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    ABSTRACT: Introduction: Atypical teratoid rhabdoid tumors are highly malignant neoplasms that present in young children and can grow to a large size. Maximal safe surgical resection is a mainstay of treatment. Presentation of cases: Two cases of children under the age of two with large tumors involving the supratentorial and infratentorial compartments are presented. A two-staged operative approach combining a standard suboccipital approach to the fourth ventricle followed by an infratentorial, supracerebellar approach was utilized for resection. Discussion: Maximal safe surgical resection of large tumors in young children is challenging. A staged approach is presented that affords maximal tumor resection while minimizing perioperative morbidity. Conclusion: A staged operative approach appears safe and efficacious when resecting large tumors from both the infratentorial and supratentorial compartments in children less than two years of age.
    Full-text · Article · Jan 2016 · International Journal of Surgery Case Reports
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    ABSTRACT: Pericranial flaps are widely used for dural repair as they are easily accessible and have a lower rate of infection than artificial grafts. Vascularized flaps increase the rate of successful dural closure and minimize the risk of cerebrospinal fluid leak and infection. However, regional access can be limited by the necessity of maintaining the vascularized pedicle. Classically, frontal-based vascularized flaps have been used for dural repair after orbitalfrontal approaches to large anterior fossa meningiomas. We present an alternative lateral temporal-based flap for dural repair in orbitalfrontal approaches.
    Full-text · Article · Jan 2016 · Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
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    ABSTRACT: Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. The role of chemoprophylaxis in this setting is poorly defined, leading to a wide variability in clinical practice. A comprehensive review of the literature was performed in an effort to summarize relevant data and construct a chemoprophylaxis protocol to be implemented in a Level I Trauma Center. The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24 h after the demonstration of a stable intracranial injury by computed tomography (CT).
    No preview · Article · Aug 2014 · Clinical Neurology and Neurosurgery
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