Volume 31: Issue 5 (May 2023)
inJournal of Neurosurgery: Pediatrics-
In Brief
Flexible neuroendoscopy is shown for navigation through a dilated cerebral aqueduct to fenestrate a fourth ventricular arachnoid cyst and perform endoscopic third ventriculostomy for management of hydrocephalus through a single frontal entry burr hole. Treatment of fourth ventricular arachnoid cysts has not been widely discussed in the literature, and this is the first description of the use of flexible neuroendoscopy to treat a child with this pathology. The authors discuss key surgical considerations, anatomy, and operative technique.
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In Brief
This case-control study aimed to investigate possible risk factors for the development of congenital hydrocephalus (CH) in low- and middle-income country settings. Maternal diseases during pregnancy, younger maternal age, lack of periconceptional folic acid intake, being a housewife, paternal illiteracy, consanguinity, use of assisted fertilization, and presence of other congenital anomalies were shown to increase the risk of having a child with CH. Some modifiable risk factors are amenable to public health interventions to decrease the burden of CH.
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In Brief
The objective of this study was to estimate the diagnostic performance of parents for recognizing ventriculoperitoneal shunt failure in their child. The parental sensitivity was 66.7%. Parents who were more knowledgeable of their child's disease and had good communication with their neurosurgeon were found to have better diagnostic sensitivity. These results suggest that communication strategies should be reviewed, especially in vulnerable populations. In low- and middle-income countries, having an additional screening tool for diagnosing shunt malfunction could save lives.
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In Brief
Despite the merits of endoscopic third ventriculostomy (ETV) instead of shunt revision at the time of shunt malfunction (secondary ETV), concerns about its efficacy and complications remain. This meta-analysis demonstrated relatively good overall pooled rates of success at 3, 6, and 12 months of follow-up with low rates of complication. This meta-analysis suggests that secondary ETV is an effective, safe, and feasible option that is worth considering in pediatric patients with shunt malfunction.
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In Brief
The objective of this paper was to use semistructured interviews with caregivers of children with hydrocephalus to understand the stresses and coping mechanisms involved with an initial diagnosis and with living with hydrocephalus. A top priority for parents was balanced, trustworthy information, available and updated throughout the child's life. This information can help pediatric neurosurgeons design systems to better support families living with hydrocephalus.
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In Brief
巴氯芬泵手术部位感染(SSI) in children is very high and represents a significant source of morbidity, yet the patient- and procedure-specific risk factors and effective strategies to mitigate infection risk are poorly understood. The authors conducted the first multicenter prospective effort to study this problem using the science of quality improvement through the Cerebral Palsy Research Network, demonstrating 75% compliance with a 13-step surgical protocol and an overall infection rate of 4.2%. Using these data to further refine a protocol and expanding its use may lead to significant reduction of SSI complicating CSF shunt surgery.
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In Brief
作者知识的变化相比,改编电影tive, and quality-of-life (QOL) scores in children with craniopharyngioma who underwent treatment with gross-total resection (GTR) versus partial resection followed by radiotherapy (PR+RT). No significant differences in the trajectory of intellectual functioning or QOL were observed. However, patients treated with GTR exhibited significant improvements over time in overall adaptive behavior (p = 0.04) and conceptual skills (p = 0.01) compared with patients treated with PR+RT. These results provide new insight and evidence to guide the decision-making process in the management of craniopharyngiomas.
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In Brief
This study represents the largest series of incidental unruptured brain arteriovenous malformation in children to date. Compared with their symptomatic counterparts, incidental unruptured brain arteriovenous malformations were smaller in size, and a lower proportion of these patients had deep venous drainage and they presented at a younger age. Incidental unruptured brain arteriovenous malformations can have excellent outcomes with this treatment algorithm: size < 3 cm with microsurgical resection (with or without embolization), size > 3 cm, or inoperable location with radiosurgery.
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In Brief
破裂风险异构大脑法国当代艺术有不同的看法riovenous malformations (AVMs), and the authors sought to characterize how variations in AVM rupture risk in pediatric compared with adult patients affect individual 5-factor R2eD AVM scores. The results demonstrated that the R2eD AVM score was not useful for clinical application in pediatric AVM patients and suggest that differences exist between adults and children related to factors associated with the presentation of hemorrhagic brain AVMs.
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In Brief
The objective of this study was to create a clinical vagus nerve stimulation (VNS) prediction tool for use in an outpatient setting. Despite large sample size and rigorous model optimization, clinical variables alone were not able to accurately predict VNS response among pediatric patients with drug-resistant epilepsy. This score may be useful after further validation, although its predictive ability underscores the need for more robust biomarkers to predict treatment response.
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In Brief
A cohort of pediatric neurosurgeons was surveyed regarding the management of asymptomatic newborns with lumbosacral findings. High levels of agreement (> 90%) were found regarding the need for imaging of subcutaneous lipomas, faun tail nevi, large skin tags, and deep/atypical lumbosacral dimples. Low levels of agreement (< 70%) were found for vascular marks and gluteal crease deviations. Evidence regarding the usefulness of these findings as markers of occult spinal dysraphism is needed to guide clinical decision-making.
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In Brief
The purpose of this study was to investigate the effects of pudendal nerve tetanic stimulation on motor evoked potentials (MEPs) in pediatric craniotomy. The authors observed the amplification effect of MEPs with pudendal nerve tetanic stimulation, and the amplification effect of direct cortical stimulation on MEPs without increasing false negatives in pediatric craniotomy. These findings suggested the likelihood of more accurate intraoperative MEP monitoring in pediatric craniotomy cases.
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In Brief
The authors sought to compare the ability of resting-state functional MRI (rs-fMRI) for language lateralization in the pediatric population with conventional task-based fMRI (tb-fMRI) used as the gold standard. The language laterality concordance between tb-fMRI and rs-fMRI data ranged from 68% to 80% for assessment based on the laterality index of the independent component analysis with the highest Jaccard Index and for subjective evaluation by visual inspection of activation maps, respectively. There was insufficient evidence to support rs-fMRI independently in securing lateralization of language.
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In Brief
Researchers examined cerebral pressure autoregulation (CPA) using the pressure reactivity index (PRx) and optimal cerebral perfusion pressure (CPPopt) in children with severe traumatic brain injury (TBI). They found that preserved CPA (low PRx) was associated with favorable outcome. CPPopt appears to be higher when CPA is most impaired. CPPs below CPPopt contributed to unfavorable outcome in young children. These findings increase the knowledge of CPA in pediatric TBI, which may be of importance for the future management.
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