Volume 26: Issue 5 (Nov 2020)
inJournal of Neurosurgery: PediatricsIllustration from Aldave (pp 572–577). Images created by Katherine Relyea and printed with permission from Baylor College of Medicine.
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In Brief
Most pediatric management strategies are extrapolated from adult studies, including the standard practice of maintaining the head of bed (HOB) at a 30° elevation to minimize the risk of elevated intracranial pressure (ICP). In this prospective study of pediatric patients with severe TBI, the authors investigated the effect of different head positions on ICP, cerebral perfusion pressure, and cerebral venous outflow through the internal jugular veins on postinjury days 2 and 3, days considered as the peak risk for intracranial hypertension. They show that the optimal HOB needs to be individualized for each TBI patient, even on a daily basis.
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In Brief
The objective of this study was to seek explanations for racial disparities in trauma-related mortality after traumatic brain injury (TBI) in childhood. The study succeeded in narrowing the field of possible explanations to factors recorded in the Trauma Quality Improvement Program (TQIP) registry. After statistical adjustment for the clinical and system factors recorded in the registry, mortality among Black children was no worse than among White children. There is no need to invoke dietary, environmental, genetic, or epigenetic factors to explain this racial disparity in trauma outcomes. Efforts to eliminate disparities in TBI outcomes must focus first on processes recorded in the TQIP registry.
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In Brief
The authors studied anxiety, depression, fatigue, and headache burden in the pediatric hydrocephalus population. This study is important because knowing the prevalence of these factors in this population provides an opportunity to potentially increase the quality of life by addressing these psychosocial comorbidities.
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In Brief
The authors used survey methodology to elicit information regarding what treatment-related factors are important and how they are prioritized in order to arrive at a treatment preference when a family is confronted with a decision regarding the initial surgical treatment for childhood hydrocephalus. The authors believe that patient/parental preferences and how they impact treatment choice is an underexplored yet vitally important topic, and the information presented here is valuable from many perspectives.
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In Brief
A neurodevelopmental outcome analysis and brain volumetry study was performed in children who underwent neuroendoscopic lavage due to hydrocephalus after interventricular hemorrhage in the neonatal period. This is the first outcome analysis for a cohort of patients who underwent neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates.
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In Brief
The authors instituted a new shunt protocol utilizing intraventricular and topical vancomycin and describe their shunt infection rates over a prolonged period of time. Their results are hypothesis generating, and the authors propose that intraventricular and topical administration of vancomycin as part of a standardized shunt operation protocol may be an appropriate option for preventing pediatric shunt infections.
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In Brief
Neurosurgeons use the size of the cerebral ventricles to diagnose hydrocephalus, but no reference exists for normal growth patterns in children. In this study, the authors used a computer program to calculate the 3D volume of the ventricles from 687 brain MRI scans obtained in normal children, which produced normal growth curves. These normal growth curves can help clinicians detect patterns of abnormal growth of the cerebral ventricles and diagnose hydrocephalus in the appropriate clinical context.
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In Brief
The authors performed a retrospective single-center study to evaluate the safety of responsive neurostimulation (RNS) in pediatric patients with drug-resistant epilepsy. The results suggested that RNS is a safe and efficacious treatment, with infections being the main complication.
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In Brief
The authors analyzed whether intraoperative electrocorticography (ECoG) has an effect on epilepsy surgery outcomes in children. They established that patients who underwent ECoG-guided modification of the surgical plan achieved significantly higher rates of seizure freedom than those in whom the modification was not feasible, and the long-term complication rate was not higher in this group of patients. Based on this study, intraoperative ECoG is a reliable tool to guide resection and predict seizure outcomes in pediatric patients undergoing epilepsy surgery.
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In Brief
在这项研究中,作者旨在确定whether insular resection results in cognitive or developmental decline after epilepsy surgery in children with focal cortical dysplasia. Insular epilepsy surgery did not carry a significant reduction in intellectual/developmental quotient. This study provides additional evidence on cognitive and developmental risks in pediatric epilepsy surgery involving the insula.
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In Brief
The authors redefine the morbidity and yield of biopsy procedures in the modern era of frameless navigation, advanced preoperative imaging, and intraoperative MRI (iMRI) and demonstrate that brainstem biopsies can be accomplished with a high degree of safety and efficacy. A multidisciplinary approach to target selection is critical to a successful outcome.
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In Brief
The survival course of congenital glioblastoma in infants diagnosed within their first 3 months of life was modeled. Overall survival of these patients was shown to be much longer than that of adult glioblastoma, and their survival can be predicted by the use of chemotherapy and resection. This study indicates that congenital glioblastoma should not be viewed similarly to adult glioblastoma, but rather as a separate clinical entity.
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In Brief
The author presents his experience with a novel transcallosal translamina terminalis approach for resection of a large craniopharyngioma. This corridor allows the optimal opening of the lamina terminalis extending up to the anterior commissure, providing a wider exposure of the tumor compared with the classic approaches through the lamina. The author demonstrated that this approach can constitute a safe option for select suprasellar tumors and be an additional resource in the neurosurgical armamentarium.
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In Brief
The authors report on the first prospective case series of children (n = 14) with different brain lesions involving motor- or language-eloquent locations who were scheduled for transcranial magnetic stimulation (TMS) motor and/or language mapping and consecutive diffusion tensor imaging fiber tracking of motor- and language-related white matter tracts. They analyzed the feasibility of TMS and its influence on counseling and surgical strategy. In 6 patients the surgical strategy was adapted according to navigated TMS data, and in 6 patients the extent of resection was redefined.
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