Volume 24: Issue 5 (Nov 2019): Pages 481-610

in Journal of Neurosurgery: Pediatrics

Mathematical model representation of cerebrovascular physiology for calibration-free, patient-specific, noninvasive and continuous intracranial pressure estimation. Anatomical drawing © Sara Jarret, CMI. Published with permission. See the article by Fanelli et al. (pp 509–519).

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    In Brief

    The authors studied delayed complications of pediatric nonoperative skull fractures and the factors associated with follow-up. This can help identify ways to decrease unnecessary radiation exposure to patients and cost.

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    In Brief

    Pediatric gunshot wounds to the head (GSWHs) are a leading cause of death and disability in the US pediatric population, but research on this topic is lacking. The authors analyzed 2847 incidents from the years 2003–2012 from the National Trauma Data Bank. They showed trends in incidence and injury characteristics over the years, as well as the epidemiology of GSWH on a national level in the US.

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    In Brief

    Up to now, continuous assessment of intracranial pressure requires invasive monitoring. This study in children used continuous radial artery blood pressure and continuous middle cerebral artery blood flow velocity measurements to generate an accurate and reliable noninvasive, continuous assessment of intracranial pressure. This new engineering approach does not require calibration, and it has application to instances and settings in which invasive intracranial pressure monitoring is either currently unavailable or considered too invasive.

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    In Brief

    The authors analyzed how Chiari and syrinx characteristics relate to scoliosis in patients with Chiari-associated syringomyelia. These findings will help guide treatment of patients with scoliosis and Chiari-associated syrinygomyelia by furthering understanding of the pathophysiology of scoliosis in this group of patients.

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    In Brief

    This is the largest pediatric study dedicated to evaluating the incidence, risk factors, etiologies, and outcomes of perioperative neurological deficits following cervical fusion in an institution with vast volumes and experience in pediatric cervical spine fusion.

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    In Brief

    The authors used questionnaires to collect data across a group of senior pediatric neurosurgeons regarding variability in practice patterns and preferences related to care of patients with myelomeningocele (MMC), including clinic experience, newborn management, hydrocephalus management, transition to adulthood, clinical indications for shunt revision, Chiari II malformation decompression (C2MD), and tethered cord release (TCR). While there were multiple areas of agreement among respondents, the results show important disparities regarding key areas of decision making and significant variation in the clinical management of chronic hydrocephalus, C2MD, and TCR, which underscore the need for further research into these specific areas.

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    In Brief

    Among all patients undergoing microdiscectomy at a pediatric academic hospital, the authors reviewed premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative therapies, indications for surgical intervention, complications, and postoperative outcomes. This work was important because it helps to understand that pediatric microdiscectomy safely and efficaciously provides long-term pain relief and return to daily activities among patients with symptomatic lumbar disc disease in whom conservative management has failed.

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    In Brief

    The role of emergency clot removal in children having strokes is uncertain, even though it is well established in adults. The purpose of this study was to identify how many cases have been reported in children and find out how successful the procedure is in this population.

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    There are very few studies in the available literature that evaluate the utility of intraoperative MRI in neurological surgery. The authors report a large series of patients who underwent surgery for brain tumors from a high-volume single center.

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    The authors performed 579 volumetric studies of 46 neurofibromatosis type 2 (NF2)–associated vestibular schwannomas in a cohort of young NF2 patients (age cutoff 25 years) and investigated tumor growth and volume before and after surgery as well as possible influencing factors. Surgery significantly reduced tumor growth rate. Large volumes, increasing patient age, and constitutional truncating of NF2 mutations seem to be possible risk factors, and these patients should be monitored more closely with imaging.

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    In Brief

    The authors summarize the progress made in detecting diffuse intrinsic pontine glioma in the biofluids of patients. This will inform readers of how the management of this brain tumor can be improved, because surgery is very dangerous and limited.

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    The authors characterized outcomes of hydrocephalus secondary to congenital toxoplasmosis, finding that more rapid shunting of hydrocephalus resulted in improved outcomes independent of anatomy, which is expected to help many patients, neurosurgeons, and others caring for them.

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