Rate of infusion and cannula size can significantly affect convective distribution of molecules, whereas preinfusion sealing time and variations in infusate concentration have no effect in this small animal model. Understanding the parameters that influence convective delivery within the CNS can be used to enhance delivery of potentially therapeutic agents in an experimental setting and to indicate the variables that will need to be considered for optimum use of this approach for drug delivery in the clinical setting.

Craniosynostosis is the premature fusion of one or more of the cranial sutures. About 8% of the patients have familial or syndromic forms of synostosis, and in the remainder it occurs as a spontaneous isolated defect. Familial craniosynostosis syndromes are typically transmitted as an autosomal dominant trait resulting in disruption of the fibroblast growth factor receptor pathway. Familiarity with the characteristic head shapes resulting from craniosynostosis allows bedside diagnosis and differentiation from positional plagiocephaly. Because of the risks associated with untreated craniosynostosis, surgical treatment is usually undertaken soon after diagnosis. Current surgical methods include open calvarial reconstruction, minimally invasive strip craniectomy with use of postoperative molding helmet, minimally invasive strip craniectomy with spring implantation, and cranial distraction. Early referral to a pediatric craniofacial center allows all treatment options to be explored.

The rate of serious complications from external lumbar drainage for normal pressure hydrocephalus is low. It is hoped that continued evaluation of the procedure will lead to further reductions in the complication rate.

Object Spinal aneurysmal bone cysts (ABCs) constitute a rare and clinically challenging disease, primarily affecting the pediatric population. Information regarding the management of spinal ABCs remains sparse. In this study the authors review their experience with spinal ABCs at Children's Hospital Boston. Methods The medical records of all patients treated surgically for primary spinal ABCs between January 1998 and July 2010 were retrospectively reviewed. Results Fourteen cases were identified (6 males and 8 females, ages 5–19 years old). The ABCs were located throughout the spine, with an equal number in the thoracic and lumbar spine, and rarely in the cervical spine. The majority of patients presented with back pain, but neurological deficits and spinal deformity were common. A variety of radiographic techniques were used to establish the diagnosis, including needle biopsy. Preoperative selective arterial embolization was performed in 7 cases (50%), and the majority of cases required spinal instrumentation along with resection. Mean follow-up was 55.9 months (range 15–154 months) after initial intervention. Two ABCs recurred (14%), at 9 months and 8 years after incomplete initial resection, and the patients underwent reoperation. Complete resection was ultimately achieved in all cases. All patients were asymptomatic and neurologically intact at their last follow-up evaluation, and showed no evidence of deformity or recurrence on imaging. Conclusions Computed tomography and MR imaging are adequate for an initial evaluation of spinal ABCs, although solid variants can present a diagnostic challenge. Given the high rates of recurrence with residual disease, complete obliteration of the lesion should be the goal of treatment. Preoperative embolization is often performed, although in the authors' opinion the degree of bleeding tends not to support its routine use. Long-term follow-up is warranted as recurrences can occur years after initial intervention. However, gross-total excision in conjunction with spinal stabilization, as needed, usually provides cure of the ABC and excellent long-term spinal alignment.