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e services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern, and neurosurgeons worldwide should consider the optimal strategies to mitigate these risks as the pandemic eases.

Sonolucent cranioplasty implants were recently introduced into clinical practice and tested for use with transcranioplasty ultrasound (TCUS). In situations where dural substitutes (DSs) are needed during closure, such as in extracranial-intracranial bypass, it is unclear if the DS influences the imaging quality of TCUS. The aim of this study was to assess the influence of DSs on imaging quality during TCUS assessment with sonolucent cranioplasty.

A tofu vascular brain model was constructed with a ClearFit implant in between 2 layers of tofu. Injection of saline solution through a 6-F Envoy DA XB endovascular catheter (6-F Envoy DA XB) inserted into the deeper tofu layer mimicked an intracranial vessel. TCUS image quality, including Doppler, with 4 different DSs (DuraGen, Durepair, DuraMatrix-Onlay, DuraMatrix Suturable) placed under the cranioplasty was compared against a control by 2 examiners. A literature search of MEDLINE and EMBASE was conducted to find previous reports of acoustic properties of DSs.

TCUS assessment including Doppler was feasible with the model in longitudinal and axial planes, and the pulsatile particle injection was visualized in real time. DuraGen and Durepair showed Doppler quality and picture detail comparable to the control, while the DuraMatrix-Onlay and DuraMatrix Suturable were inferior to the control. The literature search yielded only 1 previous report on acoustic properties of DSs.

DSs interfere differentially with imaging quality during TCUS assessment. However, these results are based on a benchtop model and need to be further assessed in the clinical setting.

DSs interfere differentially with imaging quality during TCUS assessment. However, these results are based on a benchtop model and need to be further assessed in the clinical setting.

Microvascular decompression with transposition of the involved vessels provides good surgical outcomes in cases of complex and recurrent neurovascular compression syndromes. We conducted a literature review to illustrate the variations in the surgical techniques used for transposition and to provide a practical decision-making scheme for transposition of the involved vessel.

A PubMed Medline database record search was conducted using the following algorithm ("Microvascular Decompression Surgery"[Mesh]) OR (((Microvascular) OR (Macrovascular)) AND decompression AND surgery) AND (transposition). Only articles that detailed the intraoperative techniques were included.

A total of 48 articles were included. The adjacent anatomical walls to which the compressing vessel can be anchored were divided into 4 groups; A roof (tentorium cerebelli), B anterior wall (posterior surface of petrous bone and clivus), C posterior wall (petrosal surface of the cerebellum), and D "no wall" required. A new decision-making schne the technique and material that can be used to anchor involved vessel. This scheme is an efficient method to inform the intraoperative decision-making process.

Recurrent hydrocephalus may occur as a complication of neurosarcoidosis with chronic inflammation. We present a case that required a combination of multistage endoscopic diversion of the cerebrospinal fluid pathway and shunt surgery.

A 34-year-old man presented with progressive nausea and vomiting. Magnetic resonance imaging revealed hydrocephalus with leptomeningeal enhancement along the base of the fourth ventricle and the bilateral foramina of Luschka. Concurrent endoscopic third ventriculostomy and biopsy were performed. The diagnosis was neurosarcoidosis. Immediately after the procedure, the endoscopic third ventriculostomy stoma was occluded, and a right ventriculoperitoneal shunt was urgently performed. However, left unilateral hydrocephalus developed during the late phase of immunosuppressive therapy for neurosarcoidosis. Endoscopic septostomy with repositioning of the ventricular catheter was indicated. Intraoperative findings included a white pasty tissue with nodules that covered the ventricular wall close to the foramen of Monro and sealed the side holes of the catheter. Chemotherapy with a tumor necrosis factor-α inhibitor was initiated after the surgical procedure. The patient had an uneventful course without recurrence of hydrocephalus for >6 months.

Endoscopic diversion of the cerebrospinal fluid pathway should be actively considered for treating hydrocephalus without a shunt and performing biopsy simultaneously. Even if a subsequent shunt is needed, complex hydrocephalus can be avoided with a combination of endoscopic techniques.

Endoscopic diversion of the cerebrospinal fluid pathway should be actively considered for treating hydrocephalus without a shunt and performing biopsy simultaneously. Even if a subsequent shunt is needed, complex hydrocephalus can be avoided with a combination of endoscopic techniques.

We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti.

We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis.

We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%.

The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.

The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Climbazole Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.