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tumor, that are amenable to surgical resection. Seizures whose originations appear on EEG as regional in nature may require further evaluation to pinpoint their sources. In this case, surgeons implant electrodes onto the brain and observe patients in the ICU. Vagus nerve stimulation is a noncura- tive option for generalized epilepsy treatment. This therapy involves implant- ing a generator under the collarbone with subdermal leads connecting to the left vagus nerve in the neck. The generator sends signals of predetermined intensity and chronological intervals to the vagus nerve that, in turn, sends signals to the brain that will reset abnormal signals causing seizures. Decreasing the number and severity of abnormal signals from the vagus nerve to the brain has been demonstrated to be effective for manag- ing seizures. Patients who experience warning signs of oncoming seizures use a magnetic device to initiate the generator and stave off the seizure. When nonsurgical options fail, Dr. Trinidad performs surgery using neuronavigational imaging technology for enhanced visualization. Magnetic resonance imaging (MRI) studies are loaded onto a computer, which registers and plots the imaging into a 3-D virtual map of the brain. This advanced technol- ogy allows Dr. Trinidad to precisely locate her instrumentation and the anatomy of the patient's brain, providing exact data to plan and complete a surgical procedure. Room to Grow For patients with craniosynostosis, a condition characterized by the premature fusion of an infant's cranial sutures, early diagnosis and treatment is the gold stan- dard. To treat these patients, Dr. Trinidad surgically removes the prematurely fused suture. If there are multiple fused sutures, causing irregular head and brain growth that may potentially cause headaches and retarded development, surgery to remove fused sutures must be repeated to allow for normal growth. Dr. Trinidad notes that careful attention to hemostasis is essential because of lower blood volume in pediatric patients, so she uses a combina- tion surgical resection and electrocautery device to prevent delayed bleeding from the bone — the area responsible for significant postoperative bleeding. Spinal Fluid Circulation and Its Problems Commonly presenting with head- aches, Chiari malformations affect approximately one in 1,000 people and may be accompanied by symptoms such as choking or swallowing problems, ringing in the ears, or the development of a syrinx — a cavity in the spinal cord formed by improperly circulating spinal fluid — that can cause pain in extremi- ties and balance problems. Infants may also present with a bulging fontanel or rapid head growth. Early treatment for a Chiari malformation is paramount, as a patient who does not receive treatment can experience vomiting and depressed consciousness that may precipitate coma and death. If, however, in older children, symptoms persist and interfere with the patient's quality of life, surgical intervention to decompress the Chiari malformation is initiated. To decompress the chiari malformation and relieve the crowding around the foramen magnum, a portion of the skull at the back of the head is removed. Dr. Trinidad opens the cover of the brain and performs a duraplasty — removal of the dura, the outermost layer of tissue protecting the brain — to facilitate better circulation of spinal fluid. Many of Dr. Trinidad's patients see immediate results and remain in the hospital for five days on average. Treatment for Pediatric Brain and Spinal Cord Tumors Neurosurgeons at Neurological Surgery, P.C. are equipped to treat the entire range of pediatric brain tumors, including craniopharyngiomas, medul- loblastomas, and tumors located in the pineal region. While resection is ideal, inoperable tumors and those located in the pineal region can be treated using Gamma Knife or CyberKnife technology. According to Dr. Grant, the initial goal is intuitive: entirely remove the tumor, if possible. Craniopharyngiomas present a techni- cally challenging combination of surgical and radiation treatment. Dr. Grant notes that the tumor itself is benign, but its location near the pituitary gland and Dr. Trinidad measures the growth of the baby's head. This is important in treating hydrocephalus, craniosynostosis and plagiocephaly. Dr. Trinidad treated this baby for plagiocephaly.

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