In Brief
The primary assessment of school-age outcomes in the Management of Myelomeningocele clinical trial did not show better adaptive behavior and cognitive skills in the prenatal group. In this secondary analysis, the need for a cerebrospinal fluid shunt masked stronger adaptive behavior and cognitive skills in the unshunted groups (both prenatal and postnatal). Disease severity and dynamic changes in hydrocephalus status seem to be the primary factors in the need for shunting and a major determinant of adaptive behavior and cognitive outcomes after prenatal surgery.
In Brief
The authors sought to characterize comorbidities and complications associated with the management of posthemorrhagic hydrocephalus (PHH) in a large national inpatient care data set. Important findings were that regional differences exist within the United States and that later PHH interventions are significantly associated with higher costs and significant complications even after adjustment for prematurity and birth weight. Given the trends in practice variability and the associated complications with later interventions, this work highlights the need for consensus practice guidelines.
In Brief
Programmable valves have gained increasing popularity in the treatment of pediatric hydrocephalus. In this study, the valve and shunt survival rates of programmable shunt systems were significantly prolonged (p < 0.05) compared with those of a fixed-pressure pediatric valve. Additionally, there were no overdrainge-related complications with programmable valves. These results indicate a more widespread use of programmable valves in infants for the treatment of hydrocephalus.
In Brief
Postoperative hydrocephalus after hemispherectomy for pediatric epilepsy is still being understood. In a retrospective review of 114 pediatric patients who underwent hemispherectomy, 13 patients (11%) developed postoperative hydrocephalus requiring permanent cerebrospinal fluid diversion in the form of ventriculoperitoneal shunting. This occurred at a median of 1 year after surgery. Postoperative external ventricular drainage appears to reduce this likelihood, whereas postoperative infection and previous history of seizure surgery were shown to increase this likelihood.
In Brief
This study evaluates the safety and efficacy of stereotactic laser ablation (SLA) for the treatment of pediatric epilepsy. Seizure freedom was achieved in 50% of patients, and 87.7% of patients experienced a favorable outcome (Engel class I/II) at the 1-year follow-up. A history of pre-SLA surgery, a pathology of MCD, and targets requiring 2+ laser trajectories for coverage were negative predictors for attaining seizure freedom. This is the largest series on SLA in pediatric epilepsy patients.
In Brief
Researchers evaluated pediatric patients who have intractable epilepsy and were treated with a combination of vagus nerve stimulation and brain-responsive neurostimulation. Multiple forms of neuromodulation are used to treat drug-resistant epilepsies, but there are little data showing how these devices interact with each other or if they are safe to use together in adolescents. This study demonstrates that the concomitant use of two neurostimulation devices can be safe and potentially effective for this difficult-to-treat population.
In Brief
The authors performed what is, to their knowledge, the first objective automatic 3D evaluation of imaging data from patients with unicoronal craniosynostosis (UCS) to determine how orbital morphology changes from surgery and growth in UCS patients compared with controls. Global and local shape differences persisted in patients at age 3 years. The changes were largest on the affected side but varied most on the other side. These findings may have implications for the development of future surgical treatment protocols in UCS patients.
In Brief
In an affected mother and her three affected children, the authors investigated cases of nonsyndromic craniosynostosis (CS) associated with a novel mutation (c.469c>A) in the transmembrane channel protein TRPV4, a ubiquitously expressed protein previously implicated in skeletal dysplasia, osteoarthropathy, and motor/sensory neuropathy. In these CS cases, possibly demonstrating the first reported association of CS and TRPV4, the mutation did not seem to affect transmembrane channel activity but may have interfered with protein-ligand binding. This discovery expands our genetic and functional understanding of TRPV4 and may inform genetic counseling of affected patients and lead to the development of experimental models to study the molecular-genetic mechanisms of CS.
In Brief
This study aimed to investigate the postoperative course of supratentorial epidural hematoma in 48 infants aged less than 18 months. The authors found an unexpected high incidence of cerebral ischemia that burdens the outcome with neurological deficit and epilepsy. These strokes are secondary to systemic hypovolemia and mass effect because of delayed diagnosis related to the apparent innocuousness of the trauma. The authors highlight the need for rigorous anesthesia management and follow-up in this age group.
In Brief
The authors aimed to investigate differences in the emergency department management of pediatric traumatic brain injury (TBI) between designated trauma and nontrauma centers in Asia and Latin America. Limited differences based on designated trauma status were found, and the authors reported that the overall implementation rate of current TBI guidelines was low. These findings emphasize the need to investigate TBI management and specific barriers to guideline implementation in Asia and Latin America.
In Brief
The authors retrospectively compared the efficacy and safety of different surgical techniques used in pediatric Chiari malformation type I (CM-I) patients. Cerebellar tonsil reduction, by coagulation or resection, resulted in superior improvement of syringomyelia without increased complications. Current debate focuses on duraplasty versus bone-only decompression and the notion that the former is more efficacious despite increased complication rates. On the basis of this investigation, the authors concluded that more invasive techniques, such as tonsil coagulation or resection, may provide greater objective radiological efficacy yet similar safety in the treatment of CM-I patients.
In Brief
The authors performed a retrospective study of clinical data at two academic institutions for 13 pediatric neurosurgical patients with moyamoya arteriopathy identified in the context of morning glory disc anomaly (MGDA). These patients may develop compromised perfusion that may require revascularization surgery, some manifesting years after initial evidence of structural abnormality. Although there is recognition of comorbid MGDA and moyamoya disease, and the authors report results of empiric management, additional data to prescribe a long-term follow-up algorithm would require multi-institutional collaborations such as the International Pediatric Stroke Organization.
In Brief
This study aimed to evaluate the efficacy and safety of combination therapy with bevacizumab, irinotecan, and temozolomide in children with central nervous system (CNS) embryonal tumor relapse. The findings suggest the potential efficacy and safety of combination chemotherapy in patients with relapsed or refractory pediatric CNS embryonal tumors. In particular, data on the efficacy of safety of this regimen in the relapsed or refractory atypical teratoid/rhabdoid tumor population are limited.
In Brief
Although most patients with spina bifida (SB) survive into adulthood, these patients still have varying degrees of physical disabilities that can impact mental health and cause psychological distress. Researchers leveraged a large-population database that showed a higher prevalence of mental health and substance use disorders in young adults with SB compared with the general population. Multidisciplinary care coordination is needed, particularly during the transition from pediatric to adult care.
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
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.
In Brief
The objective of this study was to compare the epidemiology, severity, microbial causes, and management of pediatric sinusitis- and otitis media-related intracranial infections in the periods before and during the COVID-19 pandemic. At the authors' institution, there has been an approximately 3-fold increase in cases of sinusitis- and otitis media-related intracranial infections during the COVID-19 pandemic. The next steps will include expansion of this study to other pediatric centers throughout the United States and Canada.
In Brief
The authors sought to characterize the population of patients with neural tube defects (NTDs), maternal characteristics, and referral patterns in southwestern Uganda. The majority of mothers reported prenatal folate supplementation and antenatal care, whereas an antenatal ultrasound was performed in less than one-quarter of patients. Patient mortality was associated with younger age at presentation, need for blood transfusion and oxygen supplementation, and maternal education level. This is the first study to describe the population of patients with NTDs and their mothers in southwestern Uganda.
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.
W
MMCs closed with that technique virtually always develop a tethered
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 authors investigated robot-assisted (RA) stereotactic MRI-guided placement of intracerebral devices in pediatric epilepsy patients. Although this method is rapidly becoming a standard procedure, to the authors' knowledge no previously reported study has specifically investigated the accuracy of RA stereotactic MRI–guided laser ablation in an exclusively pediatric population. This focus is important because of anatomical differences in children compared with adults that may influence placement accuracy and hence subsequent outcomes. This study demonstrated that RA stereotactic MRI–guided laser ablation for epilepsy in children is highly accurate and the accuracy data may aid in surgical planning.
In Brief
Researchers used optical coherence tomography (OCT) and percentage of sagittal suture fusion to determine relationships between degree of suture fusion and intracranial pressure (ICP) in patients with nonsyndromic sagittal craniosynostosis. Increased percentage of posterior sagittal suture fusion, but not total suture fusion, was associated with increased ICP by OCT parameters. This relationship may suggest associations between regional suture fusion patterns and increased ICP in patients with craniosynostosis.
OBJECTIVE
Untethering surgery for a tight filum terminale is a common treatment with considerable efficacy and safety. On the other hand, retethering has been reported to occur. One of the major mechanisms of retethering is adherence of the cut end of the sectioned filum to the midline dorsal dural surface. To prevent retethering, the authors sectioned a filum terminale at the rostral level to the dural incision to keep the distance between the cut end of the sectioned filum and the dural incision and investigated whether this procedure decreased the occurrence of retethering.
METHODS
Among the patients who underwent untethering surgery for a tight filum terminale between 2012 and 2016, patients followed up more than 5 years were included in the study. Symptoms, comorbid malformations, preoperative imaging, surgical details, perioperative complications, and long-term outcomes were reviewed retrospectively.
RESULTS
Retrospective data for a total of 342 cases were included. The median age at surgery was 11 months (range 3–156 months). Preoperative MRI revealed 254 patients (74.3%) had a low-set conus. There were 142 patients (41.5%) with filar lipoma and 42 patients (12.3%) with terminal cyst. Syringomyelia was found in 29 patients (8.5%). In total, 246 patients (71.9%) were symptomatic and 96 patients (28.1%) were asymptomatic. There were no perioperative complications that required surgical intervention or prolonged hospitalization. The mean postoperative follow-up was 88 months (range 60–127 months). There were 4 patients (1.2%) with retethering who presented with bladder and bowel dysfunction. The mean time from initial untethering to retethering was 54 months (range 36–80 months). All 4 patients underwent untethering surgery, and preoperative symptoms resolved in 3 patients.
CONCLUSIONS
The retethering rate after untethering surgery for a tight filum terminale in our series was lower than those in previously reported studies. Sectioning the filum terminale at the rostral level to the dural incision was considered an effective way to prevent retethering.
In Brief
This study examined long-term outcomes after ventriculoperitoneal shunt (VPS) placement and endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) in 82 and 266 infants with hydrocephalus, respectively, estimating that 59% of patients would have shunt freedom at 11 years of follow-up after ETV/CPC. ETV/CPC success exceeded that predicted with ETV alone, and corrected age < 2.5 months, severe ventriculomegaly, excess intraoperative bleeding, and prior CSF diversion predicted both reoperation and VPS placement. These results define long-term outcomes after ETV/CPC relative to VPS and can assist with patient selection.
In Brief
Researchers conducted a scoping review to qualitatively describe the current state of the literature on healthcare disparities in pediatric neurosurgery. Although there has been an increase in the number of publications discussing pediatric neurosurgical healthcare disparities, mostly about the categories of race/ethnicity and socioeconomic status within the last decade, there remains a scarcity of information regarding healthcare disparities in neurosurgery. This review lends to future research strategies, specifically addressing healthcare disparities in the pediatric population.
In Brief
The purpose of this study was to conduct a ventriculoperitoneal shunt survey comparison between ultra-low-dose CT (ULD CT) with a tin filter and digital plain radiography in pediatric patients in an emergency setting regarding diagnostic performance, effective dose, and examination time. Results showed a better chance for detecting additional findings introduced by shunt dysfunction, and good visualization of the position or disruption of the shunt catheter that was comparable or superior to plain radiography. Furthermore, ULD CT provided a simple evaluation tool for inexperienced doctors with a shorter staff time and was better for patient comfort.
In Brief
The current study investigated the effects of prior recurrent head injury on the symptom profiles of student-athletes after another suspected concussion. During follow-up testing, patients with multiple prior concussions had greater severity of cognitive, sleep, and neuropsychiatric symptoms than patients with a single prior concussion. Careful assessment of these specific symptoms should be considered for patients with a history of repetitive head trauma prior to return to play.
In Brief
The authors analyzed their outcomes from the management of pineal region tumors over the last 30 years. They concluded that gross-total resection provides the best survival, and there is no superiority of supracerebellar infratentorial approach over the occipital transtentorial approach. Neuroendoscopy was an essential tool for diagnosis and treatment. The authors have one of the largest case series of pediatric pineal region tumors in Latin America, and they hope that their expertise can help other centers around the world in the management of such challenging tumors.
In Brief
In this study the authors described patterns of return-to-learn (RTL) in athletes by school level (middle school/high school/college), and evaluated predictive value of school level on RTL. The mean RTL (days) were as follows: 8.0 (middle school), 8.5 (high school), and 15.6 (college). Univariate/multivariable models showed longer RTL in collegiate versus middle school/high school athletes. Collegiate athletes seen at a multidisciplinary concussion center had longer RTL than their middle school/high school counterparts. Collegiate athletes have more resources in school, and thus those presenting to a specialty clinic may represent a more complicated recovery.
In Brief
The objective of this study was to report the rate of spinal inclusion cyst (sIC) formation in patients who underwent open prenatal myelomeningocele (MMC) repair, with a focus on management and outcome. In this cohort, the rate of sIC formation was 23% with a median age to presentation of 20 months. The use of a dural patch appears to have a positive correlation with sIC formation. This study suggests that children with prenatally repaired MMC are at higher risk for development of sIC at an earlier age than those who undergo postnatal repair.
In Brief
Children growing up with a ventriculoperitoneal (VP) shunt face changing conditions. A child-adapted patient simulator was used to assess the drainage dynamics of VP shunts. The results indicated that unprotected differential pressure valves can lead to overdrainage in infants, while low-pressure valves with gravitational units (GU) may prevent overdrainage through 5 years of age and medium-pressure valves with GU admit physiological intracranial pressures through at least 10 years of age. Devices preventing overdrainage should be included in the first shunt, and opening pressures should be adjusted as children grow.
In Brief
Researchers sought to distinguish between brain tumor recurrences and therapy-induced imaging changes (TIIC) in children using multimodal MRI. The authors found that TIIC had high T2-weighted signal without nodules (contrary to recurrences), higher apparent diffusion coefficient, and lower cerebral blood flow measured using arterial spin labeling. These findings may help in making a therapeutic decision when faced with suspected TIIC on brain MRI in these patients.
In Brief
The objective of this study was to present the results of training with a low-cost simulation model for endoscope-assisted sagittal craniosynostosis repair. Between the first and last training, all the participants improved their Global Rating Scale performance and decreased the time required to complete the task and the number of errors made. The low-cost model proved to be efficient for the acquisition of skills within the simulation scenario.
OBJECTIVE
The two main objectives of this study were to explore the rate of spinal dysraphism within bladder and cloacal exstrophy and to analyze the relationship between spinal dysraphism surgery, including timing of spinal dysraphism surgery, with urological and neurological outcomes.
METHODS
A prospectively maintained IRB-approved database of pediatric exstrophy patients treated from 1982 to 2021 was retrospectively reviewed for patients with spinal dysraphism. Spinal dysraphism was categorized into the following 7 subtypes: lipoma-based closed defect, myelomeningocele, meningocele, diastematomyelia, myelocystocele, low-lying conus with tethered cord/fatty filum, and sacral bony defect. Other factors assessed included patient demographic characteristics, type of spinal dysraphism procedure, reoperation, complication, presence of other neurological problems (e.g., hydrocephalus, Chiari malformation), neurological status, and urological function.
RESULTS
Analysis revealed that 114/1401 patients had coexisting spinal dysraphism. Of these 114, sufficient records including type of dysraphism were available for 54. Spinal dysraphism was most common within cloacal exstrophy (83.3% [45/54 patients]), followed by cloacal exstrophy variants (9.3% [5/54]), classic bladder exstrophy (3.7% [2/54]), and classic bladder exstrophy variants (3.7% [2/54]). Within spinal dysraphism, lipoma-based closed defects (63.0% [34/54]) and low-lying conus with tethered cord/fatty filum (11.1% [6/54]) were most common. Hydrocephalus and Chiari malformation occurred in 24.1% (13/54) and 11.1% (6/54) of patients. All 13 patients with hydrocephalus underwent shunt placement. Among those who underwent neurosurgical intervention, the complication rate for spinal dysraphism was 14.6% (7/48). Motor function data were available for 41 patients and revealed that motor function declined for 2/41 (4.8%) patients and improved for 6/41 (14.6%) after neurosurgery. There was no statistical difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure.
CONCLUSIONS
The authors have reported the surgical management and outcomes of patients with exstrophy and coexisting spinal dysraphism (n = 54). In 54 patients, spinal dysraphism was most common in the subset of patients with cloacal exstrophy (83.3%). Lipoma-based closed defects (63.0%) and low-lying conus with tethered cord/fatty filum (11.1%) were the most common, and the rates of hydrocephalus and Chiari malformation were 24.1% and 11.1%, respectively. There was no difference in lower-extremity motor outcome related to timing of neurosurgery and exstrophy closure.
OBJECTIVE
Down syndrome (DS) affects 1 in 700 live births and approximately one-third of patients develop craniovertebral junction (CVJ) instability, diagnosed by clinical examination and radiological measures such as the atlantodens interval (ADI) and space available for the cord (SAC). Patients with symptomatic CVJ instability are at increased risk for spinal cord injury. There are no guidelines for surgical management of CVJ instability in DS, the existing literature is sparse, and there is a lack of consistent pediatric data. This systematic review aimed to synthesize practice patterns of the surgical management of CVJ stability in pediatric DS patients to facilitate future standardization of care.
METHODS
Peer-reviewed studies reporting surgical management of CVJ instability in pediatric DS patients were systematically reviewed. Inclusion criteria were studies reporting primary data on patients younger than 18 years with DS, who had CVJ instability evaluation and underwent surgical treatment. Bias risk was assessed. Descriptive statistics of the independent patient data were presented. Interval variables were analyzed using the Wilcoxon rank-sum test.
RESULTS
Of 1056 records, 38 studies were included. Of the included patients, 169 (6%) underwent surgery. The surgical indication was symptomatic, radiologically confirmed CVJ instability in 81% of the patients, presenting with myelopathy (30%), weakness (25%), abnormal gait (24%), torticollis (15%), and neck pain (14%). A cutoff of ADI ≥ 4 mm or SAC ≤ 14 mm, cord compression, cord signal change, and anomalous bony anatomy were used in diagnosing CVJ instability. Surgical approaches focused on internal fixation with posterior occipitocervical or atlantoaxial instrumented fusion in 57% and 44% of patients, respectively. Autograft, wiring, and allograft constructs were used in 48%, 45%, and 9% of patients. Anterior cervical approaches were performed in 6% of patients. Preoperative and postoperative external orthoses were used in approximately 50% of patients. The surgical mortality rate was 3%, and the complication rate was 36%.
CONCLUSIONS
Assessment of CVJ instability in DS is based on radiographic and clinical factors. Surgery is recommended if symptoms are present, and the procedure type depends on patient factors, degree of instability, anomalous bony anatomy, and reduction results to relieve cord compression. Most commonly, posterior instrumented fusion is used. However, further research is required to determine the strength of evaluation methods, create standardized guidelines for evaluation and surgical treatment, and investigate the long-term results of different surgical techniques.
In Brief
The authors analyzed the quality of YouTube videos on hydrocephalus in the local language Filipino and compared their content and engagement with videos in English. Using an online survey, they also determined whether the videos addressed the needs of caregivers. They noted a gap between the content available on YouTube and the information that caregivers needed. Here the authors emphasize the role of neurosurgeons in ensuring that online information on hydrocephalus is comprehensible, accurate, and up-to-date.
In Brief
Researchers used a novel imaging technique, arterial spin labeling, to quantitatively evaluate changes in cerebral blood flow (CBF) in persisting postconcussive symptoms, including headache, in children and adolescents following a concussion. Global CBF was not associated with persisting postconcussive symptoms, nor was female posttraumatic headache at 2 weeks postinjury. Findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.
In Brief
Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis following acute mastoiditis. This review of the current metadata shows that most cases will recanalize with the standard use of antibiotics, otologic surgery, and anticoagulation. However, an appreciable proportion of these patients will develop symptomatic otogenic hydrocephalus. The possible need for permanent CSF diversion should be recognized in these instances.
In Brief
In this study the authors sought to generate and validate a novel three-factor predictive tool to accurately differentiate early versus delayed recovery from sport-related concussion in pediatric patients. Patient information used for patient assessment include data from the initial Post-Concussion Symptom Scale, time to presentation, and history of prior concussion (area under the curve = 0.80). The resulting tool has been demonstrated to be easy to implement for support of clinical decision making and to guide resource allocation, clinic discharge, follow-up timing, and/or ancillary service referrals following concussion in pediatric patients.
In Brief
Use of intraoperative topical antibiotics is well documented in the orthopedic literature, but scarce in patients requiring intrathecal baclofen pumps for spasticity. In this retrospective study, a new protocol was implemented calling for topical vancomycin and tobramycin at the pump site during these procedures. Infection rates were significantly reduced after this change. The authors believe that the addition of intraoperative antibiotics is a key step toward optimizing patient care and outcomes in this high-risk population.
In Brief
In this study the authors evaluated the classification utility of common craniometrics for trigonocephaly and their reliability when derived from 2D photographic, 3D optical, and CT images. Measurements obtained for the anterior arc angle (AAA) and metopic index were highly effective for enabling the discrimination of trigonocephaly from non-trigonocephaly deformities, while the AAA showed high degrees of correlation when used with photographic, optical, or CT images. This information may be useful to craniofacial surgeons as they decide how best to track outcomes in patients with trigonocephaly.
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
This study sought to characterize the effect that the COVID-19 pandemic had on the incidence and severity of abusive head trauma (AHT) in pediatric patients. The overall incidence of AHT was stable during the pandemic, but there was a higher incidence of mortality secondary to ischemic brain injury from AHT.
In Brief
This retrospective study aimed to identify risk factors of intraoperative blood transfusion in pediatric craniotomy for intracranial tumor resection. Lower body weight, higher American Society of Anesthesiologists physical status, preoperative anemia, large tumor size, and prolonged duration of surgery were found to be significant risk factors. The identification and modification of risks might be beneficial to reduce the probability of transfusion and improve allocation efficiency of limited blood component resources.
In Brief
The authors utilized a multi-instituional cohort to identify factors associated with repeat imaging and hemorrhage progression and/or neurosurgical intervention in children with mild traumatic brain injury (mTBI) and intracranial injury. While many factors were associated with patients undergoing repeat neuroimaging, only epidural hematoma, seizures, and age were predictive of hemorrhage progression and neurosurgical intervention. These results may provide a foundation for evidence-based repeat neuroimaging practices in children with mTBIs and intracranial injuries.
In Brief
The authors present their 11-year experience of endoscope-assisted metopic suturectomy without helmet use in 62 patients. This mini-invasive technique led to good/excellent results in patients (age 0-6 months) with moderate and severe forms of trigonocephaly, and its application can be extended to treatment of moderate forms in children in the age range of 6 to 8 months. These encouraging results suggest that in the future trigonocephaly may be treated with lower risks and costs.
In Brief
Seventy-three pregnancies with ventriculomegaly were followed with ultrasonography before delivery and postnatally for an average of 14.6 months. Their neurodevelopmental status and the important effective factors were investigated. Ventriculomegaly was mild or moderate in more than 68% of patients. Serial ultrasonography scans showed that ventriculomegaly regressed or remained stable in most patients. During follow-up, most children had normal developmental status. Despite the analysis of different prenatal factors, only progression of ventriculomegaly (p = 0.028) and associated cranial abnormalities (p = 0.018) had significant relationships with neurodevelopmental prognosis.
In Brief
The objective of the study was to determine the significance of hindbrain herniation status following prenatal repair of myelomeningoceles as it relates to short-term outcomes including shunt-dependent hydrocephalus. Hindbrain herniation reversal was not associated with CSF diversion surgery within the 1st year of life or prior to neonatal intensive care unit discharge. This study provides data contrary to the commonly held view that avoidance of CSF diversion surgery is strongly associated with hindbrain herniation reversal.
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.