Volume 29: Issue 2 (Feb 2022)
inJournal of Neurosurgery: PediatricsIllustration from Kozyrev et al. (pp 141–149).
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In Brief
An international working group of female pediatric neurosurgeons summarized the status and challenges of women in pediatric neurosurgery worldwide. Unmet needs were found to include board certification, the recognition of pediatric neurosurgery as a subspecialty, a lack of female pioneers, and academic advancement. The present study has provided significant data and an international perspective to address advancements for women in this field.
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In Brief
The authors sought to evaluate the natural history and pathological spectrum of incidental thalamic tumors in children from eight pediatric centers. The key finding was that thalamic incidentalomas in children included mostly low-grade lesions; however, high-grade lesions may also present as incidentalomas. Thus, radiological follow-up of lesions is mandatory, as even lesions with a typical low-grade appearance may evolve over time.
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In Brief
Researchers investigated the dosimetric parameter associated with long-term control of sellar and parasellar tumors after Gamma Knife surgery. D98% was significantly associated with long-term tumor control, with D98% ≥ 10 Gy being necessary for craniopharyngiomas. The study results have shown that D98% would be a reliable index of the minimum required dose for long-term control of sellar and parasellar tumors in proximity to the optic apparatus, helping clinicians prescribe the proper effective dose for tumor control while maintaining safety, especially in regard to radiation-induced optic neuropathy.
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In Brief
在这项研究中,作者试图量化burden of pediatric neurosurgical disease in a rural developing country. Pediatric neurosurgical disease, predominantly trauma and congenital anomalies, accounted for 20.4% of the total neurosurgical needs at a single center in Nigeria. The study results provides insight into the burden of pediatric neurosurgical disease and the barriers to neurosurgical care in a low-middle-income country.
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In Brief
The authors have enumerated all previously reported high-confidence congenital hydrocephalus risk genes, as well as reviewed the history of gene discovery and particular phenotypic findings for each gene. Additionally, they have provided evidence of an increasing gene discovery rate as sequencing technologies become increasingly more accessible, the multifold benefits of genetic diagnosis, and the necessity of further gene discovery and functional investigation to improve clinical understanding. Incorporating genomic investigation into the workup of all patients with complex congenital hydrocephalus is recommended.
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In Brief
Researchers investigated variables associated with postoperative seizures following endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC) for treatment of pediatric hydrocephalus. The most significant finding was that 0% (0 of 18) of patients who received prophylactic perioperative levetiracetam experienced postoperative seizures compared with 47% (9 of 19) of those who did not, indicating perioperative levetiracetam may be efficacious in preventing postoperative seizures. This study is the first to include EEG data showing that seizures may be associated with endoscope placement.
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In Brief
The objective of this study was to determine the various complications of neuroendoscopic septostomy and their incidence rates. Compared with endoscopic third ventriculostomy/choroid plexus cauterization, septostomy for other indications did not appear to harbor additional risk. In this large series, ventricular size, morphology, and other intraoperative factors did not affect the rate of complications.
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In Brief
Investigators reviewed a large cohort of children who underwent cerebral angiography to rigorously evaluate complication rates and risk factors. Complications occurred in 6.5% of procedures, including neurological complications in 1.9% and nonneurological complications in 4.8%. Most complications were transient. Female sex and a history of hypertension or ischemic stroke were associated with increased risk of complications. These findings may facilitate clinical discussions of risks and benefits of cerebral angiography in children.
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In Brief
预测的结果erior fossa decompression for pediatric patients with Chiari I malformation type (CM-I) hinges on the availability of reliable and holistic outcome assessment tools. The objective of this study was to incorporate patient-centered quality-of-life instruments in an outcome assessment. As measured with the Patient-Reported Outcomes Measurement Information System (PROMIS) tool, a pilot cohort showed moderate improvement of health-related quality of life after surgery. This report exemplifies the utility of patient-centered metrics in the evaluation of surgical treatment of pediatric patients with CM-I.
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In Brief
In this systematic review, the authors sought to review the published evidence on the use of cranial neuromodulation—deep brain stimulation (DBS) and responsive neurostimulation (RNS)—for pediatric drug-resistant epilepsy (DRE). From 35 studies, they found 72 children who had undergone DBS and 42 who had undergone RNS. Overall, 75% and 73.2% of DBS and RNS patients, respectively, experienced > 50% reduction in seizures. This study shows the paucity of evidence for promising treatment options for pediatric DRE.
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In Brief
The underlying biomechanical differences between the pediatric and adult cervical spine are incompletely understood. Computational spine modeling, like finite element modeling (FEM), can address that knowledge gap. A pediatric cervical spine FEM was created that accurately predicts axial tension and flexion-extension range of motion when ligamentous and annulus material properties are reduced to 50% of published adult properties. This model shows promise for use in surgical simulation procedures and as a normal comparison for disease-specific FEMs.
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In Brief
The authors sought to study predictors for early posttraumatic seizures (EPTSs) in children with moderate to severe traumatic brain injury (TBI), the association between EPTSs and death, and the association between EPTSs and poor functional outcomes. EPTSs occurred more commonly in younger children with TBI and were associated with poor functional outcomes among children who survived TBI. The authors’ findings have validated those of other single-center studies on the association between EPTSs and poor outcomes in children with TBI.
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