Volume 24: Issue 4 (Oct 2019): Pages 353-479

in Journal of Neurosurgery: Pediatrics
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    In Brief

    The authors show that injury to the superior cerebellar peduncle detected on diffusion tensor imaging is associated with persistent unsteady gait at follow-up in children who underwent resection of posterior fossa tumors. Diffusion tensor imaging is a potential imaging biomarker for neurological dysfunction after posterior fossa tumor resection in children.

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    In Brief

    The authors examined diffusion tensor imaging (DTI) changes of the inferior olivary nuclei (IONs) in the immediate postoperative period after posterior fossa tumor resection among medulloblastoma patients who subsequently developed posterior fossa syndrome (PFS). They found abnormal DTI changes in the bilateral IONs immediately after posterior fossa tumor resection in children who developed PFS, particularly in the left ION, which may serve as an early imaging marker of PFS.

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    In Brief

    The authors looked for novel imaging features that could be associated with posterior fossa syndrome, a challenging condition in which children become mute and develop a variety of emotional and behavioral symptoms following surgery for tumors in the back of the brain, also known as the posterior fossa. They found that children who went on to develop this condition had decreased blood flow in their frontal lobes, which improved when their symptoms improved. This study adds to an understanding of why this condition occurs and may allow neurosurgeons to predict which children will develop this condition in the future.

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    In Brief

    This project shows that children with cerebral aneurysms have excessive arterial tortuosity compared to healthy children. The data show a similar degree of lengthening and tortuosity in children with known cerebral arteriopathies.

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    In Brief

    In this study, the authors utilized the Kids’ Inpatient Database (KID) to study the effect of hospital volume of pediatric cerebrovascular malformations (CVMs) on outcomes. This study is important because it identifies demographic trends and highlights the finding that children requiring craniotomy for intervention of CVM had better outcomes at high-volume centers. This finding can help direct these patients to high-volume centers in order to improve care and outcomes.

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    The authors used a blood pool agent called ferumoxytol in conjunction with MRI to detect residual or recurrent brain arteriovenous malformations (AVMs) in children. They found that this imaging modality performed equally well to the gold standard, digital subtraction angiography (DSA), which exposes patients to large doses of radiation. This is important for children, as surveillance of AVMs typically requires multiple DSA studies. Hence, this approach of using ferumoxytol-enhanced MRI is considered to be a safe and comparable alternative for monitoring AVMs, without exposing patients to unwanted effects of radiation.

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    The authors evaluated the long-term outcome of pediatric patients with Muenke syndrome who underwent surgery for craniosynostosis according to the treatment protocol used at the authors’ institution, which includes a single craniofacial procedure. The results show that patients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension and that that there is no need for a routine second craniofacial procedure, and follow-up should focus on visual, speech, and hearing assessment and outcomes.

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    In Brief

    The authors developed a new mixed-reality model for craniosynostosis surgical training. Physical and virtual craniosynostosis simulation provided the required psychomotor and cognitive skills previously acquired only during practical surgical apprenticeship.

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    There is increased interest in exploring minimally invasive options for patients with intractable epilepsy. This patient population has often had multiple prior surgeries, and thus interventions that minimize surgical morbidities are crucial. The authors investigated a novel approach to completion corpus callosotomy using laser interstitial thermal therapy. The results show that completion corpus callosotomy using laser interstitial thermal therapy can be performed with a good safety profile and produce durable targeted seizure remission rates comparable to those obtained with open completion surgeries.

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    The authors used an advanced, multivariate, data-driven approach, partial least squares analysis, to identify unique patient phenotypes associated with dissociable mobility and disability outcomes following deep brain stimulation (DBS) for childhood dystonia. The results of this investigation provide a greater understanding of multidimensional associations among predictors and outcomes in childhood dystonia and may inform the selection of surgical candidates for DBS.

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    In Brief

    This is the largest study in terms of sample size to characterize the trends, incidence, and risk factors for blunt cerebrovascular injury in pediatric trauma.

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    This study is the first to show that diffusion MRI (dMRI) data can be obtained from fast brain MRI reliably, without need for sedation, setting the stage for incorporating dMRI into routine care of hydrocephalus patients.

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    In Brief

    The authors investigated the impact of patient and hospital-level risk factors on extended length of hospital stay (LOS) following elective posterior spinal fusion surgery (≥ 4 levels) for adolescent idiopathic scoliosis (AIS). This study's findings suggest that patient comorbidities and intra- and postoperative complications all contribute to extended LOS after spinal fusion for AIS, and thus multimodality interventions may be needed to improve the value of care, lower costs, and better overall patient outcomes.

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