In Brief
Researchers utilized the area deprivation index (ADI) and the social vulnerability index to examine whether neighborhood disadvantage impacts interventions and outcomes of patients with craniosynostosis. Belonging to a more deprived ADI group was associated with greater risk of speech/language concerns and decreased likelihood of physician- or parent-reported desire for revision. Connecting families to community-based early intervention services and utilizing standardized clinic notes to document physical examination findings may help reduce existing disparities.
In Brief
The objective of this study was to compare open surgery and endoscope-assisted surgery in a single center to treat children < 6 months of age with craniosynostosis. This study is unique because none of the patients (with the exception of those diagnosed with coronal synostosis) used helmet therapy for the correction of craniosynostosis. To the authors' knowledge, this is the first study conducted in non-North American and non-European children showing the outcomes in craniosynostosis management.
OBJECTIVE
A literature gap exists comparing whole head shape outcome following correction of sagittal craniosynostosis. The objective of this multicenter study was to provide an analysis of long-term results following three different endoscopic strip craniectomy techniques for correction of sagittal craniosynostosis: 1) spring-assisted strip craniectomy, 2) wide-strip craniectomy with biparietal and bitemporal barrel-stave wedge osteotomies plus helmet orthosis, and 3) narrow-strip craniectomy plus orthosis without barrel staves.
开云体育世界杯赔率
预处理和术后3 d stereophotogrammetric images were collected from patients who underwent craniosynostosis surgery. Procedures were divided among institutions as follows: spring-assisted strip craniectomies were performed at Atrium Health Wake Forest Baptist Hospital; narrow-strip craniectomies were performed at St. Louis Children’s Hospital by one craniofacial surgeon; and wide-vertex craniectomies were performed at St. Louis Children’s Hospital prior to 2010, and then continued at Children’s Medical Center Dallas. Pre- and postoperative 3D whole-head composite images were generated for each procedure to visually represent outcomes at final follow-up and compared with age-matched normal controls.
RESULTS
Patients in the spring-assisted strip craniectomy group showed normalization of frontal bossing and skull height compared with age-matched controls, whereas patients undergoing wide-strip craniectomy showed greater correction of occipital protrusion. Patients in the narrow-strip craniectomy cohort had intermediate results between these outcomes. Nested aggregate head shapes showed good correction of head shapes from all techniques.
CONCLUSIONS
This large, retrospective, multicenter study illustrated whole head shape outcomes from three different craniectomy procedures. Although each procedure showed some differences in loci of primary correction, all three surgical methods demonstrated good correction of primary scaphocephalic deformity.
In Brief
This pediatric venous thromboembolism (VTE) prediction tool was developed for patients with traumatic brain injury (TBI). Diagnosis of ventilator-associated pneumonia and presence of a central venous catheter were the strongest VTE risk factors. The calculated VTE risks in patients with isolated severe TBI were higher compared to the results from existing tools for a broad trauma population.
In Brief
The objective of this study was to assess whether insurance status impacted healthcare resource utilization and outcomes in adolescent patients presenting with a spinal cord injury (SCI). The authors found that insurance status was not independently associated with obtaining imaging, undergoing surgery, hospital adverse events, or length of hospital stay. This study highlights the need to identify other patient- and hospital-related factors that may contribute to disparities in outcomes in adolescents presenting with SCI.
In Brief
Researchers used mathematical analysis to compare the intracranial pressure dynamics of dogs to the dynamics of a simple electrical tank circuit. The dynamics were very similar. This study provides insight into the means by which the arterial pulse is buffered in the cranium, and suggests a new understanding of hydrocephalus and other disorders of intracranial dynamics.
In Brief
作者的目的是调查马分流nagement in children with abdominal pseudocysts–peritoneal reimplantation versus implantation in a nonperitoneal site. The primary outcome was shunt failure (infection/malfunction). No differences were found in overall shunt failure rate; however, noninfectious shunt revisions were more common in the nonperitoneal distal catheter sites and infection was a more common reason for failure after reimplantation in the abdomen. This study will inform the management of abdominal pseudocysts in children with hydrocephalus.
OBJECTIVE
Pediatric primary brain tumors are the leading cause of death among childhood cancers. Guidelines recommend specialized care with a multidisciplinary team and focused treatment protocols to optimize outcomes in this patient population. Furthermore, readmission is a key metric of patient outcomes and has been used to inform reimbursement. However, no prior study has analyzed national database–level records to evaluate the role of care in a designated children’s hospital following pediatric tumor resection and its impact on readmission rates. The goal of this study was to investigate whether treatment at a children’s hospital rather than a nonchildren’s hospital has a significant effect on outcome.
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再入院全国数据库记录2010 to 2018 were analyzed retrospectively to evaluate the effect of hospital designation on patient outcomes after craniotomy for brain tumor resection, and results are reported as national estimates. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if craniotomy for tumor resection at a designated children’s hospital was independently associated with 30-day readmissions, mortality rate, and length of stay.
RESULTS
A total of 4003 patients who underwent craniotomy for tumor resection were identified using the Nationwide Readmissions Database, with 1258 of these cases (31.4%) treated at children’s hospitals. Patients treated at children’s hospitals were associated with decreased likelihood of 30-day hospital readmission (OR 0.68, 95% CI 0.48–0.97, p = 0.036) compared to patients treated at nonchildren’s hospitals. There was no significant difference in index mortality between patients treated at children’s hospitals and those treated at nonchildren’s hospitals.
CONCLUSIONS
The authors found that patients undergoing craniotomy for tumor resection at children’s hospitals were associated with decreased rates of 30-day readmission, with no significant difference in index mortality. Future prospective studies may be warranted to confirm this association and identify components contributing to improved outcomes in care at children’s hospitals.
In Brief
研究人员试图确定因素是predictive of tumor progression and/or the need for future tumor-directed treatment in pediatric patients with tectal plate gliomas. Patients with certain imaging characteristics or specific symptomatology at presentation were more likely to require future tumor-directed treatment. However, this patient population has excellent outcomes and survival overall, although there is still room for improvement in individualized treatment and disease course monitoring.
In Brief
Vasospasm following brain tumor resection in children and youth is a rare complication with a poorly understood pathophysiology. The authors present their institutional experience with this rare entity and supplement it with a systematic review. The authors reported an incidence of 3.5% and showed that this complication's clinical course is not benign, with most children and youth having significant disability at long-term follow-up. This study represents the largest pediatric case series in the published literature, as well as the first systematic review of vasospasm after brain tumor resection that focuses on pediatric patients.
In Brief
This case series presents 5 patients with a pathological diagnosis of subependymal giant-cell astrocytoma (SEGA), but they did not otherwise meet the clinical criteria for a diagnosis of tuberous sclerosis. All subjects had negative germline tuberous sclerosis complex (TSC) test results. This study highlights the fact that although tumors may carry aTSC1orTSC2mutation, not all children with SEGA have tuberous sclerosis.
In Brief
The objective of the paper was to determine the clinical characteristics of patients in whom a small, subhemispheric resection failed, who went on to become seizure free after undergoing a hemispherectomy. The presence of a known hemispheric pathology such as Rasmussen encephalitis or a pathology involving > 2 lobes such as focal cortical dysplasia is predictive of subhemispheric surgery failure. This study helps in selecting patients who should proceed to a hemispheric surgery and avoid smaller, less successful, subhemispheric resections.
In Brief
This paper is an individual patient data meta-analysis of 42 patients that evaluated the thalamic responsive neurostimulation (tRNS) outcomes for treating drug-resistant epilepsy (DRE). The authors found that tRNS resulted in a 73% seizure reduction rate in the entire population, with pediatric cases showing 75% seizure reduction and adult cases showing 69%. The authors additionally outlined other measures that should be included in future studies that use tRNS in order to better quantify this technique's success in treating DRE.
OBJECTIVE
Postnatal repair for myelomeningocele (MMC) is a time-sensitive and technically challenging procedure. More experienced hospitals may provide improved outcomes for the complexity of care associated with these patients. No prior study has investigated the impact of MMC treatment at pediatric hospitals. The authors sought to examine the effect of pediatric hospital designation on patients undergoing postnatal MMC repair to identify factors associated with maximizing improved patient outcomes.
开云体育世界杯赔率
再入院全国数据库记录2010 to 2018 were analyzed retrospectively to determine the effect of hospital designation on patient outcomes after postnatal MMC repair. Univariate and multivariate regression analyses of patient and hospital characteristics were conducted to evaluate if MMC repair at a designated pediatric hospital was independently associated with patient outcomes of perinatal infection rates, discharge disposition, and length of stay.
RESULTS
总数的6353 underw儿科患者ent postnatal MMC repair between 2010 and 2018, 2224 (35.0%) received care at a pediatric hospital. Those with an extreme level of disease burden as defined by the all patient refined diagnosis-related group severity of illness index were more likely to be treated at a pediatric hospital (p = 0.03). Patients undergoing repair at a pediatric hospital were also associated with a decreased likelihood of perinatal infection (OR 0.54, 95% CI 0.35–0.83, p = 0.005); greater likelihood of routine disposition (OR 4.85, 95% CI 2.34–10.06, p < 0.0001); and shorter length of stay (incidence rate ratio 0.88, 95% CI 0.77–0.995, p = 0.04).
CONCLUSIONS
Pediatric patients requiring intervention for postnatal repair of MMC may benefit from the multidisciplinary subspeciality care offered at pediatric hospitals. The authors found that postnatal repair of MMC at pediatric hospitals was associated with a greater likelihood of improved patient outcomes.
OBJECTIVE
Trigeminal neuralgia (TN) is a rare disorder, affecting 4–13 per 100,000 people annually. Only 1%–1.5% of these cases are reported before the age of 18 years. The initial management of pediatric TN is based on symptomatic treatment, using first-line medications including carbamazepine, based on data from adult treatment studies. Many of these children are refractory to medication and undergo excessive workup and ineffective therapies before neurosurgical referral. The objective of this study was to perform a comprehensive review of literature-reported pediatric-onset TN, analyzing demographics, diagnostic practices, and complications in this population.
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An institutional, retrospective chart review was performed to identify patients younger than 18 years old who were diagnosed with classic TN and referred for surgical evaluation at Oklahoma Children’s Hospital (OCH). A systematic review of all pediatric patients undergoing microvascular decompression (MVD) for pediatric-onset TN was also performed.
RESULTS
Three patients from OCH were identified, ranging in age from 3 to 11 years. All 3 patients had received multiple ineffective medical therapies before referral for neurosurgical evaluation. In 2 cases, imaging demonstrated potential vascular compression of the trigeminal nerve. In the final case, imaging demonstrated no vascular compression, but compression was found at the time of MVD. All cases were successfully treated using MVD. The literature review identified 49 cases of pediatric TN treated using MVD. All 49 cases were identified as classic TN with neurovascular compression demonstrated either on imaging or found at the time of surgery. The average age at symptom onset was 11.72 years, while the average age at MVD was 19.6 years. The average duration of symptoms before undergoing MVD was 8.2 years. There was a female predominance in the literature review, with a female-to-male ratio of 1.88:1. The right side was involved in 56% of cases, the left side in 40%, and bilateral involvement occurred in 4% of cases. The most common distribution of TN was both V2/3 branches (38%) of the trigeminal nerve, followed by solely the V2 branch (22%). A successful outcome (Barrow Neurological Institute pain intensity score of I or II) was reported in 79% of patients at the last follow-up (mean 69.1 months).
CONCLUSIONS
There are currently no guidelines for diagnosing or treating pediatric TN. MVD is a safe and effective option in this patient population. Early evaluation for surgical intervention could be critical for early pain relief and reduced disease morbidity.
In Brief
In adolescent athletes with sport-related concussion (SRC), the authors sought to assess the relationship between symptoms at the initial clinic visit and time to referral for vestibular therapy and evaluate whether earlier referral is associated with faster recovery. Although symptoms at the initial clinic visit did not predict time to vestibular therapy referral, patients with earlier referral had a faster concussion recovery. This study adds to the literature focused on the optimal timing and indications for referring patients to vestibular therapy following SRC.
TO THE EDITOR: We read with great interest the article by Bollo et al.
In Brief
This study aimed to establish normal growth curves for choroid plexus volume and lateral ventricles volume in the pediatric population. Rapid increases in choroid plexus and lateral ventricles volumes were observed until 1 year of age, followed by plateaus at approximately 1.5 ml and 10 ml, respectively. This study provides essential reference data for objectively assessing hydrocephalus and choroid plexus-related disorders in pediatric patients.
In Brief
There is no consensus on the safety of stereotactic biopsy in diffuse intrinsic pontine gliomas (DIPGs). Researchers characterized the risk of biopsy in DIPG patients by performing a systematic review. The mean age at diagnosis was 7.5 years, and the complication rate was 13%. No mortality was attributed to biopsy. With acceptable surgical risk and high diagnostic yield, biopsy of DIPG can allow for characterization of molecular features that may influence prognosis and the development of therapeutic strategies.
In Brief
Middle meningeal artery (MMA) embolization has gained traction in the treatment of chronic subdural hematoma (cSDH) in the adult population but has shown slower adoption in the pediatric age group. The authors describe their experience with MMA embolization for various indications in medically complex children with SDHs and discuss the technical considerations of performing this procedure in children. This work helps to define the indications for MMA embolization in the pediatric population and lays the groundwork for further study and adoption of this procedure within pediatric neurosurgery.
OBJECTIVE
In this study, the authors describe their 10-year single-institution experience with single-step complete corpus callosotomy (CCC) for seizure management in pediatric and adult patients with catastrophic, medically refractory, nonlocalizing epilepsy at Advent Health Orlando.
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The authors conducted a retrospective observational study of patients aged 6 months to 49 years who underwent clinically indicated CCC for drug-resistant nonlocalizing epilepsy at Advent Health Orlando between July 2011 and July 2021. Follow-up ranged from 12 months to 10 years.
RESULTS
Of the 101 patients (57% of whom were male) who met eligibility criteria, 81 were pediatric patients and 20 were ≥ 18 years. All patients had seizures that appeared poorly lateralized on both electroencephalograms and clinical semiological studies. Of 54 patients with drop seizures before CCC, 29 (54%) achieved stable freedom from drop seizures after CCC. Of the 101 patients, 14 (13.9%) experienced stable resolution of all types of clinical seizures (International League Against Epilepsy classes 1 and 2). The most common postoperative neurological complication was a transient disconnection syndrome, observed in 50% of patients; of those patients, 73% experienced syndrome resolution within 2 months after surgery, and all resolved by the 2-year follow-up. Formal neuropsychological test results were stable in 13 patients assessed after CCC.
CONCLUSIONS
CCC is an effective and well-tolerated palliative surgical technique. In this study, drop attacks were reduced after CCC but could recur for the first time as late as 44 months after surgery. Other seizure types were also reduced postoperatively but could recur for the first time as late as 28 months after surgery. Nearly 14% of patients achieved stable and complete freedom from seizures after CCC. Re-evaluation after CCC can reveal lateralized seizure onset in some patients.
In Brief
The objective of this study was to investigate whether gross-total resection (GTR) can prolong survival after pediatric ependymoma recurrence, not only for first recurrence but also subsequent relapses. The authors' findings suggest that GTR can result in long-term survival for both first local relapses and second recurrences. To the best of their knowledge, this is the first study to analyze the role of surgery in recurrent ependymomas on multiple recurrences.
In Brief
The authors present the surgical indications of pediatric Rathke's cleft cysts (RCCs), comparing 41 surgically treated and 52 observed patients. This study suggests that ophthalmological abnormalities are the major surgical indication. On the other hand, headache and endocrine abnormalities are not absolute indications for surgery. Cyst fenestration with partial wall resection via an endoscopic endonasal approach is the recommended surgical method. This study will contribute to determining the precise treatment strategy for pediatric RCCs.
In Brief
A historical review of stereoelectroencephalography (sEEG) is presented, beginning from its origins and detailing its constant, stepwise evolution over time. The authors present each step in its progression to its current form—a highly advanced, accurate, safe, and efficient intervention for valuable diagnostic epilepsy surgery. By understanding the history of sEEG, modern-day surgeons can investigate further refinements to continue this trend.
OBJECTIVE
Pediatric achondroplasia is often associated with conditions requiring neurosurgical intervention, including CSF diversion and multilevel spinal decompression. However, there is a lack of clinical guidelines and reliable estimates of the benefits and risks of these interventions. This study aimed to summarize the literature on the neurosurgical management of pediatric achondroplasia patients in order to aid in determining optimal treatment and standardization of care.
开云体育世界杯赔率
系统回顾的同行评审的研究an objective diagnosis of achondroplasia, patient demographic information, and available data on neurosurgical interventions performed before 18 years of age for cervicomedullary compression, spinal stenosis, and hydrocephalus was performed. Study quality and risks of bias were assessed using standardized scores. Independent patient data on surgical indications, outcomes, reoperations, and complication risks were aggregated using means and percentages.
RESULTS
Of 204 records, 25 studies with 287 pediatric achondroplasia patients (mean age 25 ± 36 months) treated for cervicomedullary compression (n = 153), spinal stenosis (n = 100), and obstructive hydrocephalus (n = 34) were evaluated. Symptomatic cervicomedullary compression occurred early in life (mean age 31 ± 25 months), with apnea (48%), T2-weighted MRI cord signal (28%), myelopathy (27%), and delayed motor skills (15%) requiring foramen magnum decompression observed in 99% of patients, as well as cervical laminectomy in 65% of patients. Although 91% of treated patients had resolution of symptoms, 2% mortality, 9% reoperation, and 21% complication rates were reported. Spinal stenosis was treated in relatively older children (mean age 13 ± 3 years) with laminectomy (23%), as well as with instrumented fusion (73%) for neurogenic claudication (59%), back pain (15%), and sciatica (8%). Although 95% of patients had symptom resolution after surgery, 17% reported complications and 18% required reoperation. Of the hydrocephalus patients (mean age 56 ± 103 months), half were treated with endoscopic third ventriculostomy (ETV) and half had a shunt placed for progressive ventriculomegaly (66%), headaches (32%), and delayed cognitive development (4%). The shunted patients had a 3% mortality rate and an average of 1.5 shunt revisions per patient. None of the patients who underwent ETV as the primary procedure required a revision.
CONCLUSIONS
Neurosurgical intervention for pediatric achondroplasia conditions, including cervicomedullary compression, spinal stenosis, and hydrocephalus, is associated with high recovery rates and good outcomes. However, complications and reoperations are common. Further studies with follow-up into adulthood are needed to evaluate the long-term outcomes.
In Brief
Researchers investigated the incidence and risk factors of coagulation dysfunction in pediatric epilepsy surgical patients. Valproate and low body weight increased the risk of coagulopathy, including thrombocytopenia and hypofibrinogenemia, and may lead to additional surgically related blood transfusion. More attention should be paid to the perioperative coagulation function of pediatric epilepsy surgical patients.
OBJECTIVE
The objective of this paper was to investigate the factors associated with successful epileptogenic zone (EZ) identification and postsurgical seizure freedom in pediatric patients with drug-resistant epilepsy who underwent first-time stereoelectroencephalography (SEEG).
开云体育世界杯赔率
The authors conducted a retrospective cohort study of all consecutive patients younger than 18 years of age at the time of recommendation for invasive evaluation with SEEG who were treated from July 2009 to June 2020. The authors excluded patients who had undergone failed prior resective epilepsy surgery or prior intracranial electrode evaluation for seizure localization. For their primary outcome, the authors evaluated the relationship between clinical and radiographic factors and successful identification of a putative EZ. For their secondary outcome, the authors investigated whether these factors had a significant relationship with seizure freedom (according to the Engel classification) at last follow-up.
RESULTS
The authors included 101 patients in this study. SEEG was safe, with no major morbidity or mortality experienced. The population was complex, with an MRI lesion present in less than 40% of patients and patients as young as 2.9 years included. A proposed EZ was identified in 88 (87%) patients. Patients with an older onset of epilepsy (OR 1.20/year, p = 0.04) or epilepsy etiology suspected to be due to a developmental lesion (OR 8.38, p = 0.02) were more likely to have proposed EZ identification. Patients with a preimplantation bilateral seizure-onset hypothesis (OR 0.29, p = 0.047) and those who underwent longer periods of monitoring (OR 0.86/day, p = 0.006) were somewhat less likely to have proposed EZ identification. The presence of an MRI lesion was a positive factor on secondary analyses (OR 4.18, p = 0.049; 1-tailed test). Fifty percent of patients who underwent surgical treatment with resection or laser ablation achieved Engel class I outcomes, in contrast to 0% of patients who underwent neuromodulation. Patients with a preimplantation hypothesis in the frontal/parietal lobes had increased odds of seizure freedom compared with patients with a hypothesis in other locations (OR 3.64, p = 0.01).
CONCLUSIONS
Pediatric SEEG is safe and often identifies a proposed resectable EZ. These results suggest that SEEG is effective in patients with frontal/parietal preimplantation hypothesis, with or without identified lesions on MRI.
In Brief
本研究的目的是报告长期comes of patients with craniopharyngioma undergoing surgical treatment and study rates of endocrinological and hypothalamic dysfunction in association with extent of resection. Both subtotal resection and gross-total resection were associated with significant endocrinological sequelae after 1 year. It demonstrated that even in cases in which subtotal resection was pursued, significant endocrine morbidity ensued. Only cyst aspiration, catheter placement, and other truly minimally invasive procedures spared hypothalamic insult.
In Brief
The authors conducted a systematic literature review of clinical characteristics and management of pediatric patients with diagnosis of brain tumor and related epilepsy. Neuro-oncological and epilepsy-focused approaches involving tumor-guided resection and resection supplemented by electrophysiology were investigated. The findings highlight the insufficiency of available data to favor one approach. The authors conclude that further prospective and multicenter investigations are needed to determine the optimal management approach for pediatric patients with brain tumor presenting with seizures.
OBJECTIVE
One consideration in pediatric stereoencephalography (SEEG) is decreased skull thicknesses compared with adults, which may limit traditional bolt-based anchoring of electrodes. The authors aimed to investigate the safety profile, complication rates, and technical adaptations of placing SEEG electrodes in pediatric patients.
开云体育世界杯赔率
The authors retrospectively reviewed all patients aged 12 years or younger at the time of SEEG implantation at their institution. Postimplantation CT scans were used to measure skull thickness at the entry point of each SEEG lead. Postimplantation lead accuracy was also assessed.
RESULTS
Fifty-three patients were reviewed. The median skull thickness was 4.1 (interquartile range [IQR] 3.15–5.2) mm. There were 5 total complications: 1 retained bolt fragment, 3 asymptomatic subdural hematomas, and 1 asymptomatic intracranial hemorrhage. Median radial error from the lead target was 3.5 (IQR 2.24–5.25) mm. Linear regression analysis revealed that increasing skull thickness decreased the deviation from the intended target, implying an improved accuracy to target at thicker skull entry points; this trended towards improved accuracy, but did not achieve statistical significance (p = 0.54).
CONCLUSIONS
This study found a 1.9% hardware complication rate and a 9.4% asymptomatic hemorrhage rate. Suturing electrodes to the scalp may represent a reasonable option if there are concerns of young age or a thin skull. These data indicate that invasive SEEG evaluation is safe among patients 12 years old or younger.
TO THE EDITOR: We read with great interest the work by Beaudreault and colleagues
In Brief
This study of 363 tethered cord release (TCR) surgeries is the largest single-institution series to date examining postoperative complications and long-term secondary retethering in both simple and complex TCR surgeries. Simple TCR surgeries demonstrated safety, rare complications, and low secondary retethering rates. Complex TCR surgeries showed higher risks of complications and secondary retethering. In complex TCR surgeries, modifiable risk factors, including operative laser use, may be linked to an increased risk of retethering in the long term.
TO THE READERSHIP: An error appeared in the article by Gayden et al. (
A typographical error in the name of gene mutation appears throughout the article. The mutation "c.4
In the
In this study, the authors detected a novel variant, c.496C>A in
In Brief
This study aimed to examine the rates of ventriculoatrial (VA) and ventriculoperitoneal (VP) shunt infection and failure in pediatric patients with a history of necrotizing enterocolitis. Patients with VA shunts required significantly more revisions and had a shorter time until failure than patients with VP shunts, but these groups had statistically similar numbers of infections. When feasible, neurosurgeons and pediatric surgeons can consider placing a VP shunt even if the patient has a history of necrotizing enterocolitis.
In Brief
This study sought to quantify the change in frontal deformities among neonates with metopic ridges over the 1st year of life. In a retrospective review, the authors found that the frontal bone angulation in isolated frontal ridge patients did not change significantly and was consistently > 2.2 radians. In comparison, surgically treated trigonocephaly patients had frontal bone angulations of < 2.2 radians. This work informs providers counseling families of neonates with frontal ridging.
In Brief
This objective of this study was to highlight the diagnosis and treatment of occipital neuralgia in pediatric patients The main finding was that in carefully selected patients, occipital nerve decompression is an effective treatment option for occipital neuralgia. Both visual analog scale pain scores and the number of pain medications were significantly reduced in the cohort postoperatively. This study adds an effective decision tree for adequate selection of surgical candidates and an educational video presenting the key aspects of the procedure.
In Brief
Researchers summarized the natural history, symptomatology, and predictors of hemorrhage of 131 patients treated at a single pediatric tertiary care center over a 17-year period. The familial cases (27% of the total) and patients with larger lesions were more likely to have progression of disease over a shorter time interval. Surgical intervention was effective in producing symptom resolution.
In Brief
The authors explored how various clinical factors affected the degree of obstruction and failure rates of ventricular catheters (VCs) used to manage hydrocephalus. The number of lifetime revisions, duration of implantation, and entry site of the VC correlated with the degree of VC obstruction but did not predict it. Contact of the VC with the ventricular wall and the age of the patient at their first surgery predicted the degree of VC obstruction.
In Brief
预测大脑半球切除术的成功应用t of medically refractory epilepsy is challenging. The Hemispherectomy Outcomes Prediction Scale (HOPS) was proposed to assist with prognosticating seizure outcomes after hemispherectomy. However, external validation of the score has not been performed. The authors performed a validation study of the HOPS score using their 20-year, two-surgeon experience. Logistic regression and Bayesian approaches were used to validate the HOPS score, but the data do not provide external validity. This approach underscores the need for rigorous, standardized, and prospective measures (including reliability and validity testing) for predicting outcomes in pediatric epilepsy surgery.
TO THE EDITOR: We read with great interest the article by Maleknia et al.
In Brief
Researchers sought to create H3 K27—altered diffuse midline glioma (DMG) cell lines and patient-derived xenografts without using precious tissue by simply washing the biopsy probe after sample collection. Probe washing after stereotactic needle biopsy for collecting viable DMG tumor cells for development of patient-derived cell lines and xenografts was feasible and safe. This new technique facilitates procurement of untreated tumor samples and the development of treatment-naive disease models at minimized additional risk to the patient.
In Brief
Researchers assessed socioeconomic and race-based differences in the treatment of sagittal synostosis. They found that Black children were more likely to undergo open vault reconstruction, had longer surgeries, and were from areas of greater socioeconomic disadvantage. The results reflect local state Medicaid policy, which did not cover postoperative helmet therapy for endoscopic sagittal synostosis repair. Due to the results of this study, the state Medicaid program changed its policy to cover postoperative helmet therapy for sagittal synostosis.
In Brief
The authors' multi-institutional investigation compared school-age anthropometric measurements obtained on 3D photographs and patient-reported outcomes among patients who underwent repair of isolated sagittal craniosynostosis with either calvarial vault remodeling or endoscopic strip craniectomy. The authors found that, at school age, endoscopic repair produced a clinically meaningful and significantly greater improvement in anthropometric outcomes compared with open repair. Referral to a craniofacial surgeon before 6 months of age is essential to allow patients to undergo this repair technique.
In Brief
Researchers reported their institutional experience of invasive group A streptococcus (iGAS) and intracranial infection raise awareness of the complications of iGAS and optimize neurological outcomes. Five children were treated for intracranial complications of iGAS. Neurological outcomes varied; 3 patients returned to near neurological baseline, 1 had significant residual neurological deficits, and 1 patient died. Awareness of intracranial complications of iGAS and prompt referral to a pediatric neurology or neurosurgical center is crucial to optimize neurological outcomes.
In Brief
The authors performed a systematic review to analyze clinical outcomes and anesthetic procedures for children undergoing awake craniotomy (AC). AC is used to maximize resection while protecting vital brain structures. However, concerns for safety and tolerability in children limit its use. The authors analyzed 30 articles for data that included incidences of intraoperative seizures, conversion to general anesthesia, completion of monitoring tasks, and postoperative complications in pediatric patients who underwent AC. Overall, the study results suggest that AC can be safe and tolerable in children.
In Brief
This article describes a novel placement technique of Ommaya reservoirs via a lateral supraorbital incision and supraorbital minicraniotomy for cystic craniopharyngiomas. This is an effective, safe, and cosmetically satisfactory approach in patients with cystic craniopharyngiomas that are causing local mass effect but are not amenable to traditional stereotactic or endoscopic Ommaya reservoir placement.
In Brief
研究旨在了解po的行为sterior fossa ependymomas in children and consolidated previously reported prognostic factors to reinforce the best therapeutic choices. The authors identified three types of involvement of the hindbrain and its correlation to progression-free survival. Thus, surgery should be carefully planned according to the involvement of the hindbrain, focusing on the gross-total resection. If not achieved on the first attempt, second-look surgeries and adjuvant radiotherapy are great strategies.
In Brief
Researchers conducted a survival analysis of children with medulloblastoma treated in a national public hospital in Peru. Failure to complete oncologic treatment was the most important factor associated with poor prognosis, both in terms of overall and event-free survival. High-risk patients and subtotal resection were also associated with poor prognosis. Interventions are needed to promote the completion of adjuvant oncologic therapy for medulloblastoma in disadvantaged populations.
In Brief
This proof-of-concept study tested a novel proximal access device, the intraparenchymal stent, to demonstrate feasibility for treatment of hydrocephalus in a validated ovine model. The stent successfully ameliorated ventriculomegaly with less clogging compared with that in the traditional ventriculoperitoneal shunt group. The stent design holds promise to increase shunt durability, lower costs, and provide access for percutaneous revision.
In Brief
The authors conducted a retrospective study to determine the indications and results of surgical treatment for sacral arachnoid cysts in pediatric patients. Surgery was found to be an effective treatment method in symptomatic sacral arachnoid cysts. This study contributed to the literature concerning the diagnosis, treatment, and follow-up process of this rare pathology in the pediatric age group.
TO THE READERSHIP: An error appeared in the article by Dias et al. (
In
Cox proportional hazards regression analysis on time to first TCR. Functional motor levels were referenced to upper lumbar rather than to thoracic levels, as subjects with thoracic-level lesions, lacking any
In Brief
In a large cohort of children with severe traumatic brain injury undergoing emergency hemicraniectomy, researchers identified diffuse axonal injury in the diencephalon and brainstem as powerful predictors of poor outcome.
TO THE EDITOR: I read with interest the article by Whitehead et al.
TO THE EDITOR: We read with great interest the article by Garcia et al.
In Brief
年代ocial determinants of health can have a profound effect on outcomes. The authors sought to determine if there are sociodemographic differences between patients who underwent fetal surgery versus those who underwent postnatal surgery for myelomeningocele. There was a significant difference in the commercial insurance rate and a marked difference in the racial and ethnic makeup of the two groups. Future studies should account for these demographic differences, and fetal centers should commit to minimizing preventable disparities.
T
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.
TO THE EDITOR: We read with great interest the article by Adamski et al.
Adamski et al. provided an excellent description of the contrast-based shuntogram technique and presented their experience with 95 cases, reporting a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 61.2% for valve failure within 1 year from the performance of the test. Of the patients with a negative result (with a normal flow of contrast), 38.8% were later
TO THE EDITOR: We read with great interest the article by Berns et al.
The "shunt design trial" that Berns et al. included in their analysis demonstrated that three valves commonly
In Brief
Investigators applied lesion network mapping to children with focal cortical dysplasia who underwent surgery for drug-resistant epilepsy. Lesion volumes with persistent seizures after surgery tended to have stronger connectivity to attention and motor networks and weaker connectivity to the default mode network, compared with lesion volumes with seizure-free surgical outcomes. Network connectivity–based lesion-outcomes mapping may offer new insight for determining the impact of lesion volumes discerned according to both size and specific location.
In Brief
The goal of this paper was to describe a neurosurgical educational partnership and the early results in developing pediatric craniofacial expertise in Southeast Asia. After brief, focused training through partnership with an institution in the United States followed by consistent telecollaboration, Vietnamese neurosurgical colleagues were able to rapidly scale up treatment of craniosynostosis with good outcomes. Global neurosurgical partnerships are feasible and effective methods of education and development of local neurosurgical expertise in low- and middle-income countries.
In Brief
The authors describe the joint collaboration of the Necker-Enfants Malades and the Sainte-Anne Hospital for transitional care in surgical neurooncology. They suggest that neurosurgeons involved in transitional care should combine both pediatric and adult surgical neurooncology skills to optimize care management of these patients within a dedicated multidisciplinary organization framework. This study highlights the importance of organizing a transitional care in surgical neurooncology to improve patient care.
In Brief
The authors aimed to provide a systematic review of the clinical applications as well as the rate and nature of complications of laser interstitial thermal therapy in the pediatric population. Currently, the most common applications of laser interstitial thermal therapy are for the treatment of refractory epilepsy and surgically inaccessible brain tumors. The overall complication rate was approximately 16%, with no deaths. This work represents the first systematic review that examines the utility of laser interstitial thermal therapy in the pediatric population.
I
In Brief
The authors sought to determine if there was a difference in scoliosis outcomes between patients with Chiari malformation type I (CM-I) and scoliosis who received posterior fossa decompression (PFD) with or without duraplasty. After controlling for relevant preoperative variables, the authors found that those patients receiving duraplasty were less likely to have progression of their scoliosis compared with those who received extradural PFD, although rates of spinal fusion between the two groups were similar. This finding has implications for clinical management of patients with CM-I and scoliosis.
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