The authors performed a functional genomics analysis of nonsyndromic craniosynostosis (nsCS) to determine when, where, and in what cell types nsCS-associated genes converge during development. They found that nsCS genetic risk converges in cells and transcriptional networks that concurrently impact skull, meninges, and brain development. These findings suggest a primary impact on neurodevelopment in nsCS, providing an explanation for why some children with nsCS continue to have neurodevelopmental disability despite correction of cranial defects. The authors hypothesize that genetic factors may be more important for determining overall neurodevelopmental outcome than either the timing or type of surgical correction used (endoscopic vs open).
This study investigated the long-term outcome of cervical saccular limited dorsal myeloschisis. The findings indicate favorable ambulation and sphincter control, regardless of the lesion level or type. Myelocystocele-type lesions displayed higher rates of hydrocephalus, Chiari type II malformation, and neurological deficits in comparison with stalk-type lesions. Older age at surgery and spinal anomalies were associated with neurologic deficits. Overall, cervical saccular limited dorsal myeloschisis has a better outcome compared with true myelomeningocele in more distal areas.
Researchers examined the longitudinal profile of cerebrospinal fluid (CSF) parameters (leukocyte count, proportion of neutrophils, and protein and glucose concentrations) in 109 children with culture-proven CSF shunt infections. A higher proportion of neutrophils at diagnosis was associated with one or more complications (contiguous soft-tissue infection, worsening hydrocephalus, CSF leak, intracranial bleed, brain abscess, venous thrombosis, reinfection after insertion of the new shunt, other complication, ICU admission, or death). However, wide variability in CSF parameters may limit their clinical utility.
Researchers synthesized available studies reporting patient outcomes and operative complications associated with corpus callosum ablation (CCA). CCA is associated with an acceptable complication profile and meaningful reduction in atonic seizures; however, accurate targeting is crucial for avoiding off-target or subtotal ablation and to minimize morbidity while maximizing palliation. CCA is a minimally invasive alternative to open CC, although further work is needed to validate the noninferiority of CCA compared with other approaches.
This study aimed to evaluate the effects of thin-split encephalomyosynangiosis (EMS) in combined revascularization surgery on postoperative outcomes in pediatric patients with moyamoya disease (MMD). The authors found that thin-split EMS can reduce transient neurological events that do not accompany crying or hemodynamic changes. Furthermore, the procedure has sufficient prevention effects against stroke events during the chronic postoperative period. The thin-split EMS method could be valuable for revascularization in pediatric patients with MMD.
研究人员使用机器学习预测seizure freedom and to identify important predictors of seizure freedom following MR-guided laser interstitial thermal therapy (MRgLITT) in children with epilepsy. Important predictors of seizure freedom included video-EEG concordance, lesion size, preoperative seizure frequency, and number of antiseizure medications. The gradient-boosting machine performed better than other machine learning algorithms. The ability to measure an individual's probability of seizure freedom could assist with optimal patient selection, and with counseling patients before MRgLITT.
Complex craniocervical pathology occasionally requires novel approaches to manage difficult structural or compressive lesions. To mitigate the risk of intraoperative injury to anomalous vasculature, this paper describes the combined use of preoperative vertebral artery embolization prior to skull base surgery in 3 patients with complex congenital bony pathology. On long-term follow-up, no adverse effects were noted in any patient from this combined approach.
The authors conducted a retrospective analysis of 70 patients undergoing evaluation during shunt failure to find predictors of ETV success. They found that age < 36 months, primary inflammatory hydrocephalus, and obstruction at fourth ventricle outlets were associated with ETV failure. A meta-analysis is also provided, confirming the results. Finally, the authors focus on patients experiencing signs and symptoms of global rostral midbrain dysfunction syndrome during shunt dysfunction, in which ETV is effective in improving clinical outcome.
This study aimed to identify patient demographic and injury factors associated with major and immobility-related adverse events among children with spinal cord injury. The authors demonstrated that cervical complete injuries, concomitant severe abdominal trauma, and Glasgow Coma Scale scores < 13 at presentation were associated with the occurrence of adverse events. These findings have important implications for pediatric spinal cord injury providers and should be used to inform care pathways for patients sustaining these injuries.
The authors review their experience with total cranial vault remodeling (TCVR) to correct scaphocephaly in a technical note and retrospective case series. The technique is safe and results in sustained biparietal expansion, anteroposterior shortening, and a pronounced reduction of frontal bossing. The latter is attributed to a distinctive feature of the technique: frontal release and pterional decompression. No implantation of foreign material or postoperative helmet therapy is needed.
This study evaluated whether indirect revascularization in pediatric patients with moyamoya disease leads to periventricular anastomosis (PVA) regression. Of 89 hemispheres in 58 patients, postoperative PVA regression was observed in PVA arising from choroidal arteries (p < 0.001) and was more common in hemispheres with robust postoperative collaterals than in hemispheres with fair postoperative collaterals (54.5% [36/66] vs 30.4% [7/23]; p = 0.015). These results suggest that indirect revascularization might reduce future hemorrhage risk in pediatric patients with moyamoya disease.
The objective of this study was to describe the management of hydrocephalus in achondroplasia over a 60-year period at four skeletal dysplasia centers. The authors found that 123 of the 1374 (9%) patients underwent treatment of hydrocephalus at a median age of 14.6 months. While some centers treated nearly 30% of their achondroplasia patients born before 2000 for hydrocephalus, this rate has fallen to below 6% at all centers. Despite enlarged CSF spaces and relative macrocephaly, treatment of hydrocephalus in achondroplasia has become rarer in the last 20 years.
The authors performed a systematic review investigating the effect on upper-extremity spasticity and functionality after lumbosacral selective dorsal rhizotomy in cerebral palsy. They observed a clear postoperative improvement in upper-extremity spasticity and functionality. Possible but unproven mechanisms include somatosensory cortex reorganization, decrease in abnormal electrical transmission throughout the spinal cord, improved posture, occupational/physical therapy intensification, and a maturation effect. This study is the first overview of this fascinating phenomenon.
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.
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.
没有共识stereotacti的安全c 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.
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.
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.
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.
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.
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.
This study's objective was to report long-term outcomes 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.
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.
本研究脊髓栓系释放363 (TCR)杂志eries 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.
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 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.
健康问题社会决定因素能产生深远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.
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.
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.
本文的目的是描述一个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.
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.
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.
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.