Publish Before Print
in Journal of Neurosurgery: Pediatrics
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In Brief
The authors’ study makes a significant contribution to the literature because it details the treatment of pediatric patients with ATRTs in Japan and shows the limitations of current multimodal treatments, especially craniospinal irradiation. This finding is important because most ATRTs occur in infants and young children.
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In Brief
The study evaluates the need for screening spinal MRI scans in children who undergo resection of low-grade glioma tumors from their posterior fossa. The need (or not) of such scans has clinical and financial implications, and thus reflects the importance of this study.
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In Brief
The authors used direct brain stimulation to find the locations of language, as both seen and heard, in pediatric patients undergoing brain surgery. These findings are helpful to compare to previously reported adult language mapping results and are important to consider when removing brain lesions that are in and around these important sites in pediatric patients.
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In Brief
The authors used postoperative MRI along with diffusion tensor imaging in patients with drug-resistant epilepsy to investigate the role of residual temporal stem connections in recurrent seizures following endoscopic vertical approach hemispherotomy and used cadaveric studies to determine how this problem may be avoided. This study is important in identifying the problem of residual temporal stem during hemispheric disconnection, determining how to identify this problem during surgery, and identifying the role of repeat surgery if seizures are not controlled.
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In Brief
The authors evaluate the prevalence of hypertension among moyamoya disease (MMD) patients. It is important because the long-term deleterious effects of hypertension in pediatric MMD patients seem to be inevitable. As a result, a high prevalence of hypertension in pediatric MMD patients was found. Pediatric neurosurgeons ought to predict and prepare for the development of essential hypertension after surgical treatment of MMD.
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In Brief
The authors interviewed parents of children with traumatic brain injury (TBI) and clinicians who care for these children and asked what role parents should play in deciding whether or not to place an intracranial pressure monitor (ICP) in the child's skull. Important findings were that parents and clinicians agreed that decision making about ICP monitoring in children with TBI is the clinicians’ role, which should not be shared with the parents, while parent needs were to be informed and also be included as observers of the process of multidisciplinary decision making by the clinician teams.
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In Brief
The authors studied the management of children with a congenital spinal cord anomaly and found that there are differences in the care these patients receive depending on where they live, how sick they generally are, and whether they have an abnormal fluid collection in the spinal cord. This study is important because it sheds light on these differences in a condition that has not been studied as deeply before.
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In Brief
Despite the high incidence of pediatric brain tumors, literature is scarce on examining risk of readmission among pediatric patients undergoing resection of intracranial tumors. The authors studied readmission rate following brain tumor surgery to stratify the risk factors of readmissions in this subset of pediatric patients.
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In Brief
Telemedicine has a growing role in providing access to neurosurgical care in underserved communities. The authors studied the socioeconomic benefits of having a pediatric neurosurgery telemedicine clinic and quantified the cost savings to families. They calculated average cost savings as a function of distance from the telemedicine and main clinics.
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In Brief
The authors systematically reviewed published studies involving selective dorsal rhizotomy (SDR) and/or intrathecal baclofen (ITB) in patients with cerebral palsy (CP) who cannot walk. Traditionally SDR has been used mostly for children with moderate CP, who can walk. There is a growing interest in helping patients with severe CP using SDR, as it is less risky than ITB. In this study the authors show a need for further research, and that these treatments appear at least equal in this population.
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In Brief
The most effective surgical technique aimed at treating Chiari malformation type I with syringomyelia remains controversial, with options ranging from bone-only posterior fossa decompression (PFD) to PFD with duraplasty (PFDD) and to PFDD with tonsillar reduction (PFDD-T). This is an 8-center prospective study comparing PFDD and PFDD-T, demonstrating feasibility and challenges and presenting pilot data that show no significant advantage to tonsillar reduction.
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In Brief
In this study the authors attempted to investigate cognitive function in the presurgical phase of pediatric patients with moyamoya disease with no apparent brain lesions. The results showed how cerebral hypoperfusion relates to cognitive decline.
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In Brief
In this study, the authors investigated the interrater reliability of a commonly used system for grading pediatric craniopharyngiomas that helps plan the surgical approach. This study shows that the interrater reliability is moderate and that the generalizability of the system is questionable. The paper highlights the need to continue to develop systems that aid the surgeon and team in planning the appropriate treatment plan for patients.
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In Brief
The authors evaluated the operative outcomes of children presenting with sterile abdominal pseudocysts related to ventriculoperitoneal shunt treatment. They found that shunts can be safely replaced in the abdomen in select patients. This is a simpler treatment than placing the shunt in the atrium or pleura and has fewer complications.
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In Brief
This is a retrospective single-center analysis of all neurosurgical strategies for the treatment of cranial and intracerebral metastases in pediatric patients diagnosed with neuroblastoma. The study reports the largest series of neurosurgical resections of cranial and intracerebral neuroblastoma metastases to date.
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In Brief
The authors established a standard technique for measuring movement of the junction of the head and spine in patients with Down syndrome. This technique will allow doctors to describe mobility of the upper spine in a consistent way in order to help with determining when and how to treat these children with activity restriction or surgery.
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In Brief
This report outlines a single-institution experience with ganglioglioma of the brainstem in pediatric patients in order to highlight the complex treatment challenges and explore novel treatment avenues such as targeting BRAF V600E via vemurafenib.
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In Brief
This study used the National Inpatient Sample to assess the effect of hospital characteristics (such as size, region, and scoliosis fusion volume) on the cost of neuromuscular scoliosis fusion. Prior studies have shown that the cost of neuromuscular scoliosis fusion is significantly higher than more common forms of scoliosis; decreasing such costs would in turn decrease the financial burden on the healthcare market and increase overall patient access to care.
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In Brief
The authors studied several experimental models of induced hydrocephalus in a fetal lamb model and found that BioGlue was the most effective and did not produce inflammatory side effects. This novel use of BioGlue produces a model with the potential for new insights into hydrocephalus pathology and the development of therapeutics in obstructive hydrocephalus without the confounding effects of neuroinflammation.
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In Brief
The authors critically evaluated return-to-play timelines for pediatric patients after thoracolumbar spinal surgery. They found a lack of current standardized guidelines in the literature. Thus, they assessed and refined appropriate timelines for patients and doctors to use when determining appropriate return to play.
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In Brief
Craniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement, and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The rarity of the condition and infrequent exposure during residency limit extraoperative training, and lack of cadaveric teaching tools, given the pediatric nature of synostosis, compounds this challenge. The authors created lifelike 3D-printed models of human infants with craniosynostosis that were incorporated into a practical course for endoscopic and open correction. A survey of participants in the hands-on training sessions demonstrated that the model is highly useful to neurosurgical trainees.
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In Brief
The authors report on their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy. Stenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy.
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In Brief
This work demonstrates the incidence and incidence rate of nonaccidental trauma (NAT), specifically abusive head trauma, seen at Women and Children’s Hospital of Buffalo (now the John R. Oishei Children’s Hospital) in the Western New York counties served by Kaleida Health. Having this local information is of particular importance given that patterns of NAT vary across the United States. The damage inflicted by NAT to a child’s health and development warrants surveillance of its occurrence and evaluation of current measures aimed at its prevention.
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In Brief
The authors pooled data from published studies on the risk of stroke in pediatric moyamoya, in order to determine which type of surgical operation was best at reducing future stroke from occurring. This study is important for neurosurgeons to guide management of pediatric moyamoya patients.
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In Brief
An estimated 40%–50% of all ventriculoperitoneal shunts fail within 2 years of placement, typically via proximal shunt obstruction. This study suggests that addition of an antisiphon device distal to the primary valve leads to a significant decline in the rate of ventricular catheter obstruction, validating similar results published in 2010 and implicating shunt overdrainage as a central cause of proximal shunt obstruction.
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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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In Brief
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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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
The authors investigated the impact affective disorders have on perioperative complication rates, length of stay, and total costs in adolescents undergoing elective posterior spinal fusion surgery (≥ 4 levels) for adolescent idiopathic scoliosis. This study’s findings suggest that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis compared to adults, and thus further study is needed in order to manage these complex patients postoperatively in order to better overall patient satisfaction and the quality of care delivered.
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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 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
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 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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