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We aimed to analyze the potential for postoperative (PO) medication suspension and reduction, emphasizing passive withdrawal.Retrospective study of patients under 18 years old submitted to surgical treatment for pharmacoresistant epilepsy and classified as Engel I during the first year of PO follow-up. Therapeutic management was evaluated through discontinuation or reduction of medications, both in terms of the number of ASM prescribed and in daily maintenance dosages in mg/kg.ASM withdrawal started in the first year PO and occurred in 1.2% of cases, with a significant yearly reduction in the number of ASM during follow-up (p 0.001). A comparison of the most commonly used ASM in daily mg/kg between the preoperative period (preop) and PO showed a reduction of ASM maintenance dosages during PO. Even though recurrence of seizures was observed 5 years after surgery, 125 patients (85%) were still classified as Engel I, albeit a higher number of ASM per patient was observed. Most patients showed no changes in cognitive and adaptive behavior evaluation between preop and PO, even in those who were able to reduce ASM.Significant reduction observed both in the number and daily maintenance dosages of ASM following each year of PO may be an indirect measure of the effectiveness of epilepsy surgery.

We reassess the impact that robotization has on wages and employment, using a database on US commuting zones from 1990 to 2007. Using an argument based on the transitional dynamics we show that the negative displacement effects of robotization can be surpassed by productivity and reallocation effects, leading to positive effects on employment after a certain level of penetration in industry. In fact, we confirm this effect through regressions that are subject to different robustness checks. Previous evidence according to which robotization always decreases employment and wages are thus not confirmed.

Which dimensions of globalisation have an impact on social expenditure? How do different social welfare policies react to globalisation? This paper addresses these questions focusing on 36 Organisation for Economic Co-operation and Development countries over the period 1990–2015 and applying system Generalised Method of Moments to deal with endogeneity. We consider different dimensions of globalisation, economic, social and political, and their potential differentiated impacts on variegated social welfare policies. According to our findings, all the dimensions of globalisation have a positive effect on total social expenditure and on most of its components, although the influence is not statistically significant for social globalisation. The social welfare policies affected by globalisation are old age pensions, incapacity related, family and unemployment benefits and active labour market policies. These results can shed additional light on social and economic outcomes of globalisation such as poverty, inequality, long run growth and economic recovery.

Although increasing evidence confirms neuropsychiatric manifestations associated mainly with severe COVID-19 infection, long-term neuropsychiatric dysfunction (recently characterized as part of “long COVID-19” syndrome) has been frequently observed after mild infection. We show the spectrum of cerebral impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, ranging from long-term alterations in mildly infected individuals (orbitofrontal cortical atrophy, neurocognitive impairment, excessive fatigue and anxiety symptoms) to severe acute damage confirmed in brain tissue samples extracted from the orbitofrontal region (via endonasal transethmoidal access) from individuals who died of COVID-19. In an independent cohort of 26 individuals who died of COVID-19, we used histopathological signs of brain damage as a guide for possible SARS-CoV-2 brain infection and found that among the 5 individuals who exhibited those signs, all of them had genetic material of the virus in the brain. Brain tissue samples from these five patients also exhibited foci of SARS-CoV-2 infection and replication, particularly in astrocytes. Supporting the hypothesis of astrocyte infection, neural stem cell–derived human astrocytes in vitro are susceptible to SARS-CoV-2 infection through a noncanonical mechanism that involves spike–NRP1 interaction. SARS-CoV-2–infected astrocytes manifested changes in energy metabolism and in key proteins and metabolites used to fuel neurons, as well as in the biogenesis of neurotransmitters. Moreover, human astrocyte infection elicits a secretory phenotype that reduces neuronal viability. Our data support the model in which SARS-CoV-2 reaches the brain, infects astrocytes, and consequently, leads to neuronal death or dysfunction. These deregulated processes could contribute to the structural and functional alterations seen in the brains of COVID-19 patients.

Objective Describe the epidemiological profile and social-economic burden that hydrocephalus patients represent to the national public health system, using data available at the online database of the Brazilian Health Ministry (DataSUS). Methods This is a populational study based on descriptive statistics of all clinical and surgical appointments included in the DataSUS database. Data included herein were collected between 2015 and 2021 and subdivided into three main groups, related to hydrocephalus incidence and mortality, hospitalizations, and financial costs. Results In the study period, 3993 new cases of congenital hydrocephalus were diagnosed, with 6051 deaths overall. The mortality rate in the country was 1.5/100000 live births and the prevalence was 0.374/100000 inhabitants. The number of hospitalizations resulting from treatment procedures and complications of hydrocephalus was 137,880 and there was a reduction of up to 27.2% during the SARS-CoV-2 pandemics concerning previous years. Total costs for hydrocephalus management in the country amounted to 140,610,585.51 dollars. Conclusions Hydrocephalus has a significant impact on public health budgets and pediatric mortality rates; however, it is probably underestimated, due to the paucity of demographic data and epidemiological studies in Latin America and, specifically, in Brazil. The dataSUS also has several limitations in accessing certain data related to hydrocephalus, making it difficult to have a more assertive understanding of the disease in Brazil. The results of this study provide important guidance for future research projects in clinical and experimental hydrocephalus and also the creation of public policies for better governance and care of hydrocephalus patients.

Groups (Grp) 3 and 4 are aggressive molecular subgroups of medulloblastoma (MB), with high rates of leptomeningeal dissemination. To date, there is still a paucity of biomarkers for these subtypes of MBs. The RNA-binding protein Musashi-1 (MSI1) is a neural stem cell marker, characterized as a gene translation regulator and associated with high oncogenicity in several human cancers. In this study, we investigated the clinical significance and biological functions of MSI1 in Grp3/Grp4-MBs. First, we assessed the expression profile of MSI1 in 59 primary MB samples (15-WNT, 18-SHH, 9-Grp3, 17-Grp4 subgroups) by qRT-PCR. MSI1 mRNA expression levels were also validated in an additional public dataset of MBs (GSE85217). The ROC curve was used to validate the diagnostic standards of MSI1 expression. Cell cycle, cell viability, and apoptosis were evaluated in D283 Med cell-line (Grp3/Grp4/MBs) after shRNA-mediated knockdown of MSI1 plus cisplatin treatment. We identified an overexpression of MSI1 with a high accuracy to discriminate Grp3/Grp4-MBs from non- Grp3/Grp4-MBs. In addition, MSI1 knockdown promoted cell cycle interruption in the G1/S transition and, consequently, decreased the number of cells in the G2/M phase, repressed cell proliferation and sensitized D283 Med cells to cisplatin treatment by enhancing cell apoptosis. The results of the present study are the first to demonstrate that MSI1 may play a role as biomarker for Grp3/Grp4-MBs. In addition, MSI1 knockdown combined with cisplatin may offer a potential strategy to be further explored in Grp3/Grp4-MBs.

Distraction osteogenesis (DO) with an external distraction device such as the rigid external distraction frame has become an established method for treating midface hypoplasia in faciocraniosynostosis. It allows for greater advancement of the midface in comparison with traditional Le Fort III osteotomies, associated or not with fronto-orbital osteotomies (Le Fort IV). However, the forward movement of the bone segments may not always be performed obeying an ideal distraction vector, resulting in asymmetries, anterior open bite, and loosening of screws. In addition, the cost of the distraction devices is significant and may preclude their routine use in developing countries. We present an alternative device and method for craniofacial advancement in a clinical case of Crouzon’s syndrome. A 3D virtual simulation of the distraction vector and a modified external device were used in the current case. The alternative external device in this case proved to be safe, effective, and reliable.

Objectives Recently, defects in the protein kinase mTOR (mammalian target of rapamycin) and its associated pathway have been correlated with hemimegalencephaly (HME). mTOR acts as a central regulator of important physiological cellular functions such as growth and proliferation, metabolism, autophagy, death, and survival. This study was aimed at identifying specific variants in mTOR signaling pathway genes in patients diagnosed with HME. Methods Using amplicon and whole exome sequencing (WES) of resected brain and paired blood samples from five HME patients, we were able to identify pathogenic mosaic variants in the mTOR pathway genes MTOR, PIK3CA, and DEPDC5. Results These results strengthen the hypothesis that somatic variants in PI3K‐Akt‐mTOR pathway genes contribute to HME. We also describe one patient presenting with a pathogenic variant on DEPDC5 gene, which reinforces the role of DEPDC5 on cortical structural changes due to mTORC1 hyperactivation. These findings also provide insights into when in brain development these variants occurred. An early developmental variant is expected to affect a larger number of cells and to result in a larger malformation, whereas the same variant occurring later in development would cause a minor malformation. Significance In the future, numerous somatic variants in known or new genes will undoubtedly be revealed in resected brain samples, making it possible to draw correlations between genotypes and phenotypes and allow for a genetic clinical diagnosis that may help to predict a given patient's outcome.

This study reviews the attention core economics journals have paid to the topic of social policy and economic performance based on 1,356 articles published between 1957 and 2020 using bibliometric analysis and data visualisation techniques. This approach allow us, based on the assessment of bibliometric data through co-citation, co-authorship and keywords networks analysis, to identify researchers, countries, institutions and research areas and trends offering useful information that facilitates future research and policy making. The emphasis is on the empirical literature given the theoretical controversies on the sign of the relationship and its usefulness for policy making. The most active country publishing in the core journals is the USA, with Sweden leading in terms of average citations. The top publishing authors and institutions are in the US, and China is the only developing country present. Keywords analysis reveals that the most often used terms reflect common methodological approaches. Retirement issues dominate the research agenda and suggest the need for more studies addressing the economic outcomes of other welfare programs, although recent studies put more emphasis on health, education and labour market issues. This analysis can help researchers to pinpoint relevant studies, identify dominant lines of enquiry and the more recently investigated themes and, ‘standing on the shoulders of giants’, suggest new approaches to study the overall nexus.

The tuberous sclerosis complex (TSC), focal cortical dysplasia IIB (FCD IIB), and hemimegalencephaly (HME) exhibit similar molecular features that are dependent on the hyperactivation of the mTOR pathway. They are all associated with refractory epilepsy and the need for surgical resection with varying outcomes. The phosphorylated protein S6 (pS6) is a downstream target of mTOR, whose increased expression might indicate mTOR hyperactivation, but which is also present when there is no alteration in the pathway (such as in FCD type I). We have performed immunohistochemical marking and quantification of pS6 in resected brain specimens of 26 patients clinically and histologically diagnosed with TSC, FCD IIB, or HME and compared this data to a control group of 25 patients, to measure the extent of pS6 positivity and its correlation with clinical aspects. Our results suggest that pS6 may serve as a reliable biomarker in epilepsy and that a greater percentage of pS6 marking can relate to more severe forms of mTOR-dependent brain anomalies.

The neuroprotective effect of Edaravone in young hydrocephalic rats associated with a CSF derivation system was evaluated. The drug has already been shown to be beneficial in experimental hydrocephalus, but the combination of this drug with shunt surgery has not yet been investigated. Fifty-seven-day-old Wistar rats submitted to hydrocephalus by injection of kaolin in the cisterna magna were used and divided into five groups: control (n = 10), hydrocephalic (n = 10), hydrocephalic treated with Edaravone (20 mg/kg/day) (n = 10), hydrocephalic treated with shunt (n = 10) and hydrocephalic treated with shunt and Edaravone (n = 10). Administration of the Edaravone was started 24 h after hydrocephalus induction (P1) and continued until the experimental endpoint (P21). The CSF shunt surgery was performed seven days after hydrocephalus induction (P7). Open-field tests, histological evaluation by hematoxylin and eosin, immunohistochemistry by Caspase-3 and GFAP, and ELISA biochemistry by GFAP were performed. Edaravone reduced reactive astrogliosis in the corpus callosum and germinal matrix (p 0.05). When used alone or associated with CSF shunt surgery, the drug decreased the cell death process (p 0.0001) and improved the morphological aspect of the astroglia (p 0.05). The results showed that Edaravone associated with CSF bypass surgery promotes neuroprotection in young hydrocephalic rats by reducing reactive astrogliosis and decreasing cell death.

This paper explores the kinematic relation between the robot configuration in joint space and both the robot tool center point (TCP) position resolution and the robot end-effector orientation resolution with the purpose of reducing error. In the context of the use of redundant robots in neurosurgery for the placement of deep SEEG electrodes in the skull of patients suffering from epilepsy, this reduction in the error of the TCP would result in greater safety of this procedure and a consequent reduction in the possibility of surgical complications. The mechanical redundancy of the robot populates a null space where suitable joint configurations can be analyzed. In simulation, when comparing the joint configuration that obtained the smallest Cartesian error with the largest, there was a reduction of 50.23% in the Cartesian error. The results confirm the expected error disparity for different joints configurations, while the robot TCP is kept in the same position and the end-effector holds the same orientation. Our error analysis method could lead to a decrease in the risks involved in the procedure of SEEG electrode placement in neurosurgery.

OBJECTIVE Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on "ultra-early" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3 months. METHODS To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3 months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. RESULTS Sixty-four patients underwent 69 surgeries before the age of 3 months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41 months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p

Objective With the aging of the global population, an increase in the proportion of elderly patients presenting with traumatic brain injury (TBI) is expected. This population presents several distinctive characteristics that impact management and outcome of TBI, such as comorbidities, frailty, and preinjury use of medications - specially antiplatelets and anticoagulants. The purpose of this study was to assess the general characteristics and prognostic factors of elderly patients with TBI that were surgically managed at a single institution. Methods The authors performed a retrospective review of all elderly patients (age ≥ 65 years) with a history of TBI that underwent cranial neurosurgical procedures at their institution, between 2015 and 2019. Clinical characteristics, laboratory tests, and radiological scans, as well as surgeries, performed, outcome, and prognostic factors were analyzed, comprising 133 consecutive cases overall. Results The mean age of patients was 76.6 ± 7.3 years, ranging from 65 years to 97 years. There was a predominance of males (71.4%) and the most frequent mechanism of injury was fall (80.4%). Mild TBI comprised 57.1% of the cases, followed by severe TBI in 25.6%. Frequent signs and symptoms were impaired consciousness (69.9%), focal motor deficits (32.3%), and gait disturbances (12.8%). The majority had reported comorbidities upon admission (79.7%), with cardiac disease (79.2%) and diabetes (24.5%) as the most frequent. Preinjury anticoagulation was reported in 18.8% and use of antiplatelet drugs in 17.3%. The most common finding in the head CT was chronic subdural hematoma (48.1%), followed by acute subdural hematoma (37.6%). Coagulation was found to be altered in 12.8% of the patients. The most common neurosurgical procedure performed was trephination for hematoma evacuation (56.3%), followed by craniotomy (21.2%). Blood product transfusion was needed in 61.7% of the patients. Overall mortality was 42.1%, with the majority in the first month after admission (83.9%). Unfavorable outcome (Glasgow Outcome Scale

The present study hypothesized that partial replacement of ground corn (GC) by pelleted citrus pulp (PCP) and buffering (BF) inclusion in diets of lactating cows does not change lactation performance, but does reduce milk concentration of ionic calcium (iCa), increasing its stability at ethanol test and heating at 140 °C (heat coagulation time – HCT). We evaluated the effect of PCP and buffer inclusion on digestive metabolism, feeding behavior, milk yield, and milk stability of lactating cows. Sixteen Holstein cows (average milk yield of 28 ± 4.8 L/d and days in milk of 130 ± 81.0; mean ± SD) were distributed in a Latin square design with 4 replicated squares, 4 periods of 21 d (14 d for adaptation and 7 d for sampling) and 4 treatments in a 2 × 2 factorial arrangement. Treatment factor 1 was the partial replacement (134 g/kg) of GC by PCP and factor 2 was the inclusion of buffer (7.1 g/kg of Na bicarbonate plus 2.4 g/kg of Mg oxide; DM basis) in diets composed of 40:60 of forage: concentrate ratio. The partial replacement of GC with PCP reduced dry matter intake (DMI) by 1.35 kg/d, increased dry matter (DM) and neutral detergent fiber assayed with a heat stable amylase and expressed exclusive of residual ash (aNDFom) digestibility, and ruminal concentration of acetic and butyric acids, but no change was observed on milk yield, resulting in higher production efficiency. The partial replacement of GC with PCP also reduced the ruminal concentration of iso-butyric and iso-valeric acids, milk urea nitrogen concentration, and casein content and tended to reduce HCT. There was no isolated effect of GC replacement or buffer addition or their interaction on iCa concentration and milk stability at the ethanol test. For diets without the inclusion of PCP, cows increased drinking time by 8 min/d. When cows were fed diet with the inclusion of PCP, the rumination time decreased 57 min/kg physical effective aNDFom (peNDF) intake compared to when cows were fed diets without partial replacement of GC with PCP. The buffer inclusion increased milk fat content and urinary pH. However, milk stability at ethanol test did not change in response to treatments and HCT tended to be reduced when GC was replaced by PCP. The results of our study suggested that, although partial replacement of GC with PCP and BF inclusion altered DMI, short chain fatty acids (SCFA) concentration, and urinary pH, those factors did not change milk yield and milk stability.

Demonstrate that transcranial ultrasonography (TUS) scanning is viable and useful as a diagnostic method in experimental hydrocephalus, as well as to compare measurements of cerebral and ventricular width obtained from TUS scans of hydrocephalic rats with post-mortem anatomical specimens, aiming for the development of accurate criteria to establish ventricular enlargement and progression of hydrocephalus subsequently. Thirty-five male Wistar rats were used. Following hydrocephalus induction, they underwent a transcranial ultrasound scan to measure cerebral and ventricular dimensions, in the fourth and 21 post-induction days. By the end of the experiments, measurements obtained from TUS scans were compared with actual values as seen in the post-mortem specimens of each animal. Ventricular dilation could be clearly visualized in hydrocephalic animals. We performed intraclass correlation coefficient and linear regression analyses that have demonstrated a precise correlation between measurements of TUS scans and post-mortem specimens; we have found a similarity of 0,95 for the cerebral diameter and 0,97 for ventricular width. Transcranial ultrasonography is a useful and reliable diagnostic tool for experimental hydrocephalus; also, it can be used to assess the progression of ventriculomegaly in animal models of hydrocephalus.

Cognitive functioning in epileptic syndromes has been widely explored in patients with temporal lobe epilepsy (TLE), but few studies have investigated the neuropsychological profile in posterior cortex epilepsy (PCE). In this study, we investigated the presurgical intellectual profile of children and adolescents with drug-resistant PCE.Children and adolescents diagnosed with PCE (n = 25) participated in this study. The data were obtained from medical records, with assessments carried out between the years 2003 and 2019. To compare the intellectual profile, we also included patients diagnosed with frontal (n = 26) and temporal lobe epilepsy (n = 40). The Wechsler Intelligence Scales were used for the assessment of general intelligence.There was an effect of the brain region on the Working Memory Index (p 0.01), in which patients with TLE had significantly higher scores than groups with FLE (p 0.01) and PCE (p 0.05). We also demonstrated that patients with PCE tended to perform worse in the Processing Speed Index than patients with TLE (p = 0.055). The Full-Scale Intelligence Quotient, Verbal Comprehension, and Perceptual Reasoning indexes did not differ among the brain regions.Children and adolescents with PCE demonstrated significant impairment in working memory and processing speed. The pattern of cognitive dysfunction in PCE was similar to that observed in FLE, which expands the evidence of the involvement of frontoparietal networks on cognitive proficiency.

A scientific journal’s greatest responsibility is to ensure that all contributions accepted for publications are rigorously but fairly reviewed. The Editor-in-Chief and Archives of Pediatric Neurosurgery gratefully acknowledge the qualified and regular collaboration of renowned medical doctors and scientists who kindly devoted their time to constructively review the submitted articles. Their expertise and invaluable assistance contributed to maintain a high scientific standard for APN. We are thus indebted to the Editorial Board members and the following experts who reviewed papers and completed the peer-reviewing process within 2020.

COVID-19 patients may exhibit neuropsychiatric and neurological symptoms. We found that anxiety and cognitive impairment are manifested by 28-56% of SARS-CoV-2-infected individuals with mild respiratory symptoms and are associated with altered cerebral cortical thickness. Using an independent cohort, we found histopathological signs of brain damage in 25% of individuals who died of COVID-19. All of the affected brain tissues exhibited foci of SARS-CoV-2 infection and replication, particularly in astrocytes. Infection of neural stem cell-derived astrocytes changed energy metabolism, altered key proteins and metabolites used to fuel neurons and for biogenesis of neurotransmitters, and elicited a secretory phenotype that reduces neuronal viability. Our data support the model where SARS-CoV-2 reaches the brain, infects astrocytes and triggers neuropathological changes that contribute to the structural and functional alterations in the brain of COVID-19 patients.

Although increasing evidence confirms neuropsychiatric manifestations associated mainly with severe COVID-19 infection, the long-term neuropsychiatric dysfunction has been frequently observed after mild infection. Here we show the spectrum of the cerebral impact of SARS-CoV-2 infection ranging from long-term alterations in mildly infected individuals (orbitofrontal cortical atrophy, neurocognitive impairment, excessive fatigue and anxiety symptoms) to severe acute damage confirmed in brain tissue samples extracted from the orbitofrontal region (via endonasal trans-ethmoidal approach) from individuals who died of COVID-19. We used surface-based analyses of 3T MRI and identified orbitofrontal cortical atrophy in a group of 81 mildly infected patients (77% referred anosmia or dysgeusia during acute stage) compared to 145 healthy volunteers; this atrophy correlated with symptoms of anxiety and cognitive dysfunction. In an independent cohort of 26 individuals who died of COVID-19, we used histopathological signs of brain damage as a guide for possible SARS-CoV-2 brain infection, and found that among the 5 individuals who exhibited those signs, all of them had genetic material of the virus in the brain. Brain tissue samples from these 5 patients also exhibited foci of SARS-CoV-2 infection and replication, particularly in astrocytes. Supporting the hypothesis of astrocyte infection, neural stem cell-derived human astrocytes in vitro are susceptible to SARS-CoV-2 infection through a non-canonical mechanism that involves spike-NRP1 interaction. SARS-CoV-2-infected astrocytes manifested changes in energy metabolism and in key proteins and metabolites used to fuel neurons, as well as in the biogenesis of neurotransmitters. Moreover, human astrocyte infection elicits a secretory phenotype that reduces neuronal viability. Our data support the model in which SARS-CoV-2 reaches the brain, infects astrocytes and consequently leads to neuronal death or dysfunction. These deregulated processes are also likely to contribute to the structural and functional alterations seen in the brains of COVID-19 patients.

This article provides a critical review of the literature on the relationship between renewable energies and sustainability considering the three dimensions of sustainability: economic, social, and environmental. First, a bibliometric tool is used and then a more in-depth analysis of selected literature is performed, focusing on the type of renewable energy analyzed and the level of development of countries, the dimension of sustainability focused on and the country’s development level, and the type of renewable energies focused on and the dimension of sustainability analyzed. It represents a milestone in the topic giving insights on the state of the art of the research on this research area, enhancing empirical evidence on the kind of relationships and developing a discussion on how closely aligned the political and institutional discourses are with the research concerns. We conclude that, while studies on lower-income countries focus on lower-rung energies, studies on higher-income countries focus on the study of more diversified sources. Moreover, wind–solar energy is the most reported in the articles concerned with environmental sustainability. Our main recommendation is to further investigate the implementation of modern renewable energies in developing countries, to help those countries to climb the energy ladder toward cleaner energy supply.

Introduction: Neuroendoscopy is particularly useful as an adjunct in the treatment of hydrocephalus. CSF physiology differs among neonates, children and adults leading to different and conflicting results in the treatment of hydrocephalus using neuroendoscopy. The aim of our study was to review the literature regarding to analyze predictive clinical and imaging models available and discuss specific aspects of the endoscopic approach to hydrocephalus in infants Methods: Review of the medical literature to analyze predictive clinical and imaging models available and discuss specific aspects of the endoscopic approach to hydrocephalus children. Data of our series of ETV were analyzed. The patients were categorized in 3 groups: Group A (< 6 months of age), Group B (from 6 months to 1 year-old) and group C ( >1 year-old). Results: Group A - 12 patients , group B - 17 patients and group C - 85 patients. The etiology of hydrocephalus was tumors in 33 (29 %), aqueduct stenosis in 33 (29 %), cerebral malformations in 24 (21 %). The ETVSS in the low, moderate and high ETVSS groups was respectively 40%, 70.9% and 92.6%, the actual success rate: 58%, 65% and 86%. The complication rates in groups A, B and C were 33 %, 24 %, and 8 %, respectively (p=0.022). Conclusion: Endoscopic third ventriculostomy provides very good results for a number of indications in children. Every effort should be made to optimize the selection of surgical candidates on the basis of their clinical features.

Background: Posterior fossa dermoid cysts are rare, benign lesions whose diagnosis can be quite challenging because of their slow growth and subsequent paucity of symptoms. We present herein an unusual case of recurrent cerebellar abscesses induced by an adjacent extradural dermoid cyst with a complete occipital dermal sinus. Methods: The authors report the case of a 20-month-old girl who presented with signs of acutely raised intracranial pressure and whose head scans showed a left cerebellar hemisphere abscess associated with obstructive hydrocephalus. The patient was treated initially with an external ventricular drain, followed by burr-hole aspiration of the abscess and long-term antibiotics. Since the cerebellar abscess recurred, a posterior fossa craniotomy was performed and gross total resection of the lesion along with the dermal sinus tract and abscess contents was achieved. Histopathological analysis confirmed a dermoid tumor. Conclusions: The occurrence of recurrent cerebellar abscesses must always rise up the suspicion of an associated dermoid cyst. Neuroradiological scans should be carefully evaluated in search for this lesion. Once the diagnosis is established, radical resection of the cyst, sinus tract and infectious components is the treatment of choice.

Introduction: Hydrocephalus is a multifactorial disease, affecting the dynamics of cerebrospinal fluid (CSF) and leading to severe neurological impairment in children; in spite of the recent advances in hydrocephalus research, it has many physiopathological aspects that still remain poorly understood, especially after treatment. Objectives: To analyze the clinical, radiological, histopathological, and biochemical aspects of kaolin-induced hydrocephalus in an experimental model, both in the acute phase and after shunt treatment, by means of behavioral tests, magnetic resonance imaging (MRI) scans, histopathological studies, and level of inflammatory interleukins in the CSF. Methods: Seven-day-old Wistar rats were used and subdivided into three subgroups: treated hydrocephalic (n = 24), untreated hydrocephalic (n = 17), and controls (n = 5). The hydrocephalic groups underwent cisternal injection of 15% kaolin for induction of hydrocephalus at 7 days of age. The treated group was submitted to a ventricular-subcutaneous shunt (VSCS) 1 week after induction. All animals were euthanized at 21 days of age. They underwent motor function and memory testing as well as brain MRI scans. Histopathological analysis for glial fibrillary acidic protein and Ki-67 was done, and CSF was collected for measurement of IL-1β, IL-6, and TNF-α. Results: The average time to reach the water maze platform was highest in the untreated hydrocephalic group. The magnetization transfer rates were 37.21 and 33.76 before and after shunting, respectively. The mean astrocyte counts were 2.45, 1.36, and 90.5 for shunted, untreated, and control animals, respectively. The mean CSF IL-1β concentrations were 62.3 and 249.6 pg/mL, the average IL-6 levels were 104.2 and 364.7 pg/mL, and the average TNF-α values were 4.9 and 170.5 pg/mL for the treated hydrocephalic group and the untreated group, respectively. Conclusions: Pups treated with a CSF shunt showed better performance on memory tests. VSCS did not revert demyelination caused by hydrocephalus. Likewise, reactive astrocytosis and cell proliferation over the germinal matrix were not reversed after shunting. Hydrocephalic animals had raised levels of inflammatory interleukins, which returned to normal after treatment.

This paper investigates the relationship between country-risks (or conflicts) within countries and electricity production. The determinants of electricity production have been neglected in the literature that favours the relationship between energy consumption, growth and development, and despite of the major challenges on electricity supply systems. We empirically establish that weighted conflict index, as well as sub-items as anti-government demonstrations, government crises and riots negatively influence electricity production per capita, after controlling for income per capita. Country conflicts affect electricity production mostly in the long-run. Our results imply that conflicts may affect electricity production substantially and consequently the economy as a whole. Policy should emphasize the institutional framework to avoid conflicts within countries in order to secure electricity production.

This paper shows that the effect of income on the energy mix depends on the democracy level. We find that more democratic countries tend to depart from the hydroelectric power, oil, and geothermal sources of energy to rely on coal, natural gas, and modern renewable sources (nuclear, biomass, wind, and others). Less democratic countries tend to become more dependent on oil and natural gas with their own development. Moreover, the energy ladder transition from hydroelectric sources to natural gas appears to be escalated more quickly for less democratic countries. These transitions are thus more environmental friendly for more democratic countries than for less democratic ones. An extended multinomial fractional regression model is proposed to test and deal with the endogeneity of income.

Hypertrophic olivary degeneration (HOD) is a rare transsynaptic form of degeneration occurring after injury to the dentato-rubro-olivary pathway (“Guillain-Mollaret triangle”). The majority of studies have described HOD resulting from posterior fossa (PF) hemorrhage or infarction. HOD in patients undergoing PF surgery has not been well characterized. These lesions are rare and symptomatic children with HOD are even more uncommon. The purpose of this study was to evaluate HOD that develops after PF operations in children. A literature review was carried out describing 37 pediatric cases of HOD in 13 articles. In addition, two new cases of our own experience were included. HOD is a rare complication related after PF tumors surgery and symptoms may be misdiagnosed with pediatric cerebellar mutism syndrome. Children with HOD usually do not develop palatal tremor but ataxia is common.

The study of the deeply rooted determinants of development, technology and innovation is a very recent strand of the literature. This paper investigates the relationship between technology in 1500 and the ancestral genetic diversity of populations. It shows a strong hump-shaped relationship between genetic diversity and technological developments in 1500. This means that some of the technological achievements may stem from the genetic diversity mostly determined more than a millennium before. Results are robust to the introduction of several controls and to IV estimation. Moreover, our results highlight that agriculture and communication were the technologies most influenced by genetic diversity.

Craniopharyngiomas can be a surgical challenge for the pediatric neurosurgeon. Ideally, total removal must be achieved. However, the need to reduce surgical morbidity and preserve quality of life has led to a number of neurosurgical approaches in order to attain this goal. The aim of this article is to present an alternative surgical approach to these lesions and to provide the rationale for this technique. Medical charts and operative records of eight pediatric patients harboring craniopharyngiomas who underwent surgical treatment using a supraorbital eyebrow approach (SOA) were reviewed from 2014 to 2016. Only patients younger than 18 years with a minimum follow-up of 12 months were included in this study. Using pre-operative magnetic resonance (MRI) scans, tumors were classified according to their degree of hypothalamic involvement. The surgical technique is also described in detail. The study group included six males and two females with a mean age of 10 years (range, 2–16 years). The SOA was used successfully in elective surgery of eight craniopharyngiomas. The hypothalamus was displaced by the tumor in three patients and severely involved in five patients. Subtotal resection was undertaken in six patients, whereas gross-total resection was achieved in two. Endoscopic assistance was used after standard microscopic visualization in two out of eight cases. Cosmetic outcomes were excellent, and the complication rate related to the surgical procedure was quite low, apart from diabetes insipidus (which occurred in three out of the eight patients). In one patient, a large subdural collection needed surgery for evacuation. Mean follow-up was 23.2 months (range, 12–36 months). Additionally, no CSF leak or wound infection was identified. The supraorbital eyebrow approach is an alternative route to operate on craniopharyngiomas in properly selected cases of all pediatric age ranges, from infants to teenagers. There is sufficient working space for the endoscope and all instruments, allowing for endoscopic assistance and bimanual surgical technique. Cosmetic results are excellent, and complications related to the approach are minimal.

Surgical treatment of epilepsy in children often involves brain areas outside the temporal lobe and, therefore, techniques for extratemporal surgery must be included in the armamentarium of epilepsy surgery centers. Nowadays, disconnective procedures are preferable to traditional resective operations because they reduce the rate of complications related to extensive resections while achieving equivalent seizure outcomes. This article describes the practical anatomy and surgical techniques used for temporoparietooccipital (TPO), parietooccipital, and frontal disconnections, as well as the possibility of extending previous lobar disconnections to the whole hemisphere (hemispherotomy).