267–268 anatomy in, 267 anesthetic considerations in, 137 bipolar coagulation in, 138–141, 140f closure in, 140f, 141, 267–268 complications of, 141 dural opening in, 138, 139f laminectomy in, 138, 138f patient positioning for, 137, 137f patient selection for, 136–137 pearls and pitfalls in, 268 postoperative management of, 141, 268 preoperative preparation for, 137 procedure for, 137–141, 267–268 prognosis in, 141 skin incision for, 138, 138f, 267, 268f technique of, 138–141, 138f–140f thickened with meningocele, 251, 254f with myelomeningocele, 97, 98f, 100f with split cord malformations, 122f, 125 with tethered spinal cord, 62–63, 64f, 136–141, 262, 267–268 4/23/08 3:14:09 PM 320 Index Flat capillary hemangioma, with tethered spinal cord, 62 Flexible endoscopes, 216, 227–229, 228f Fluoroscopy, intraoperative, in ventriculoatrial shunting, 35–39 Folate, and neural tube defects, 251 Foramen of Monro, endoscopic approach to, 217, 217f–218f Forceps, endoscopic, 215, 229, 229f FRFR mutations, 256 Frontal horn, endoscopic approach to, 222–223, 222f–223f Frontal sinus repair, in fibrous dysplasia, 5–6 Frontoethmoidal encephaloceles, 69–75, 70f clinical presentation of, 70 operative procedure for, 71–73 types of, 69 Fronto-orbital advancement for coronal synostosis, 241–250, 256–261 for exorbitism, 76 for total calvarial reconstruction, 241–250, 243f Fungal infection brain abscess with, 158 shunt infection with, 235, 235t “Funnel-like” appearance, of distal conus, 62 Furstenberg test, 70 G Ganglioglioma, 276 Gentamicin, for shunt infection, 235t Glioma(s) brain stem clinical presentation of, 276 displacement by, 275, 275f exophytic, 275–276, 279 focal, 275–276, 278–279 laboratory workup for, 276 magnetic resonance imaging of, 275–276 postoperative management of, 280 prognosis of, 275 surgical treatment of, 275–280 anesthesia for, 276 cerebellar vermis splitting in, 278, 279f closure in, 279–280 complications of, 280 craniotomy for, 277, 277f dural opening in, 277, 278f–279f hemodynamic monitoring in, 276 laser use in, 278 magnification in, 278 neurophysiological monitoring in, 279 patient positioning for, 276, 277f patient selection for, 275–276 preoperative preparation for, 276 procedure for, 276–280 skin incision for, 277, 277f tumor exposure in, 278, 279f tumor resection in, 278–279, 280f nasal, vs encephalocele, 70–71 Glomerulonephritis, immune complex, ventriculoatrial shunt and, 34, 39 Glossopharyngeal nerve, craniovertebral junction abnormalities and, 20 Grasping forceps, endoscopic, 215, 229, 229f “Ground glass” appearance, of fibrous dysplasia, Growing skull fracture, 40–42 clinical presentation of, 40 common sites for, 40 incidence of, 40 postoperative management of, 42 radiological studies of, 40–41 risk factors for, 40 surgery for bipolar cautery in, 41, 42f complications of, 42 dural closure in, 41–42, 42f goal of, 41 indications for, 41 14535IDX.indd 320 procedure for, 41–42, 41f–42f venous sinuses in, 42 H Haemophilus influenzae, and shunt infection, 235t Hard palate, in transoral surgery, 22–26, 23f–24f “Harlequin eyes,” 53, 166f Headache brain abscess and, 158 Chiari I malformation and, 111 fibrous dysplasia and, moyamoya syndrome and, 171 tethered cord surgery and, 135 Height reduction, for total calvarial reconstruction, 243f, 246, 248f Helmet use for coronal synostosis, 257 for lambdoid synostosis, 192, 192f, 197 for posterior plagiocephaly, 197 for sagittal synostosis, 292 Hemangioma, flat capillary, with tethered spinal cord, 62 Hemimyelocele, split cord malformations with, 126 Hemimyelomeningocele, 97, 100f Hiccups, postoperative, in Chiari malformations, 9, 12 Hindbrain hernias See Chiari malformations Hoarseness, postoperative, in craniovertebral junction abnormalities, 26 Hopkins, Harold H., 227 Hourglass deformity fibrous dysplasia and, telorbitism and, 32 Hydrocephalus with Chiari I malformation, 7, 111 with coronal synostosis, 256–257 with craniopagus twin separation, 213–214 with Dandy-Walker malformation, 104–110 with growing skull fracture, 40–42 with lipomyelomeningocele, 64 with myelomeningocele, 102 with occipital encephaloceles, 43 with pansynostosis, 50, 61 ventricular endoscopy for, 215, 230–231, 230f ventriculoatrial shunt for, 34–39 ventriculoperitoneal shunt for, 34, 104–110 Hygroma, subdural, ventriculoatrial shunt for, 34 Hypercanthorum, 27–32 postoperative management of, 32 surgery for calvarial bone graft for, 28, 31f complications of, 32 patient positioning for, 27 patient selection for, 27 preoperative preparation for, 27 procedure for, 27–32, 29f–31f risks of, 27 timing of, 27 Hypertelorism (telorbitism), 27–28, 88–95, 89f clinical case of, 94–95, 94f definition of, 88 postoperative management of, 32, 93–94 radiologic findings of, 88, 88f, 94f, 95 surgery for, 27–28, 88–95 blood loss in, 89 closure in, 92 complications of, 32, 93–94 craniofacial osteotomies in, 28, 29f, 90–91, 91f–93f draping for, 27, 89 flap elevation in, 89–90, 90f patient positioning for, 27, 32, 89 patient selection for, 27 preoperative evaluation for, 88–89 preoperative preparation for, 27, 89 procedure for, 27–28, 32, 33f, 89–95 results of, 94–95, 94f risks of, 27 skin incisions for, 28, 89 4/23/08 3:14:09 PM Index 321 timing of, 27 Hypertension, intracranial See Intracranial pressure Hypertension, pulmonary, ventriculoatrial shunt and, 34 Hypertensive hydrocephalus, with Chiari I malformation, Hypoglossal nerve, craniovertebral junction abnormalities and, 20, 26 Hypotelorism, with metopic synostosis, 286–288, 298–302, 301f Hypothalamus injury, in endoscopy, 226 Hypothermia, 257 I Immune complex glomerulonephritis, ventriculoatrial shunt and, 34, 39 Inclusion dermoid tumor, with myelomeningocele, 97, 99f, 100 Incontinence, tethered spinal cord and, 62, 136–137 Infected shunt, 233–240 Infection, postoperative in coronal synostosis, 19, 170, 249, 261, 311 in craniovertebral junction abnormalities, 26 in fibrous dysplasia, in filum terminale sectioning, 141 in lipomyelomeningocele, 274 in lumbosacral meningocele, 255 in metopic synostosis, 290 in orbital malposition, 32 in pansynostosis, 57–61 in plagiocephaly, 170 in sagittal synostosis, 295 in tethered spinal cord, 265 in ventricular endoscopy, 226 in ventriculoatrial shunting, 34, 39 in ventriculoperitoneal shunting, 109–110 Internal carotid arteries, in moyamoya syndrome, 171 Internal jugular vein, percutaneous access for ventriculoatrial shunt, 36, 36f Intracranial hemorrhage orbital malposition and, 32 ventriculoatrial shunt and, 34 Intracranial pressure brain abscess and, 158 coronal synostosis and, 13 craniopagus twin separation and, 213 growing skull fracture and, 40 metopic synostosis and, 286 orbital malposition and, 32 pansynostosis and, 50–51, 61 sagittal synostosis and, 291–292 total calvarial reconstruction and, 247 ventricular endoscopy and, 226 ventriculoatrial shunt and, 34 Intramedullary spinal lipomas, 62, 64 operative procedure for, 64 surgical candidates for, 64 Isolation bubble, surgical, 106–107, 107f J Jugular vein, internal, percutaneous access for ventriculoatrial shunt, 36, 36f Juvenile pilocytic astrocytoma, 276 K Klebsiella, and shunt infection, 235t Kleeblattschädel, 241 Klippel-Feil syndrome, 251 KTP laser, in endoscopy, 223, 229 L Lambdoid synostosis calvarial reconstruction for, 184–189 blood loss in, 185 complications of, 189 craniotomy in, 186–187, 186f–188f operating room setup for, 185 patient positioning for, 185, 185f patient selection for, 184–185 14535IDX.indd 321 postoperative management of, 189 preoperative preparation for, 185, 185f procedure for, 186–188 skin incision for, 186 “sunrise” appearance in, 186, 188f tiara in, 187, 187f–188f deformity with, 184, 184f–185f endoscopic-assisted craniectomy for, 190–192 closure in, 191–192 complications of, 192 metallic markers for, 190, 190f operative technique for, 191–192, 191f–192f outcome of, 193f patient positioning for, 190, 190f patient selection for, 190 postoperative management of, 192 preoperative preparation for, 190 procedure for, 190–192 skin incision for, 190–191, 191f helmet use in, 192, 192f, 197 incidence of, 194–195 intraoperative photographs of, 201, 201f vs nonsynostotic plagiocephaly, 184, 194, 197 posterior plagiocephaly with, 194–202 diagnostic criteria for, 194 features and diagnosis of, 194t morphology of, 194, 195f–196f postoperative management of, 201–202 surgical management of, 194–202 alternatives to, 197 blood loss in, 197–198, 201 complications of, 201–202 contraindications to, 197 craniotomy in, 199–201, 200f draping in, 198 eye protection in, 198, 198f indications for, 197 patient positioning for, 198, 198f patient selection for, 194–195 preoperative preparation for, 197–198 procedure for, 198–201 skin flap in, 198–199, 199f skin incision in, 198, 199f technique in, 198–201 radiologic findings of, 190, 194, 196f–197f, 201 Laminectomy for Chiari I malformation, 112, 115 for filum terminale sectioning, 138, 138f for lipomyelomeningocele, 148 for lumbosacral meningocele, 254, 254f for posterior fossa decompression, 281, 283f in selective dorsal rhizotomy, 177–180, 180f for split cord malformations, 119–120, 120f, 122, 143, 144f for tethered spinal cord, 132f, 138, 138f Lasers for brain stem glioma, 278 for endoscopy, 223, 229 for lipomyelomeningocele, 149, 150f for tethered spinal cord, 153, 264 Latex precautions, 129, 152 Leptomeningeal cyst, 40 See also Growing skull fracture Lespinasse, Victor Darwin, 227 Lingual swelling, postoperative, in craniovertebral junction abnormalities, 26 Lipomas See also Lipomyelomeningocele dorsal, 148 intramedullary spinal, 62, 64 operative procedure for, 64 surgical candidates for, 64 terminal, 148 transitional, 151 Lipomyelomeningocele(s), 62, 64–68, 147–151, 269–274 anatomical variations of, 68, 270–272 caudal, 64, 270–272, 273f clinical presentation of, 64, 147, 269 4/23/08 3:14:09 PM 322 Index Lipomyelomeningocele(s), (continued) definition of, 147 diagnosis of, 269–270, 270f dorsal, 64, 148, 270–271, 271f–272f multidisciplinary approach to, 270 natural history of, 65 postoperative management of, 151, 273–274 radiologic findings of, 64–65, 147, 269–270 surgery for, 269–274 anesthesia considerations in, 147 blood loss in, 270, 274 closure in, 151, 272–273 complications of, 151, 273–274 conservative approach in, 149, 150f dorsal roots in, 66–67, 66f dural closure in, 67, 67f dura-lipoma complex in, 66–67, 66f exposure in, 65–66, 65f, 147–148 laminectomy in, 148 laser use in, 149, 150f long-term results of, 67–68 neural tube reconstitution in, 66, 67f patient positioning for, 147, 270 patient selection for, 64–65, 269–270 preoperative preparation for, 65, 147, 270 procedure for, 65–67, 65f–67f, 147–151, 270–273 skin incision in, 65, 65f, 147, 148f, 270 specialized instrumentation for, 273 technique of, 147–151, 148f–149f, 151f timing of, 65, 147, 269–270 syringohydromyelia with, 64, 66, 68f terminal, 148 tethered cord with, 64, 269 transitional, 151, 270, 272, 273f Longus capitis muscle, in transoral surgery, 24 Longus colli muscles, in transoral surgery, 22, 23f–24f, 24 Lumbar puncture, in brain abscess, 159 Lumbosacral meningoceles postoperative management of, 255 surgical repair of, 251–255 anesthesia for, 252 approach in, 253–255 closure in, 255, 255f complications of, 255 draping in, 253 filum terminale sectioning in, 254f, 255 follow-up of, 255 goals of, 251 instrumentation for, 252 laminectomy in, 254, 254f patient positioning for, 253, 253f patient selection for, 251–252 preoperative preparation for, 252 procedure for, 252–255 skin incision in, 253–254, 253f Lung disease, brain abscess with, 157–158 M Magnetic resonance angiography of craniopagus twins, 209, 211f of craniovertebral junction abnormalities, 20, 21f, 26 of moyamoya syndrome, 171, 175–176, 176f Magnetic resonance imaging of anterior cranial base encephalocele, 71 of brain abscess, 159, 160f of brain stem gliomas, 275–276 of Chiari II malformation, 10, 12 of Chiari I malformation, 7, 9, 111, 114, 114f, 285 of coronal synostosis, 311 of craniopagus twins, 209, 210f, 213 of craniovertebral junction abnormalities, 20, 26 of Dandy-Walker malformation, 104, 106f of filum dysgenesis, 267 of growing skull fracture, 40–41 of lipomyelomeningocele, 64–65, 147, 269–270 14535IDX.indd 322 of meningocele, 252 of metopic synostosis, 298 of moyamoya syndrome, 171, 175–176 of myelomeningocele, 102, 103f of occipital encephaloceles, 43 of pansynostosis, 50, 61 of spastic cerebral palsy, 177 of split cord malformations, 119, 142 of syringomyelia, 111, 114, 114f of tethered spinal cord, 62–63, 129, 130f, 136–137, 136f, 141, 152–153, 262–263, 267 in ventricular endoscopy, 215, 230 Magnetic resonance venography, of craniopagus twins, 209, 211f Marchac forehead templates, 57, 167, 168f, 186 Mastoiditis, brain abscess with, 157–158, 158f Meningitis brain abscess with, 157–158 postoperative in colloid cyst removal, 232 in craniovertebral junction abnormalities, 26 in hypertelorism, 93 in orbital dystopia, 93 in orbital malposition, 32 with posterior fossa decompression, 285 Meningocele(s) cervical, 251 definition of, 251 diagnosis of, 251–252 embryopathy of, 251 lumbosacral postoperative management of, 255 surgical repair of, 251–255 anesthesia for, 252 approach in, 253–255 closure in, 255, 255f complications of, 255 draping in, 253 filum terminale sectioning in, 254f, 255 follow-up of, 255 goals of, 251 instrumentation for, 252 laminectomy in, 254, 254f patient positioning for, 253, 253f patient selection for, 251–252 preoperative preparation for, 252 procedure for, 252–255 skin incision in, 253–254, 253f postnatal evaluation and care of, 252 prenatal evaluation and care of, 251–252 prognosis of, 251 radiographic findings of, 251–252 thoracic, 251 ventral sacral, 251 Methylene blue markings in coronal synostosis, 259 in pansynostosis, 53, 56f Metopic synostosis, 286–290, 296–303 cognitive impairment with, 286 compensatory growth in, 286, 288f, 296 definition of, 286 diagnosis of, 286, 296–297, 297f etiology of, 296, 298 multidisciplinary approach to, 297–298 ophthalmologic exam in, 286, 297–298 postoperative management of, 289–290, 302–303 radiologic findings of, 286, 296–297, 296f–297f, 298, 302, 302f referring pediatrician and, 298 relapse or recurrence of, 290 skull deformity in, 286, 288f, 296–297, 296f–297f surgery for blood loss in, 290, 298, 303 closure in, 288–289 complications of, 289–290, 302–303 craniofacial reconstruction in, 287–288, 288f, 299–302, 301f–303f 4/23/08 3:14:10 PM Index 323 craniotomy in, 287, 288f, 299, 299f dural opening in, 299 flap elevation in, 287 indications for, 286 osteotomies in, 287, 288f, 299, 300f outcome of, 303 patient positioning for, 287 patient selection for, 286–287, 296–297 plate-and-screw fixation in, 288–289, 298–302 preoperative preparation for, 287, 297–299 procedure for, 287–289, 299–302 skin incision in, 287, 299 specialized instrumentation for, 289 timing of, 286–287, 298 Metronidazole, for shunt infection, 235t Microcephaly, pansynostosis with, 50 Middle cerebral artery, in craniopagus twins, 209, 211f, 212 Minimally invasive neurosurgery, 227 See also Endoscopy, ventricular Miniplates for exorbitism, 78 for fibrous dysplasia, 5, 6f for lambdoid synostosis, 187f, 201–202 for pansynostosis, 61 for plagiocephaly, 167–168, 167f, 169f, 170, 201–202 for sagittal synostosis, 293 Monro, foramen of, endoscopic approach to, 217, 217f–218f Moyamoya syndrome, 171–176 angiographic appearance of, 171 clinical presentation of, 171 congenital syndromes associated with, 171 definition of, 171 incidence of, 171 medical treatment of, 171 origin of term, 171 pial synangiosis for, 171–176 advantages of, 171 anesthesia in, 172 arachnoid opening in, 174, 174f–175f closure in, 175 complications of, 175 dural opening in, 173–174, 174f follow-up of, 175–176, 176f patient positioning for, 172–173, 172f patient selection for, 171 postoperative management of, 175–176 preoperative preparation for, 171–172 procedure of, 172–175, 173f–175f skin incision in, 173 radiologic findings of, 171–172, 175–176, 176f MRA See Magnetic resonance angiography MRI See Magnetic resonance imaging MSX mutations, 256 Mucocele, postoperative, 93 Mycobacterium tuberculosis, and brain abscess, 158 Myelomeningocele(s) Chiari II malformations with, 7, 10–12 coexisting anomalies with, 96 hydrocephalus with, 102 inclusion dermoid tumor with, 97, 99f, 100 placode protection in, 96 postoperative management of, 103 closure site care, 103 patient care, 103 prenatal diagnosis of, 96 size of sac, 97 split cord malformations with, 97, 100f, 116, 123f, 124, 126 surgical closure of, 96–103 anatomical reconstruction in, 97–102, 102f–103f dural closure in, 101f, 102 goals of, 96 missed abnormalities in, 97 patient selection for, 96 preoperative preparation for, 96 preservation of neural tissue in, 97 14535IDX.indd 323 preservation of neurologic function in, 96–97 preservation of vascular supply in, 97, 98f procedure for, 97–102 separation of normal from abnormal skin in, 97, 99f skin closure in, 102 timing of, 96 tethered spinal cord with repair of, 97, 100, 102f, 129–135, 152–156, 262–265 postoperative management of, 135, 153–156, 264 shunt evaluation in, 152–154 surgery for, 263–265 anatomy in, 263 anesthesia for, 129 arachnoid opening in, 132f, 133–134, 133f closure in, 134–135, 134f, 153, 155f, 264 complications of, 135, 153–156, 264–265 draping for, 130 dural opening in, 132f, 133, 152, 154f exposure in, 130–134 goal of, 129 laminectomy in, 132f laser use in, 153, 264 microinstruments for, 152–153, 154f nerve roots in, 133, 133f operating room setup for, 129–130 patient positioning for, 129–130, 131f, 152 patient selection for, 129, 152 pearls and pitfalls in, 265 placode dissection in, 152–153, 154f–155f precautions in, 129 preoperative preparation for, 129 principle of, 129 procedure for, 129–135, 152–153 skin incision in, 130, 131f, 152, 153f, 264 timing of, 152 thickened filum terminale with, 97, 98f, 100f thoracolumbar, 101f, 102 types of, 97 unrepaired, natural history of, 96 N Nafcillin, for shunt infection, 235t Nasal glioma, vs encephalocele, 70–71 Nasal profile, in hypercanthorum, 28–32, 29f–31f Nasoethmoidal encephaloceles, 69, 70f Nasofrontal encephaloceles, 69, 70f Nasogastric feeding tube, in transoral surgery, 24–25, 25f Naso-orbital encephaloceles, 69, 70f Nausea brain abscess and, 158 postoperative, in Chiari malformations, 9, 12 Nd:YAG laser for brain stem glioma, 278 in endoscopy, 223, 229 Needle aspiration, of brain abscess, 159–161, 161f, 163f Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for brain stem glioma, 278 in endoscopy, 223, 229 Neural tube defects, 7, 10–12, 96–103 See also Lipomyelomeningocele(s); Meningocele(s); Myelomeningocele(s) Neural tube reconstruction, 66, 67f, 97–102, 102f–103f Neurofibromatosis type 1, 251 Neurogenic bladder, tethered spinal cord and, 62 Nocardia, and brain abscess, 158, 161 Nutritional status, and transoral approach, 20 O Occipital advancement, for total calvarial reconstruction, 241–250, 243f Occipital encephaloceles, 43–49, 69 location of, 43 postoperative management of, 48–49 size range of, 43 skin coverage of, 43 4/23/08 3:14:10 PM 324 Index Occipital encephaloceles, (continued) surgery for anesthetic technique for, 43 complications of, 48–49 draping in, 44 dural/periosteal closure in, 45–46, 47f forceps use in, 44, 45f neural tissue management in, 44–45, 46f orbit protection in, 43, 44f patient positioning for, 43, 44f patient selection for, 43 preoperative preparation for, 43 procedure for, 43–48 scissor use in, 44, 45f skin closure in, 46–47, 48f–49f timing of, 43 Occipital horn, endoscopic approach to, 223–224, 224f–225f Occipital ligaments, in transoral surgery, 22 Occult spinal dysraphism, 62, 64 Odontoid process, in transoral surgery, 23f–24f, 24 Omental transposition and transplantation, 171 Optic nerve fibrous dysplasia and, orbital malposition and, 27, 32 Orbital dystopia, 88–95, 89f anteroposterior, 27 definition of, 88 postoperative management of, 93–94 radiologic findings of, 88, 88f rotatory, 27 surgery for, 88–95 blood loss in, 89 closure in, 92 complications of, 93–94 craniofacial osteotomies in, 90–91, 91f–93f draping for, 89 flap elevation in, 89–90, 90f patient positioning for, 89 preoperative evaluation for, 88–89 preoperative preparation for, 89 procedure for, 89–95 skin incisions for, 89 vertical, 27 Orbital malposition, 27–33 See also Hypercanthorum; Hypertelorism; Hypotelorism postoperative management of, 32 recurrence of, 27, 32 surgery for anesthesia for, 27 calvarial bone graft for, 28, 31f complications of, 32 costochondral bone graft for, 28, 31f goal of, 27 patient positioning for, 27, 32 patient selection for, 27 preoperative preparation for, 27 procedure for, 27–32, 29f–31f, 33f risks of, 27 timing of, 27 types of, 27 Orbital nerve, in fibrous dysplasia, Orbital reconstruction in coronal synostosis, 15–18, 16f–17f, 244–246, 246f, 306–310 in metopic synostosis, 287–288, 288f, 299–302, 301f–303f Osteomyelitis brain abscess with, 157 postoperative in coronal synostosis, 19, 170, 261 in craniovertebral junction abnormalities, 26 in fibrous dysplasia, in metopic synostosis, 290 in orbital malposition, 32 in plagiocephaly, 170 14535IDX.indd 324 Otitis media, brain abscess with, 157–158, 158f P Palatal dehiscence, 26 Palate, in transoral surgery, 22–26, 23f–24f Pansynostosis, 50–61 clinical signs of, 50 hydrocephalus with, 50, 61 postoperative management of, 57–61 radiologic findings in, 50 surgery for anesthetic considerations in, 51 bioethics review for, 50 blood loss/hemorrhage in, 50–51, 57 cerebrospinal fluid leaks in, 53, 61 closure in, 57 complications of, 57–61 craniofacial reconstruction in, 52f, 53–57, 54f–56f, 58f–60f dead space in, 61 draping in, 51 dressing in, 57 infection in, 57–61 methylene blue markings in, 53, 56f miniplate fixation in, 61 monitoring in, 51 operating room setup in, 51, 60f patient positioning for, 51, 52f, 53, 60f, 61 patient selection for, 50 preoperative preparation for, 50–51 procedure for, 51–57 risks of, 50 skin incision in, 51–53 specialized instrumentation in, 57 technique for, 53–57 timing of, 50 “thumbprinting” appearance of, 50, 52f, 53, 54f Papilledema, with brain abscess, 158 Pericranial tissue repair, in fibrous dysplasia, 5–6 Pfeiffer syndrome, 256 Pharyngeal dehiscence, 26 Pharynx, in transoral surgery, 22–26, 23f–24f Phonation, Chiari II malformation and, 10 Pial synangiosis, 171–176 advantages of, 171 anesthesia in, 172 arachnoid opening in, 174, 174f–175f closure in, 175 complications of, 175 dural opening in, 173–174, 174f follow-up of, 175–176, 176f patient positioning for, 172–173, 172f patient selection for, 171 postoperative management of, 175–176 preoperative preparation for, 171–172 procedure of, 172–175, 173f–175f skin incision in, 173 “Ping-pong” fractures, 83, 84f Plagiocephaly, 165–170 artist’s rendering of, 166f nonsynostotic, 184, 194, 197 posterior computed tomography of, 194, 196f–197f, 201 diagnostic criteria for, 194 features and diagnosis of, 194t incidence of, 194–195 morphology of, 194, 195f–196f postoperative management of, 201–202 surgical management of, 194–202 alternatives to, 197 blood loss in, 197–198, 201 complications of, 201–202 contraindications to, 197 craniotomy in, 199–201, 200f draping in, 198 eye protection in, 198, 198f 4/23/08 3:14:10 PM Index 325 indications for, 197 patient positioning for, 198, 198f patient selection for, 194–195 preoperative preparation for, 197–198 procedure for, 198–201 skin flap in, 198–199, 199f skin incision in, 198, 199f technique in, 198–201 postoperative management of, 170 surgery for blood loss in, 166, 170 closure in, 168–170 complications of, 170 craniofacial reconstruction in, 167–168, 167f–169f craniotomy in, 167–168, 167f–168f flap elevation in, 166–167 patient positioning for, 166 patient selection for, 165 preoperative preparation for, 165–166 procedure for, 166–170 radiologic findings of, 165 skin incision in, 166–167 specialized instrumentation in, 170 timing of, 165 Plain films See X-rays Plate fixation in coronal synostosis, 17, 17f, 19, 167–168, 167f, 169f, 170, 261, 308–310 in craniopagus twin separation, 212, 213f in exorbitism, 78 in fibrous dysplasia, 5, 6f in hypertelorism, 91 in lambdoid synostosis, 187f, 201–202 in metopic synostosis, 288–289, 298–302 in orbital dystopia, 91 in pansynostosis, 61 in plagiocephaly, 167–168, 167f, 169f, 170, 201–202 in sagittal synostosis, 293 Pneumatic systems, for endoscopy, 216, 217f Posterior fossa, endoscopic approach to, 224–225, 225f Posterior fossa decompression, without duraplasty, 281–285 closure in, 282–285 complications of, 285 contraindications to, 281 craniotomy in, 281, 283f dural band incision in, 281–282, 283f follow-up care in, 285 intraoperative ultrasound in, 281–282, 284f, 285 patient positioning for, 281 patient selection for, 281 postoperative management of, 285 preoperative preparation for, 281 procedure for, 281–285 skin incision in, 281 special equipment for, 281 surgical suite setup for, 281, 282f tonsillar pistoning in, 282, 284f Potassium-titanyl-phosphate laser, in endoscopy, 223, 229 Premature infant, shunt infection in, 233 Propionibacterium acnes, and shunt infection, 235, 235t Proptosis See also Exorbitism fibrous dysplasia and, 1, 1f, Proteus and brain abscess, 158 and shunt infection, 235, 235t Pseudocyst, with shunt infection, 234, 239f Pseudomonas, and shunt infection, 235, 235t Pseudotumor cerebri, ventriculoatrial shunt for, 34 Ptosis, coronal synostosis and, 13 Pudendal nerve monitoring, with split cord malformations, 148 Pulmonary disease, brain abscess with, 157–158 Pulmonary hypertension, ventriculoatrial shunt and, 34, 39 R Radiology See specific modalities 14535IDX.indd 325 Rectal incontinence, tethered spinal cord and, 62 Rectal sphincter electromyography, with split cord malformations, 148 Rendu-Osler-Weber syndrome, brain abscess with, 157 Retropharyngeal abscess, 26 Rhizotomy, selective dorsal, 177–183 cauda equina localization in, 179, 179f complications of, 183 conus medullaris localization in, 177–180, 179f dorsal root identification in, 181 dorsal root sectioning in, 181–183, 182f dorsal root separation in, 180f, 181 electromyography in, 177–178, 178f, 180–183, 182f, 183t indications for, 177t laminectomy in, 177–180, 180f patient positioning for, 178, 178f patient selection for, 177–178 postoperative management of, 183 preoperative preparation for, 178 procedure for, 178–183 skin incision in, 179 standard technique for, 177 ultrasound guidance in, 179, 179f Rib grafts for exorbitism, 78, 80f for fibrous dysplasia, for hypercanthorum, 28, 31f Rifampin, for shunt infection, 235t Rigid endoscopes, 216, 227–229, 228f Rotatory dystopia, 27 S Saethre-Chotzen syndrome, 256 Sagittal sinus common, in craniopagus twins, 209, 210f–212f, 212–214 in coronal synostosis, 19 in growing skull fracture, 42 in metopic synostosis, 290 Sagittal synostosis, 203–208, 291–295 compensatory growth in, 291, 291f, 292, 295 definition of, 203 diagnosis of, 291 intracranial hypertension with, 291–292 intraoperative photograph of, 206f in males vs females, 203 multidisciplinary approach in, 204 vs positional deformity, 203 postoperative management of, 208, 294–295 radiologic findings of, 203–204, 291 relapse of, 295 skull deformity in, 203, 291, 291f, 295 surgery for, 204–208, 291–295 anesthesia for, 204 blood loss in, 204, 206, 208, 292, 294–295 bone plate recontouring in, 206, 207f closure in, 293–294 complications of, 208, 294–295 craniofacial reconstruction in, 204–208, 207f, 293, 293f– 294f craniotomy in, 204–205, 205f, 293, 293f–294f draping for, 204 flap elevation in, 293 indications for, 292 outcome of, 207f, 208 patient positioning for, 204, 204f, 292–293 patient selection for, 203, 291–292 preoperative preparation for, 204, 292 procedure for, 204–208, 292–294 skin incision for, 204, 204f, 293 surgical setup for, 292–293 timing of, 203, 292 Scaphocephaly, 203, 206f Scimitar sign, 251 Scintigraphy, of brain abscess, 159 4/23/08 3:14:11 PM 326 Index Scissors, endoscopic, 215, 229 SCMs See Split cord malformations Scoliosis Chiari I malformation and, split cord malformations and, 142, 146 tethered spinal cord and, 136, 262 Screw fixation in craniopagus twin separation, 212, 213f in craniosynostosis, 16–17, 16f–17f, 19, 167–170, 201–202, 288–289 SDR See Selective dorsal rhizotomy Seizures brain abscess and, 158–159 growing skull fracture and, 41 moyamoya syndrome and, 171 occipital encephaloceles and, 43 pansynostosis and, 50 shunt infection and, 233 Selective dorsal rhizotomy (SDR), 177–183 cauda equina localization in, 179, 179f complications of, 183 conus medullaris localization in, 177–180, 179f dorsal root identification in, 181 dorsal root sectioning in, 181–183, 182f dorsal root separation in, 180f, 181 electromyography in, 177–178, 178f, 180–183, 182f, 183t indications for, 177t laminectomy in, 177–180, 180f patient positioning for, 178, 178f patient selection for, 177–178 postoperative management of, 183 preoperative preparation for, 178 procedure for, 178–183 skin incision in, 179 standard technique for, 177 ultrasound guidance in, 179, 179f Septum pellucidum, endoscopic approach to, 217, 221f, 231 Shunt See also specific types adherent catheters in, endoscopy for, 231 infected, surgical management of, 233–240 nonfunctioning, vs tethered cord, 152–154 syringoperitoneal, 112, 113f, 114–115 syringosubarachnoid, 112, 113f ventriculoatrial, 34–39 ventriculoperitoneal, 34, 104–110, 152, 213–214, 233–240 Shunt tap, 234–235, 234f Sincipital encephaloceles See Frontoethmoidal encephaloceles Single photon emission computed tomography (SPECT) of coronal synostosis, 305 of metopic synostosis, 296–297 of moyamoya syndrome, 172 Sinusitis, brain abscess with, 157, 158f Skull fractures depressed, in infants, 83–87 conservative approach to, 83 vs in older age groups, 83 “ping-pong” appearance of, 83, 84f postoperative management of, 87 surgery for anesthetic considerations in, 83 patient positioning for, 83, 84f patient selection for, 83 periosteal elevator use in, 83, 85f–86f preoperative preparation for, 83 procedure for, 83–85 risks of, 83, 87 skin incision for, 83, 85f growing, 40–42 clinical presentation of, 40 common sites for, 40 incidence of, 40 postoperative management of, 42 radiological studies of, 40–41 risk factors for, 40 surgery for 14535IDX.indd 326 bipolar cautery in, 41, 42f complications of, 42 dural closure in, 41–42, 42f goal of, 41 indications for, 41 procedure for, 41–42, 41f–42f venous sinuses in, 42 open, brain abscess with, 157 Soft palate, in transoral surgery, 22–26, 23f–24f Somatosensory evoked potentials (SEPs), intraoperative in split cord malformations, 119 in tethered cord, 263 Spastic cerebral palsy radiologic findings of, 177 selective dorsal rhizotomy for, 177–183 cauda equina localization in, 179, 179f complications of, 183 conus medullaris localization in, 177–180, 179f dorsal root identification in, 181 dorsal root sectioning in, 181–183, 182f dorsal root separation in, 180f, 181 electromyography in, 177–178, 178f, 180–183, 182f, 183t indications for, 177t laminectomy in, 177–180, 180f patient positioning for, 178, 178f patient selection for, 177–178 postoperative management of, 183 preoperative preparation for, 178 procedure for, 178–183 skin incision in, 179 standard technique for, 177 ultrasound guidance in, 179, 179f SPECT See Single photon emission computed tomography Sphenoethmoidal encephaloceles, 69 Sphenomaxillary encephaloceles, 69 Spheno-orbital encephaloceles, 69 Sphenopharyngeal encephaloceles, 69 Sphinx position, in coronal synostosis, 17, 17f Spina bifida See also Lipomyelomeningocele(s); Meningocele(s); Myelomeningocele(s) Chiari II malformations in, 7, 10–12 Spina bifida cystica, 251 Spina bifida occulta, 251 Spinal cord See also specific disorders of progressive dysfunction of, 62–68 Spinal dysraphism, occult, 62, 64 Spinal lipomas, intramedullary, 62, 64 operative procedure for, 64 surgical candidates for, 64 Split cord malformations (SCMs), 116–128, 142–146 composite, 124f, 125–126 dermal sinus tract with, 126, 127f dermoid cyst with, 126, 127f diagnosis of, 142 embryogenesis of, 116, 142 hemicords in, dural arrangements of, 116–118 meningocele with, 251 midline septum in, nature of, 116–118 multiple, 125–126 myelomeningocele with, 97, 100f, 116, 123f, 124, 126 natural history of, 142 neuroimaging studies of, 119, 124f, 142 postoperative management of, 127–128, 146 surgery for, 116–128, 142–146 anesthesia considerations in, 142 bladder dysfunction after, 128 cerebrospinal fluid leakage in, 128 closure in, 144, 145f complications of, 127–128, 146 dural opening in, 120, 121f, 122–123, 122f–123f, 126, 143–144, 145f laminectomy in, 119–120, 120f, 122, 143, 144f neurological injury in, 127–128 neurophysiological monitoring in, 119, 148 patient positioning for, 119, 143 4/23/08 3:14:11 PM Index 327 patient selection for, 118–119, 142 pitfall in, 121 preoperative preparation for, 119, 142–143 procedure for, 119–126, 143–146 skin incisions in, 119, 143, 143f special circumstances in, 125–126 technique of, 119–124, 143–146 tethered cord with, 118–119, 122f, 125, 262 type I, 116–118, 117f, 119–121, 120f–122f, 142 type II, 116–118, 118f, 121–124, 123f, 142 centromedian blood vessels with, 123f, 124 median septum in, patterns of, 121–122 septum shape in, 123–124, 123f vertebral anomalies with, 116 Staphylococcus aureus and brain abscess, 158 and shunt infection, 235, 235t Staphylococcus epidermidis, and shunt infection, 235t Stealth incision, in coronal synostosis, 258, 258f Steroids for brain abscess, 159, 161 postoperative, for brain stem glioma, 280 Strabismus, postoperative, 93 Streptococcus and brain abscess, 158 and shunt infection, 235, 235t Stroke, moyamoya syndrome and, 171, 175 Subciliary incision, in exorbitism, 78 Subclavian vein, ventriculoatrial shunting via, 36 Subdural hygroma, ventriculoatrial shunt for, 34 “Sunrise” appearance, in calvarial reconstruction, 186, 188f Superficial temporal artery, as donor vessel for moyamoya syndrome, 171, 172f, 173–176, 173f, 175f–176f Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, 171 Superior sagittal sinus, common, in craniopagus twins, 209, 210f–212f, 212–214 Superior vena cava (SVC), in ventriculoatrial shunting, 34 Suprachiasmatic cyst, endoscopic approach to, 217, 217f, 218, 220f Supraorbital artery, in fibrous dysplasia, Supraorbital nerve, in fibrous dysplasia, Surgical isolation bubble, 106–107, 107f Swallowing, Chiari II malformation and, 10 Synostosis See also specific types coronal, 13–19, 165–170, 256–261, 304–311 artist’s rendering of, 166f bilateral, 13, 15f, 256 brachycephaly with, 13, 241, 242f, 249, 256 compensatory growth in, 13, 14f–15f, 165, 166f, 241, 256, 304 definition of, 13 diagnosis of, 305 differential diagnosis of, 256 etiology of, 304 genetics of, 13, 256, 261, 305 genetic testing in, 13 individualized treatment for, 241 multidisciplinary approach to, 241–242 ophthalmologic exam in, 13 plate-and-screw fixation in, 17, 17f, 19, 167–170, 167f, 169f, 261, 308–310 postoperative management of, 19, 170, 261, 310–311 radiologic findings of, 165, 241–242, 242f, 256–257, 305–306, 305f–308f, 310–311 recurrence or relapse of, 17, 19 syndromic vs nonsyndromic, 13, 304 total calvarial reconstruction for, 241–250 turricephaly with, 13, 241, 242f, 249, 256 unilateral, 13, 14f, 165–170, 256, 304–311, 304f–305f lambdoid calvarial reconstruction for, 184–189 deformity with, 184, 184f–185f endoscopic assisted craniectomy for, 190–192 vs nonsynostotic plagiocephaly, 184, 194, 197 posterior plagiocephaly with, 194–202 14535IDX.indd 327 metopic, 286–290, 296–303 cognitive impairment with, 286 compensatory growth in, 286, 288f, 296 definition of, 286 diagnosis of, 286, 296–297, 297f etiology of, 296, 298 multidisciplinary approach to, 297–298 ophthalmologic exam in, 286, 297–298 postoperative management of, 289–290, 302–303 radiologic findings of, 286, 296–297, 296f–297f, 298, 302, 302f referring pediatrician and, 298 relapse or recurrence of, 290 skull deformity in, 286, 288f, 296–297, 296f–297f multiple suture (pansynostosis), 50–61 clinical signs of, 50 hydrocephalus with, 50, 61 postoperative management of, 57–61 radiologic findings in, 50 “thumbprinting” appearance of, 50, 52f, 53, 54f sagittal, 203–208, 291–295 compensatory growth in, 291, 291f, 292, 295 definition of, 203 diagnosis of, 291 intracranial hypertension with, 291–292 intraoperative photograph of, 206f in males vs females, 203 multidisciplinary approach in, 204 vs positional deformity, 203 postoperative management of, 208, 294–295 radiologic findings of, 203–204, 291 relapse of, 295 skull deformity in, 203, 291, 291f, 295 Syringohydromyelia Chiari II malformation and, 12 Chiari I malformation and, lipomyelomeningocele and, 64, 66, 68f tethered spinal cord and, 129 Syringomyelia in Chiari II malformation, in Chiari I malformation, 7, 9f, 111–115 difficult cases of, 112–114, 114f postoperative management of, 112–114 radiologic findings of, 111, 114, 114f in split cord malformations, 142 surgery for, 111–115 patient positioning for, 112, 113f patient selection for, 111 preoperative preparation for, 111 procedure for, 112 syringoperitoneal shunting for, 112, 113f, 114–115 syringosubarachnoid shunting for, 112, 113f Syringoperitoneal shunt, 112, 113f, 114–115 Syringosubarachnoid shunt, 112, 113f T Tarsorrhaphy in coronal synostosis, 14 in exorbitism, 77, 80–81 in fibrous dysplasia, 3, in pansynostosis, 51 in sagittal synostosis, 292 Technetium scan, of brain abscess, 159 Telorbitism (hypertelorism), 27–28, 88–95, 89f clinical case of, 94–95, 94f definition of, 88 postoperative management of, 32, 93–94 radiologic findings of, 88, 88f, 94f, 95 surgery for, 27–28, 88–95 blood loss in, 89 closure in, 92 complications of, 32, 93–94 craniofacial osteotomies in, 28, 29f, 90–91, 91f–93f draping for, 27, 89 flap elevation in, 89–90, 90f 4/23/08 3:14:11 PM 328 Index Telorbitism (hypertelorism), (continued) patient positioning for, 27, 32, 89 patient selection for, 27 preoperative evaluation for, 88–89 preoperative preparation for, 27, 89 procedure for, 27–28, 32, 33f, 89–95 results of, 94–95, 94f risks of, 27 skin incisions for, 28, 89 timing of, 27 Temporal horn, endoscopic approach to, 223, 223f–224f Temporalis muscles in coronal synostosis, 15, 167, 258, 310 in exorbitism, 77–78, 80 in fibrous dysplasia, 3, in metopic synostosis, 300–302 in orbital dystopia, 91 in pansynostosis, 57 in plagiocephaly, 167 in sagittal synostosis, 204–205, 206f, 208 in telorbitism, 32, 33f, 90–91 Temporal lobe abscess, 157 Tethered spinal cord, 62–64 challenges of, 262 clinical presentation of, 62, 136, 262 computed tomography myelogram of, 62 embryology of, 136 filum terminale dysgenesis and, 262, 267–268 filum terminale sectioning for, 136–141, 267–268 anatomy in, 267 anesthetic considerations in, 137 bipolar coagulation in, 138–141, 140f closure in, 140f, 141, 267–268 complications of, 141 dural opening in, 138, 139f laminectomy in, 138, 138f patient positioning for, 137, 137f patient selection for, 136–137 pearls and pitfalls in, 268 postoperative management of, 141, 268 preoperative preparation for, 137 procedure for, 137–141, 267–268 prognosis in, 141 skin incision for, 138, 138f, 267, 268f technique of, 138–141, 138f–140f filum terminale thickening in, 62–63, 64f, 136–141, 262, 267–268 with lipomyelomeningocele, 64, 269 magnetic resonance imaging of, 62–63, 129, 130f, 136–137, 136f, 141, 152–153, 262–263, 267 multidisciplinary approach to, 152, 262 after myelomeningocele repair, 97, 100, 102f, 129–135, 152–156, 262–265 postoperative management of, 135, 153–156, 264 shunt evaluation in, 152–154 surgery for, 263–265 anatomy in, 263 anesthesia for, 129 arachnoid opening in, 132f, 133–134, 133f closure in, 134–135, 134f, 153, 155f, 264 complications of, 135, 153–156, 264–265 draping for, 130 dural opening in, 132f, 133, 152, 154f exposure in, 130–134 goal of, 129 laminectomy in, 132f laser use in, 153, 264 microinstruments for, 152–153, 154f nerve roots in, 133, 133f operating room setup for, 129–130 patient positioning for, 129–130, 131f, 152 patient selection for, 129, 152 pearls and pitfalls in, 265 placode dissection in, 152–153, 154f–155f precautions in, 129 14535IDX.indd 328 preoperative preparation for, 129 principle of, 129 procedure for, 129–135, 152–153 skin incision in, 130, 131f, 152, 153f, 264 timing of, 152 natural history of, 63, 137 postoperative management of, 63–64 with split cord malformations, 118–119, 122f, 125, 262, 265–267 postoperative management of, 265–267 surgery for anatomy in, 265 closure in, 265 patient positioning for, 265 pearls and pitfalls in, 267 procedure for, 265, 266f skin incision in, 265 surgery for, 262–268 See also specific procedures anesthesia for, 263 blood loss in, 263 medical clearance for, 263 patient positioning for, 63, 63f, 263 patient selection for, 62, 262 preoperative preparation for, 63, 152, 262–263 procedure for, 63, 63f–64f, 263–268 skin incision for, 63, 63f x-rays of, 137, 262 Tetralogy of Fallot, brain abscess with, 157 Third ventricle anterior, endoscopic approach to, 217–218, 219f–220f posterior, endoscopic approach to, 218–220, 220f–221f Third ventriculostomy, endoscopic, 230, 230f, 232 Thoracic meningocele, 251 “Thumbprinting” appearance, of pansynostosis, 50, 52f, 53, 54f Tiara reconstruction, 167–168, 167f, 169f, 187, 187f–188f Ticarcillin, for shunt infection, 235t Tissue expanders, in craniopagus twins, 210, 211f Tobramycin, for shunt infection, 235t Tongue-and-groove reconstruction, 186–187, 186f–188f, 244–246, 247f Tonsillar pistoning, in posterior fossa decompression, 282, 284f Tooth buds, exorbitism and, 76 Total calvarial reconstruction, 241–250 anesthesia for, 242 blood loss in, 249 closure in, 246–247 complications of, 249 draping in, 244, 245f exposure in, 244, 245f final recontouring in, 246, 248f height reduction in, 246, 248f intraoperative monitoring in, 242, 247 occipital advancement in, 246, 247f orbital advancement in, 244–246, 246f outcome of, 249 patient positioning for, 243–244, 243f patient selection for, 241 postoperative management of, 249 preoperative preparation for, 242 skin incision in, 244, 245f specialized instrumentation for, 247–249 timing of, 241, 249–250 Total cranial vault reconstruction, 204–208, 291–295 anesthesia for, 204 blood loss in, 204, 206, 208, 292, 294–295 bone plate recontouring in, 206, 207f closure in, 293–294 complications of, 208, 294–295 craniofacial reconstruction in, 204–208, 207f, 293, 293f–294f craniotomy in, 204–205, 205f, 293, 293f–294f draping for, 204 flap elevation in, 293 indications for, 292 outcome of, 207f, 208 4/23/08 3:14:12 PM Index 329 patient positioning for, 204, 204f, 292–293 patient selection for, 203, 291–292 preoperative preparation for, 204, 292 procedure for, 204–208, 292–294 skin incision for, 204, 204f, 293 surgical setup for, 292–293 timing of, 203, 292 “Tower-shaped” appearance, in coronal synostosis, 13, 15f, 256 Toxoplasma gondii, and brain abscess, 158–159 Tracheostomy, in transoral surgery, 20–21 Traction, cervical, in transoral surgery, 21–22, 25–26 Transbuccal incision, in exorbitism, 78 Transethmoidal encephaloceles, 69 Transient ischemic attacks (TIAs), moyamoya syndrome and, 171 Transoral surgery, for craniovertebral junction abnormalities, 20–26, 22f Transpalatal route, to craniovertebral junction abnormalities, 24–25 Trapped ventricles, endoscopy for, 224, 230–231 Trigonocephaly, 286, 288f, 296–297, 296f–297f Tube exchanger, in transoral surgery, 25 Turricephaly, 13, 241, 242f, 249, 256 Twins, craniopagus classification of, 209 epidemiology of, 209 frontal, 209 occipital, 209 parietal, 209 photograph of, 209f radiologic studies of, 209, 210f–211f separation of, 209–214 challenge of, 214 closure in, 212, 213f complications of, 213 craniofacial reconstruction in, 210, 212, 213f craniotomy in, 212, 212f dural graft in, 212, 212f dural opening in, 212 main questions in, 209 mortality and morbidity in, 209, 214 outcome of, 214, 214f patient positioning for, 210 patient selection for, 209 plate-and-screw fixation in, 212, 213f postoperative management of, 213 preoperative embolization for, 209 preoperative preparation for, 209–210 preoperative tissue expanders for, 210, 211f procedure for, 210–212 skin incision for, 210, 211f–212f shared sagittal sinus in, 209, 210f–212f, 212–214 shared vascular anatomy of, 209–210, 210f–211f temporoparietal, 209 vertical, 209 TWIST mutations, 256, 261 U Ultrasound of Dandy-Walker malformation, 104 intraoperative in brain abscess, 161, 161f–162f in Chiari II malformation, 11 in posterior fossa decompression, 281–282, 284f, 285 in selective dorsal rhizotomy, 179, 179f in total calvarial reconstruction, 242 in ventriculoatrial shunting, 35–36, 38 of lipomyelomeningocele, 147 of meningoceles, 251–252 of myelomeningocele, 96 of split cord malformations, 142 of tethered spinal cord, 136 of ventriculoperitoneal shunt, 234–235 Urinary dysfunction lipomyelomeningocele and, 65, 68, 147, 269, 274 14535IDX.indd 329 split cord malformations and, 128 tethered spinal cord and, 62–64, 136–137 V Vagus nerve, craniovertebral junction abnormalities and, 20 Vancomycin, for shunt infection, 235, 235t Velopalatine incompetence, 26 Ventricular endoscopy, 227–232 for adherent catheters, 231, 237, 238f anesthesia for, 216, 229 approaches in, 215–226 to anterior third ventricle, 217–218, 219f–220f to foramen of Monro, 217, 217f–218f to frontal horn, 222–223, 222f–223f to occipital horn, 223–224, 224f–225f to posterior fossa, 224–225, 225f to posterior third ventricle, 218–220, 220f–221f to temporal horn, 223, 223f–224f for biopsy and treatment of tumors, 231–232 bleeding in, 225 for colloid cyst, 217, 218f, 222–223, 231–232, 231f complications of, 225–226, 232 corporate interest in, 215 CSF analysis in, 216–217 flexible, 216, 227–229, 228f general principles of, 216–217 history of, 227 for hydrocephalus, 215, 230–231, 230f imaging studies for, 215, 230 instrumentation for, 215, 227–229, 228f–229f irrigation for, 215–216, 229 lasers used in, 223, 229 learning curve for, 225 patient positioning for, 217, 222f, 223, 224f, 229 pneumatic systems in, 216, 217f postoperative management in, 225–226, 232 preoperative preparation for, 215–216, 229 procedure for, 216–225, 229–232 rigid, 216, 227–229, 228f for shunt infection, 237–238, 238f, 240 skin incision for, 216, 229 for suprachiasmatic cyst, 217, 217f, 218, 220f surgeon disorientation in, 232 surgical suite organization for, 215 training for, 215, 225, 232 Ventriculoatrial shunts, 34–39 anesthetic considerations for, 34 atrial catheter for advancing, pressure wave forms with, 37, 38f difficulty passing in patient with abnormal vascular anatomy, 39 in patient with normal vascular anatomy, 39 difficulty positioning, 39 placement of, 36, 36f, 37–38 complications of, 39 contraindications to, 34 cranial bur hole placement for, 37 EKG monitoring with, 35, 37–39 elective revision of, 39 growth-related migration of, 34, 39 imaging guidance for, 35–39 indications for, 34 intraoperative problems with, 38–39 landmarks for, 35, 35f locating ventricles in, difficulty with, 38–39 open access of common facial vein for, 36–37, 37f operative procedure for, 35–39 patient positioning for, 35–36, 35f patient selection for, 34 percutaneous access of internal jugular vein for, 36, 36f postoperative management of, 39 preoperative preparation for, 34–35 risks of, 34 special equipment for, 35 surgical steps for, 36–38 4/23/08 3:14:12 PM 330 Index Ventriculoatrial shunts, (continued) valve system for placement of, 37 selection of, 36 ventricular catheter for manometer attached to, 38 placement of, 37–38 Ventriculoperitoneal shunts, 34, 104–110 complications of, 109–110 connections of, 107, 108f in craniopagus twin separation, 213–214 CSF leakage around, 110 for Dandy-Walker malformation, 104–110 infection of adherent catheter in, 237, 238f antibiotic therapy for, 235, 235t clinical presentation of, 233–234 complications of, 233 custom catheters and drainage systems for, 240 diagnosis of, 234–235 externalization of shunt in, 238–240, 239f external ventricular drain in, 235–238, 236f–237f, 240 incidence of, 233 mortality and morbidity with, 233 pathogens causing, 235, 235t postoperative management of, 240 prevention of, 233–234 radiologic findings of, 234 risk factors for, 233 shunt replacement in, 236, 236f, 240 shunt tap in, 234–235, 234f surgical management of, 233–240 complications of, 240 patient selection for, 233 procedure for, 236–240 scenarios in, 236–237, 236f specialized equipment for, 240 ventriculoscopy in, 237–238, 238f, 240 intra-abdominal injury with, 110 nonfunctioning, vs tethered cord, 152–154 operative procedure for, 105–109 patient positioning for, 105, 107f patient selection for, 104 peritoneal catheter placement in, 108–109 positioning of, 106f postoperative management of, 109–110 14535IDX.indd 330 preoperative preparation for, 104–105 selection of equipment, 104 skin closure in, 109 skin incision for, 106, 107f surgical isolation bubble for, 106–107, 107f surgical technique for, 106–109 ventricular catheter placement in, 106–108, 109f Ventriculoscope, 227 See also Ventricular endoscopy Vertebral artery erosion, 26 Vertical dystopia, 27 “Vest-over-pants” sutures, in occipital encephalocele closure, 45–46, 47f Visual acuity, fibrous dysplasia and, Visual field, fibrous dysplasia and, Vomiting brain abscess and, 158 postoperative, in Chiari malformations, 9, 12 V-Y correction, in orbital malposition, 90, 90f, 92 W “Washboard” appearance, rib grafts and, White blood cell count (WBC), brain abscess and, 159 X X-rays of coronal synostosis, 305 of craniovertebral junction abnormalities, 20 of exorbitism, 77 of fibrous dysplasia, of growing skull fracture, 40 of hypertelorism, 88 of lambdoid synostosis, 190 of lipomyelomeningocele, 64–65, 147, 270 of orbital dystopia, 88 of plagiocephaly, 165 of sagittal synostosis, 203, 291 of split cord malformations, 142, 146 of tethered spinal cord, 137, 262 of ventriculoatrial shunt, 39 of ventriculoperitoneal shunt, 109 Y Yttrium-aluminum-garnet (YAG) laser for lipomyelomeningocele, 149 for tethered spinal cord, 153, 264 4/23/08 3:14:12 PM [...]...Continuing Medical Education Credit Information and Objectives ◆ Objectives Upon completion of this activity, the learner should be able to: 1 Describe the treatment and surgical management of pediatric neurosurgical disorders 2 Demonstrate a full understanding of current neurosurgical operative techniques in pediatric neurosurgical disorders 3 Discuss the operative management of complex pediatric neurosurgical. .. disorders ◆ Accreditation This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education through the American Association of Neurological Surgeons (AANS*) The AANS is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians ◆ Credit The AANS... the first edition of the Neurosurgical Operative Atlas in 1991 To allow for timely publication, coverage of six operations was published at bimonthly intervals in looseleaf format in the order finished manuscripts were received The completed series had nine volumes and covered the entire spectrum of neurosurgery The goal was to publish a comprehensive reference that included well-established neurosurgical. .. procedures as practiced in the United States and Canada by authors who are respected in the field Working together, the AANS Publications Committee and Thieme New York have organized the second edition of this atlas series The atlas s main purpose remains the same, to be a ready reference for well-established neurosurgical procedures for trainees and practitioners of neurosurgery worldwide The new edition... of Neurosurgery Temple University School of Medicine Temple University Hospital Philadelphia, Pennsylvania William O Bell, MD, FACS Neurosurgical Associates of the Carolinas Winston-Salem, North Carolina Frederick A Boop, MD Associate Professor of Neurosurgery Chief, Pediatric Neurosurgery Semmes-Murphey Clinic LeBonheur Children’s Hospital Memphis, Tennessee Alan R Cohen, MD Division of Pediatric Neurosurgery. .. Neurological Department of Surgery and Pediatrics George Washington University School of Medicine Division of Pediatric Neurosurgery Children’s National Medical Center Washington, DC Sami Khoshyomn, MD Pediatric Neurosurgery Fellow Hospital for Sick Children Toronto, Ontario Canada Bianca I Knoll Chief Resident Department of Plastic Surgery Yale University School of Medicine Division of Plastic Surgery... of Neurosurgery UAB Hospital Birmingham, Alabama xxi W Jerry Oakes, MD Dan L Hendly, Professor Department Surgery Division of Neurosurgery University of Alabama at Birmingham School of Medicine Pediatric Neurosurgery Children’s Hospital Birmingham, Alabama Jayesh Panchal, MD, MBA, FRCS Genesis Plastic Surgery and Medical Spa Edmond, Oklahoma Dachling Pang, MD, FRCS(C), FACS Professor of Pediatric Neurosurgery. .. Department of Neurosurgery The Children’s Hospital Boston, Massachusetts Tadanori Tomita, MD The Yaeger Professor of Pediatric Neurosurgery Professor of Neurosurgery Feinberg School of Medicine Northwestern University Chairman, Division of Pediatric Neurosurgery Children’s Memorial Hospital Chicago, Illinois Jonathan D Sherman, MD Mountain Neurosurgical and Spine Center, PA Asheville, North Carolina Edward... prevent this problem from occurring Acknowledgment This chapter is a revision of the chapter, “Fibrous Dysplasia Involving the Craniofacial Skeleton” by James T Goodrich, M.D and Craig D Hall, M.D The chapter appeared in the Neurosurgical Operative Atlas, Volume # 1, edited by Setti S Rengachary and Robert H Wilkins The Neurosurgical Operative Atlas was published by the American Association of Neurological... presentation needs to be straightforward and practical The atlas- style format using an operative narrative was selected in the belief that, like Leonardo da Vinci, surgeons are more comfortable with the “visual” image than the written word—though both are provided! Starting with the first edition of this work, we selected the chapters that dealt with pediatric subjects The original authors were asked to update .. .Neurosurgical Operative Atlas Second Edition Pediatric Neurosurgery American Association of Neurosurgeons • Rolling Meadows, Illinois Neurosurgical Operative Atlas Second Edition Pediatric Neurosurgery. .. understanding of current neurosurgical operative techniques in pediatric neurosurgical disorders Discuss the operative management of complex pediatric neurosurgical disorders ◆ Accreditation This activity... system—Surgery—Atlases Children—Surgery—Atlases Pediatric neurology—Atlases I Goodrich, James T [DNLM: Nervous System Diseases—surgery—Atlases Child Infant Neurosurgical Procedures—methods—Atlases WL