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  1. Article ; Online: Brief pump externalization without ITB wean to treat a probable pocket infection.

    Strader, Shannon / Mutchnick, Ian

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2023  Volume 39, Issue 12, Page(s) 3643–3645

    Abstract: BACKGROUND AND IMPORTANCE: Intrathecal baclofen (ITB) pumps are an effective management tool for spasticity and dystonia. In the pediatric population, ITB complications including infection are common, and strategies to minimize their impact are important. ...

    Abstract BACKGROUND AND IMPORTANCE: Intrathecal baclofen (ITB) pumps are an effective management tool for spasticity and dystonia. In the pediatric population, ITB complications including infection are common, and strategies to minimize their impact are important. Current standard of care for pump infection involves a wean of the ITB therapy followed by explantation of the hardware, which can be a three to 6-month process. CLINICAL PRESENTATION: We present a 20-year-old female who developed an pump pocket infection after revision. The pump was removed from the body but left connected. The pocket was debrided, thoroughly washed, and packed with multiple microbicidal agents. Nine days later, a new pump and proximal catheter was re-implanted without complications or interruption of medication administered intrathecally. One year later, the patient is doing well without any infectious problems. CONCLUSION: To our knowledge, this is the first report of an externalized pump and expedited reimplantation without a break in ITB therapy. Further studies are required in order to best characterize this technique as a potential alternative for infected baclofen pump pockets.
    MeSH term(s) Female ; Humans ; Young Adult ; Baclofen/therapeutic use ; Infusion Pumps, Implantable ; Muscle Relaxants, Central/therapeutic use ; Muscle Spasticity/drug therapy
    Chemical Substances Baclofen (H789N3FKE8) ; Muscle Relaxants, Central
    Language English
    Publishing date 2023-07-17
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-023-06075-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Epidural Effusion as Allergic Reaction Following Polyetheretherketone Cranioplasty: An Illustrative Case and Review of the Literature.

    Shields, Lisa B / Vessell, Meena / Mutchnick, Ian S

    Cureus

    2022  Volume 14, Issue 1, Page(s) e21390

    Abstract: Well-described complications of polyetheretherketone (PEEK) cranioplasty in pediatric patients include surgical site infection, post-operative hematoma, cerebral edema, and implant fracture. We present a rare case of hypersensitivity to PEEK presenting ... ...

    Abstract Well-described complications of polyetheretherketone (PEEK) cranioplasty in pediatric patients include surgical site infection, post-operative hematoma, cerebral edema, and implant fracture. We present a rare case of hypersensitivity to PEEK presenting as an epidural effusion in a 7-year-old male receiving a PEEK cranioplasty following a decompressive craniectomy. Within three weeks, the patient experienced fever and emesis. Erythrocyte sedimentation rate (ESR) was high (>130 mm/Hr) as well as C-reactive protein (CRP) (6.4 mg/dL). A brain MRI with contrast demonstrated both subgaleal and epidural fluid collections with T2 isointense columns projecting from the galeal surface, through the holes in the implant to the dural surface. The patient appeared clinically well. A sterile tap of the pericranial fluid showed no growth, b2-transferrin was negative, but the IgG level was high (>129.2 mg/dL) in the tap fluid. High-dose steroids reduced the epidural collection, but then the collection returned with steroid wean. A second cranioplasty operation replaced the PEEK flap with autologous bone. Postoperative imaging demonstrated markedly reduced fluid collections and a decreased midline shift. The patient remained clinically intact throughout the experience. PEEK allergy following cranioplasty is a rare entity and must be distinguished from infection or hematoma. Medical treatment with steroids can be attempted, but, if refractory, then appropriate treatment may necessitate removal of the offending PEEK implant.
    Language English
    Publishing date 2022-01-18
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.21390
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Evidence for Thalamic Responsive Neurostimulation in Treatment of Adult and Pediatric Epilepsy.

    Vessell, Meena / Willett, Andrew / Chapman, Brittany / Bina, Robert / Ball, Tyler / Mutchnick, Ian / Neimat, Joseph S

    Stereotactic and functional neurosurgery

    2023  Volume 101, Issue 2, Page(s) 75–85

    Abstract: Responsive neurostimulation (RNS) has well-established efficacy in patients with identifiable seizure foci. Emerging evidence suggests the feasibility of expanding this treatment to patients with nonfocal or multifocal epileptic profiles with thalamic ... ...

    Abstract Responsive neurostimulation (RNS) has well-established efficacy in patients with identifiable seizure foci. Emerging evidence suggests the feasibility of expanding this treatment to patients with nonfocal or multifocal epileptic profiles with thalamic targeting. Our institution performed two successful implantations of thalamic RNS (tRNS) targeting the centromedian nucleus of the thalamus (CMT), and 1-year postoperative outcomes are provided. Additionally, a literature review of all reported tRNS was conducted. Publications were excluded if they did not include demographic data and/or epilepsy outcomes at follow-up. In the literature, 19 adult and 3 pediatric cases were identified. These cases were analyzed for outcome, indications, previous operations, and surgical practice variations. Both of our patients had failed multiple previous pharmacological and neurosurgical interventions for epilepsy. Case #1 underwent tRNS with bilateral CMT stimulation. Case #2 underwent tRNS with simultaneous right CMT and right insular stimulation, although an additional lead was placed in the left CMT and left capped for potential future use. Each has achieved ≥90% reduction in seizure burden and approach seizure freedom. 71% of patients in the literature review had multifocal, bilateral, or cryptogenic seizure onset. Three patients were implanted for Lennox Gastaut (2 of 3 are pediatric). 16 patients underwent an average of 1.6 failed procedures prior to successful tRNS implantation. Taken together, the 21 adult patients reviewed have experienced an average seizure reduction of 77% at the latest follow-up. 95% of the adult patients reported in the literature experienced >50% reduction in seizure activity following tRNS and 52% experienced ≥90% reduction in seizure burden following tRNS. Pediatric patients have experienced 70-100% improvement.
    MeSH term(s) Humans ; Child ; Adult ; Deep Brain Stimulation/methods ; Epilepsy/therapy ; Seizures/therapy ; Intralaminar Thalamic Nuclei ; Neurosurgical Procedures ; Drug Resistant Epilepsy/therapy
    Language English
    Publishing date 2023-02-02
    Publishing country Switzerland
    Document type Review ; Case Reports
    ZDB-ID 645069-6
    ISSN 1423-0372 ; 1011-6125
    ISSN (online) 1423-0372
    ISSN 1011-6125
    DOI 10.1159/000528629
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Super-selective Wada test for pre-surgical leg motor function assessment: A case report.

    Kuruvilla, Alexander / Sadle, Charles J / Mutchnick, Ian / Karia, Samir / Sah, Jeetendra / Stilp, Rebecca / Dashti, Shervin / Karakas, Cemal

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2024  Volume 40, Issue 5, Page(s) 1631–1636

    Abstract: Introduction: Wada test is well-known to assess lateralization of memory and language functions; however, super-selective Wada (ss-Wada) to evaluate motor leg function is rare. We present a ss-Wada test within the anterior cerebral artery (ACA) to ... ...

    Abstract Introduction: Wada test is well-known to assess lateralization of memory and language functions; however, super-selective Wada (ss-Wada) to evaluate motor leg function is rare. We present a ss-Wada test within the anterior cerebral artery (ACA) to assess the motor function of the leg.
    Methods: Retrospective chart review.
    Results: Comprehensive phase-I/II surgical evaluation revealed an ictal focus around the left post-central gyrus with immediate involvement around the left para-central regions. To avoid potential right leg motor dysfunction with the surgery, the patient underwent a ss-Wada procedure. Angiography revealed bilateral ACAs were supplied by the left A1 segment. Super-selective microcatheter injection of amobarbital into the left ACA was performed to avoid cross-filling the contralateral ACA. The ss-Wada test confirmed no right leg motor impairment. Afterward, a craniotomy with direct cortical stimulation confirmed that the left-sided ictal/peri-ictal zone had no clear leg motor function. The patient underwent disconnection of that region and remained seizure-free at 10-month post-op follow-up without any motor or sensory deficits in the right limbs.
    Conclusion: This case demonstrates the proof of concept for ss-Wada in assessing lower extremity motor function. The ss-Wada procedure accurately predicted no motor deficits in the right leg, consistent with preserved motor function post-surgery.
    MeSH term(s) Humans ; Retrospective Studies ; Leg ; Amobarbital ; Lower Extremity ; Functional Laterality/physiology
    Chemical Substances Amobarbital (GWH6IJ239E)
    Language English
    Publishing date 2024-01-29
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-024-06302-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Efficacy of vagus nerve stimulation in managing drug-resistant absence epilepsy syndromes.

    Wessel, Caitlin / Candan, Feride Un / Panah, Paya Yazdan / Karia, Samir / Sah, Jeetendra / Mutchnick, Ian / Karakas, Cemal

    Seizure

    2024  Volume 117, Page(s) 60–66

    Abstract: Purpose: Around 11% of patients with absence epilepsy develop drug-resistant absence epilepsy (DRAE), and are at increased risk for developing psychiatric and neurologic comorbidities. Current therapeutic options for DRAE are limited. The purpose of ... ...

    Abstract Purpose: Around 11% of patients with absence epilepsy develop drug-resistant absence epilepsy (DRAE), and are at increased risk for developing psychiatric and neurologic comorbidities. Current therapeutic options for DRAE are limited. The purpose of this study was to assess the efficacy of vagus nerve stimulation (VNS) in treating DRAE.
    Methods: Our institution maintains a database of patients who received VNS between 2010 and 2022. We identified DRAE patients who were <18 years of age at seizure onset, were electro-clinically diagnosed with an absence epilepsy syndrome (childhood absence, juvenile absence, or Jeavons Syndrome) by an epileptologist, and had normal brain imaging. The primary outcome measure was post-VNS absence seizure frequency.
    Results: Twenty-six patients (M/F:14/12) were identified. Median age at seizure onset was 7 years (IQR 4-10) and patients experienced seizures for 6 years (IQR 4.3-7.6) before VNS. After VNS, the median absence seizure frequency reduced to 1.5 days (IQR 0.1-3.5) per week from 7 days (IQR 7-7), a 66% reduction seizure frequency. VNS responder rate was 80%, and seven patients achieved seizure freedom. There was no significant effect on VNS efficacy between the time from DRAE diagnosis to VNS placement (p = 0.067) nor the time from first seizure onset to VNS implant (p = 0.80). The median follow-up duration was 4.1 years (IQR 2.4-6.7), without any significant association between follow-up duration and VNS efficacy (r
    Language English
    Publishing date 2024-02-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 1137610-7
    ISSN 1532-2688 ; 1059-1311
    ISSN (online) 1532-2688
    ISSN 1059-1311
    DOI 10.1016/j.seizure.2024.01.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Risk of occult spinal dysraphism based on lumbosacral cutaneous manifestations.

    Shields, Lisa Be / Mutchnick, Ian S / Daniels, Michael W / Peppas, Dennis S / Rosenberg, Eran

    SAGE open medicine

    2021  Volume 9, Page(s) 20503121211037172

    Abstract: Objectives: Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. ... ...

    Abstract Objectives: Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered cord syndrome is a type of occult spinal dysraphism that puts abnormal traction on the spinal cord. This study analyzed neonates and infants who were referred to our pediatric urology practice and had evidence of lumbosacral cutaneous manifestation on physical examination.
    Methods: We reviewed the presence of lumbosacral cutaneous manifestations in neonates and infants evaluated in our pediatric urology clinic at our Institution over a 6-year period (1 March, 2015-28 February, 2021) with no prior diagnosis of lumbosacral cutaneous manifestation. All patients underwent a spinal ultrasound.
    Results: The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. A coccygeal pit was statistically marginally higher in abnormal versus normal spinal ultrasound (p = 0.07). Patients with only one lumbosacral cutaneous manifestation (N = 121) were significantly more likely to have a normal spinal ultrasound compared to those with two or more lumbosacral cutaneous manifestation (N = 17) (79% vs 53%, p = 0.03).
    Conclusion: Due to the varying risk of certain lumbosacral cutaneous manifestations with occult spinal dysraphism, all patients with a lumbosacral cutaneous manifestation should undergo spinal ultrasound. This study also highlights the importance of urodynamic studies when there are abnormal cutaneous findings. Routine physical examinations of the lumbar region for cutaneous manifestations of occult spinal dysraphism are vital to ensure prompt management of tethered cord syndrome and avoid potentially devastating consequences.
    Language English
    Publishing date 2021-08-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 2735399-0
    ISSN 2050-3121
    ISSN 2050-3121
    DOI 10.1177/20503121211037172
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Importance of Physical Examination and Imaging in the Detection of Tethered Cord Syndrome.

    Shields, Lisa B E / Mutchnick, Ian S / Peppas, Dennis S / Rosenberg, Eran

    Global pediatric health

    2019  Volume 6, Page(s) 2333794X19851419

    Abstract: Tethered cord syndrome (TCS) is a type of occult spinal dysraphism that may lead to permanent neurologic and orthopedic deficits. Infants with TCS may have lumbosacral cutaneous malformations (LsCMs). We studied 67 infants referred to a single pediatric ... ...

    Abstract Tethered cord syndrome (TCS) is a type of occult spinal dysraphism that may lead to permanent neurologic and orthopedic deficits. Infants with TCS may have lumbosacral cutaneous malformations (LsCMs). We studied 67 infants referred to a single pediatric urology practice for a urological concern unrelated to occult spinal dysraphism with no prior diagnosis of LsCM between March 1, 2015 and September 30, 2018. Each infant underwent a spinal ultrasound. If an abnormality was detected, they were referred to a pediatric neurosurgeon. The most common cutaneous manifestations were duplicated or bifurcated (46%) gluteal folds and gluteal asymmetry (16%). Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of the 14 infants underwent a lumbar magnetic resonance imaging. One infant had urodynamics studies and a tethered cord release. Pediatricians should be familiar with TCS and perform lumbar physical examinations for LsCMs suggestive of TCS to ensure prompt diagnosis and management and avoid potentially devastating complications.
    Language English
    Publishing date 2019-06-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2785531-4
    ISSN 2333-794X ; 2333-794X
    ISSN (online) 2333-794X
    ISSN 2333-794X
    DOI 10.1177/2333794X19851419
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Risk of occult spinal dysraphism based on lumbosacral cutaneous manifestations

    Lisa BE Shields / Ian S Mutchnick / Michael W Daniels / Dennis S Peppas / Eran Rosenberg

    SAGE Open Medicine, Vol

    2021  Volume 9

    Abstract: Objectives: Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered ...

    Abstract Objectives: Occult spinal dysraphism is a congenital failure of fusion of the posterior vertebral arches with intact skin overlying the defect. Lumbosacral cutaneous manifestations are associated with a variable risk of occult spinal dysraphism. Tethered cord syndrome is a type of occult spinal dysraphism that puts abnormal traction on the spinal cord. This study analyzed neonates and infants who were referred to our pediatric urology practice and had evidence of lumbosacral cutaneous manifestation on physical examination. Methods: We reviewed the presence of lumbosacral cutaneous manifestations in neonates and infants evaluated in our pediatric urology clinic at our Institution over a 6-year period (1 March, 2015–28 February, 2021) with no prior diagnosis of lumbosacral cutaneous manifestation. All patients underwent a spinal ultrasound. Results: The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. A coccygeal pit was statistically marginally higher in abnormal versus normal spinal ultrasound (p = 0.07). Patients with only one lumbosacral cutaneous manifestation (N = 121) were significantly more likely to have a normal spinal ultrasound compared to those with two or more lumbosacral cutaneous manifestation (N = 17) (79% vs 53%, p = 0.03). Conclusion: Due to the varying risk of certain lumbosacral cutaneous manifestations with occult spinal dysraphism, all patients with a lumbosacral cutaneous manifestation should undergo spinal ultrasound. This study also highlights the importance of urodynamic studies when there are abnormal cutaneous findings. Routine physical examinations of the lumbar region for cutaneous manifestations of occult spinal dysraphism are vital to ensure prompt management of tethered cord syndrome and avoid potentially devastating consequences.
    Keywords Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-08-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article: Management of Pre-existing Ventriculoperitoneal Shunt in Posterior Vault Distraction for Lambdoid Craniosynostosis: A Case Report and Technical Note.

    Pearson, Luke H / Thatikunta, Meena / Nuru, Mohammed / Rapp, Scott / Mutchnick, Ian

    Cureus

    2021  Volume 13, Issue 1, Page(s) e12814

    Abstract: Posterior vault distraction osteogenesis (DO) is an emerging treatment option for craniosynostosis. Operative nuances detailing surgical management are being described with increasing use and experience. In this article, we discuss the surgical ... ...

    Abstract Posterior vault distraction osteogenesis (DO) is an emerging treatment option for craniosynostosis. Operative nuances detailing surgical management are being described with increasing use and experience. In this article, we discuss the surgical management of an 8-month-old male with a ventriculoperitoneal shunt (VPS) diagnosed with bilateral lambdoid craniosynostosis and Chiari I malformation. The patient underwent successful bilateral posterior fossa DO without surgical re-implantation of the shunt. Pre- and post-operative imaging confirmed no migration of the VPS. Intracranial volume increased by 20.1% and posterior fossa volume increased by 39.9%. Our experience illustrates that posterior vault DO can be done safely in the setting of a parieto-occipital VPS, in a single operative setting, without the need of additional procedures.
    Language English
    Publishing date 2021-01-20
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.12814
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Nonendoscopic, minimally invasive calvarial vault remodeling without postoperative helmeting for sagittal synostosis.

    Mutchnick, Ian S / Maugans, Todd A

    Journal of neurosurgery. Pediatrics

    2012  Volume 9, Issue 3, Page(s) 222–227

    Abstract: Object: Multiple surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. Minimally invasive techniques have been recently emphasized, but these techniques necessitate the use of an endoscope and ... ...

    Abstract Object: Multiple surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. Minimally invasive techniques have been recently emphasized, but these techniques necessitate the use of an endoscope and postoperative helmeting. The authors assert that a safe and effective, more "minimalistic" approach is possible, avoiding the use of endoscopic visualization and routine postoperative application of a cranial orthosis.
    Methods: A single-institution cohort analysis was performed on 18 cases involving infants treated for isolated nonsyndromic sagittal synostosis between 2008 and 2010 using a nonendoscopic, minimally invasive calvarial vault remodeling (CVR) procedure without postoperative helmeting. The surgical technique is described. Variables analyzed were: age at time of surgery, sex, estimated blood loss (EBL), operative time, intraoperative complications, postoperative complications, length of stay, pre- and postoperative cephalic index (CI), clinical impressions, and results of a 5-question nonstandardized questionnaire administered to patient caregivers regarding outcome.
    Results: Eleven male and 7 female infants (mean age 2.3 months) were included in the study. The mean duration of follow-up was 16.4 months (range 6-38 months). The mean procedural time was 111 minutes (range 44-161 minutes). The mean length of stay was 2.3 days (range 2-3 days). The mean EBL in all 18 patients was 101.4 ml (range 30-475 ml). One patient had significant bone bleeding resulting in an EBL of 475 ml. Excluding this patient, the mean EBL was 79.4 ml (range 30-150 ml). There were no deaths or intraoperative complications; one patient had a superficial wound infection. The mean CI was 69 preoperatively versus 79 postoperatively, a statistically significant difference (p < 0.0001). Two patients were offered helmeting for suboptimal surgical outcome; one family declined and the single helmeted patient showed improvement at 2 months. No patient has undergone further surgery for correction of primary deformity, secondary deformities, or bony irregularities. Complete questionnaire data were available for 14 (78%) of the 18 patients; 86% of the respondents were pleased with the cosmetic outcome, 92% were happy to have avoided helmeting, 72% were doubtful that helmeting would have provided more significant correction, and 86% were doubtful that further surgery would be necessary. Small, palpable, aesthetically insignificant skull irregularities were reported by family members in 6 cases (43%).
    Conclusions: The authors present a nonendoscopic, minimally invasive CVR procedure without postoperative helmeting. Their small series demonstrates this to be a safe and efficacious procedure for isolated nonsyndromic sagittal synostosis, with improvements in CI at a mean follow-up of 16.1 months, commensurate with other techniques, and with overall high family satisfaction. Use of a CVR cranial orthosis in a delayed fashion can be effective for the infrequent patient in whom this approach results in suboptimal correction.
    MeSH term(s) Cohort Studies ; Craniosynostoses/pathology ; Craniosynostoses/surgery ; Craniotomy/methods ; Female ; Head Protective Devices ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures/methods ; Postoperative Care ; Reconstructive Surgical Procedures/methods ; Treatment Outcome
    Language English
    Publishing date 2012-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2011.12.PEDS11306
    Database MEDical Literature Analysis and Retrieval System OnLINE

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