Authors:Kyung Hyun Kim, Ji Yeoun Lee, Ji Hoon Phi, Seung-Ki Kim, Byung-Kyu Cho and Kyu-Chang Wang
Arachnoid cysts (ACs) are benign cystic lesions. The surgical indications for some ACs are controversial. While surgical procedures can be effective when an AC is a definite cause of hydrocephalus or papilledema, most ACs do not cause any symptoms or signs. Some surgeons perform several procedures on ACs because of their large size. The authors’ cumulative experience with the benign course of unoperated large sylvian ACs made them evaluate the value of surgery in cases involving large sylvian ACs. They compare the outcomes of surgery and nonsurgery in patients with large sylvian ACs (Galassi type III).
Authors:Grace M. Thiong’o, Susan S. Ferson and A. Leland Albright
This article analyzes 4 different ways of treating hydranencephaly, a devastating congenital neurosurgical condition with no globally accepted treatment strategy yet. By understanding the outcome of the different surgeries that can be offered, all of us move closer to an accepted standard of care for infants suffering from hydranencephaly.
Authors:Jorge Tirado-Caballero, Mónica Rivero-Garvia, Francisco Arteaga-Romero, Jorge Herreria-Franco, Ángel Lozano-Gonzalez and Javier Marquez-Rivas
The authors reviewed and analyzed the effects of neuroendoscopic lavage therapy in preterm infants with intraventricular hemorrhage. The motor and cognitive outcome of the patients treated by this technique is still uncertain and controversial. This paper enlightens and provides evidence of the effectivity of this treatment for the management of such complex pathology.
Authors:Zohreh Habibi, Mehdi Golpayegani, Bahar Ashjaei, Keyvan Tayebi Meybodi and Farideh Nejat
In this series, the results of ventriculosuprahepatic shunting in 12 consecutive cases with pseudocyst-associated malfunction are presented. Considering the high rate of recurrence after pseudocyst-associated distal malfunction, finding an adequate alternative cavity for a distal catheter is a significant challenge for pediatric neurosurgeons. The authors hope this approach could be helpful for colleagues who may encounter refractory peritoneal catheter malfunctions.
Authors:Ranbir Ahluwalia, Jarrett Foster, Earllondra Brooks, Jaims Lim, Shilin Zhao, Stephen R. Gannon, Bradley Guidry, John Wellons III and Chevis N. Shannon
The objective of this study was to determine whether the Chiari Severity Index (CSI) can be used to predict surgical outcomes for patients with Chiari type I malformation (CM-I) using the modified Chicago Chiari Outcome Scale (mCCOS). The CSI was not shown to be a reliable marker of postsurgical outcomes using the mCCOS. As such, no tool exists to help predict which patients with CM-I will benefit from surgery.
The authors report data on a population-based pure myelomeningocele patient series undergoing tethered cord release surgery. This is important, because available data usually are institution-based and in a mixed spina bifida population. The authors hope that their data may inform the ongoing discussion on the indication for this surgery.
Authors:Michael M. McDowell, Nitin Agarwal, Gordon Mao, Stephen Johnson, Hideyuki Kano, L. Dade Lunsford and Stephanie Greene
The authors report the largest series of pediatric arteriovenous malformations at a single center, with long-term follow-up regarding the multimodality treatment of this rare disease. The authors determined that patients have a high rate of long-term functional independence when multimodality treatment is strategically applied and that recurrences, although rare, tend to appear many years after documented obliteration and thus warrant long-term screening.
Authors:Sarah Stricker, Grégoire Boulouis, Sandro Benichi, Florent Gariel, Lorenzo Garzelli, Kevin Beccaria, Anais Chivet, Timothee de Saint Denis, Syril James, Giovanna Paternoster, Michel Zerah, Marie Bourgeois, Nathalie Boddaert, Francis Brunelle, Philippe Meyer, Stephanie Puget, Olivier Naggara and Thomas Blauwblomme
In children with intracerebral hemorrhage due to ruptured brain arteriovenous malformations (bAVMs), the authors investigated the need for external ventricular drainage (EVD) and ventriculoperitoneal shunt (VPS) placement and rates and predictive factors of hydrocephalus requiring acute EVD and VPS. The study results may be of critical help for decision making in emergencies, such as the important finding that the risk for VPS is not increased by EVD placement and therefore indications for EVD placement after bAVM rupture can be kept wide, which helps optimize the available options for intracranial pressure management.
Authors:Akshitkumar M. Mistry, Nishit Mummareddy, Travis S. CreveCoeur, Jock C. Lillard, Brandy N. Vaughn, Jean-Nicolas Gallant, Andrew T. Hale, Natalie Griffin, John C. Wellons III, David D. Limbrick Jr., Paul Klimo Jr. and Robert P. Naftel
The authors investigated the effects of high-grade glioma (HGG) contact with the subventricular zone (SVZ) on survival in a pediatric population. It is known that this association leads to worse outcomes in adults, and the authors found that HGG contact with the SVZ is associated with decreased survival in pediatric patients. Thus, tumor contact with the SVZ appears to be a negative prognosticator in HGG.
Authors:Alexandra Cutillo, Kathrin Zimmerman, Susan Davies, Avi Madan-Swain, Wendy Landier, Anastasia Arynchyna and Brandon G. Rocque
The authors conducted interviews with caregivers of children with a brain tumor in order to assess the quality of communication with the neurosurgery and oncology team during hospitalization. This study is important because caregivers are a crucial part of a child’s medical care and it is essential to understand what are best practices for communication.
Authors:Giselle E. K. Malina, Daniel M. Heiferman, Loren N. Riedy, Caroline C. Szujewski, Elhaum G. Rezaii, John P. Leonetti and Douglas E. Anderson
The authors present their institutional experience with pediatric sporadic vestibular schwannomas and report their findings from a meta-analysis of the existing literature. This study is important because it provides further insight into the presentation, tumor characteristics, and surgical outcomes for these rare tumors to help direct future treatment strategies.
Authors:Kamlesh B. Patel, Cihat Eldeniz, Gary B. Skolnick, Udayabhanu Jammalamadaka, Paul K. Commean, Manu S. Goyal, Matthew D. Smyth and Hongyu An
Multiple head CT scans in children will triple the risk of leukemia and brain cancer. The focus is to decrease radiation exposure by reducing the number of CT scans done and creating low-dose radiation protocols. MRI offers the best solution to this problem, as this generates images without radiation. The authors' long-term objective is to create a 3D reconstruction of the cranium using MRI without necessitating that the child be sedated.
Authors:Laura G. Hamant, P. David Adelson, Paul Kang, S. Danielle Brown and Jorge I. Arango
The authors compared allograft to sural nerve autograft harvested at the time of surgery for children with obstetrical brachial plexus injury. The findings would seem to indicate that the use of acellular allograft is an acceptable alternative to autograft in the surgical treatment of these children.
Authors:Cody L. Nesvick, Soliman Oushy, David J. Daniels and Edward S. Ahn
Nonsteroidal antiinflammatory drugs (NSAIDs) are highly effective in treating postcraniotomy pain, but their clinical use has been limited by fear of increased risk of perioperative hemorrhage. The authors performed a retrospective study assessing the risk of hemorrhage-related complications in children undergoing craniotomy for tumor resection who received or did not receive NSAIDs. There was no correlation between immediate postoperative NSAID use and hemorrhage-related complications, indicating that this class of medication is probably safe in this setting.
Optimizing convection-enhanced delivery (CED) for neurooncological therapeutic strategies will likely demand sequential treatments. This clinical series was intended to report on the use of multiple CED procedures and repeat dosing in children with diffuse intrinsic pontine glioma. These encouraging results related to safety, accuracy, and feasibility provide an impetus for improved clinical trial design and greater enthusiasm for device research and development.
The authors evaluated postoperative pediatric neurosurgical patients in order to determine how common postoperative fevers are and how common and helpful workups are in these patients. The authors determined that performing invasive and costly fever workups are not worthwhile in these patients in the first 4 postoperative days.
The authors created an MRI spine protocol using fast sequencing to avoid sedation in pediatric patients and then assessed its use in identifying and monitoring syrinx and spinal dysraphism. They report the first pediatric series of a fast-sequence spine MRI protocol for use in young patients that does not require sedation and is able to identify and monitor syrinx and spinal dysraphism.
The authors studied the use of subdural grids for invasive monitoring in pediatric patients 3 years old and younger with refractory epilepsy. While overall complication rates were higher in this younger cohort, subdural grid placement was not associated with an increased risk of surgical complications in that population. The study is important because there is a lack of information about the utility of this technique in very young pediatric patients, its risks, and outcomes.
The main objective of this study was to show the feasibility of fetal occipital encephalocele repair. The study showed that patients who underwent fetal correction of an occipital encephalocele experienced reversal of microcephaly and may have a satisfactory cognitive outcome when compared with patients treated after birth. The study opens new horizons for fetal neurosurgery.
The authors’ objective was to verify intracranial injury due to short falls and examine the characteristics of these falls in infants and toddlers. In the objective classification of patients into groups based on whether or not the fall was witnessed by a nonrelative, subdural hematoma, retinal hemorrhage, and neurological sequelae due to short falls were not seen after witnessed falls. This study provided the findings in a novel way to reduce the risk of misclassification and circular reasoning.
Hydrocephalus is primarily a disease of childhood in low- and-middle-income countries. Zambia is a nation in sub-Saharan Africa of 17 million people in which over half of the population lives below the international poverty line. To date, information about neurosurgical management of pediatric hydrocephalus in Zambia has been inferred from neighboring countries since no data currently exist. The authors’ research closes that gap. This study describes pediatric hydrocephalus surgical outcomes and predictors of postoperative complications.
The authors attempted to evaluate the effectiveness and safety of ventricular irrigation in cases of cerebral ventriculitis in a pediatric population, including using both endoscopic lavage as well as lavage with two-tube irrigation. The results showed a significance advantage of the lavage/irrigation technique over the conventional treatment methods (drainage with an external ventricular drain as well as systemic and intraventricular antibiotics) regarding survival, morbidity, and hospital stay duration. The study shows that ventricular lavage/irrigation is safe and effective in cases of cerebral ventriculitis in the pediatric population and neonates.
The objective of this study was to define the inflammatory response within the brain after intraventricular hemorrhage by using a neonatal rat model. After hemoglobin injection into the lateral ventricle, there was an acute inflammatory response, followed by oxidative stress that was concentrated in white matter. This study suggests that anti-inflammatory treatment for intraventricular hemorrhage may need to be given very early after injury in order to be effective.
This paper’s objective is to demonstrate a novel innovative approach to tissue-sparing hemispherotomy in patients with intractable hemispheric epilepsy without a lateral ventricle. The surgery successfully disconnected the pathologic hemisphere and the patient has been seizure free with significant improvement in achieving developmental milestones. This technique illustrates a surgical disconnection option with low morbidity for patients who would otherwise undergo a hemispherectomy with a higher risk of significant morbidity and mortality.
The author presents his experience with a novel transcallosal translamina terminalis approach for resection of a large craniopharyngioma. This corridor allows the optimal opening of the lamina terminalis extending up to the anterior commissure, providing a wider exposure of the tumor compared with the classic approaches through the lamina. The author demonstrated that this approach can constitute a safe option for select suprasellar tumors and be an additional resource in the neurosurgical armamentarium.
Neurosurgeons use the size of the cerebral ventricles to diagnose hydrocephalus, but no reference exists for normal growth patterns in children. In this study, the authors used a computer program to calculate the 3D volume of the ventricles from 687 brain MRI scans obtained in normal children, which produced normal growth curves. These normal growth curves can help clinicians detect patterns of abnormal growth of the cerebral ventricles and diagnose hydrocephalus in the appropriate clinical context.
The survival course of congenital glioblastoma in infants diagnosed within their first 3 months of life was modeled. Overall survival of these patients was shown to be much longer than that of adult glioblastoma, and their survival can be predicted by the use of chemotherapy and resection. This study indicates that congenital glioblastoma should not be viewed similarly to adult glioblastoma, but rather as a separate clinical entity.
In this study the authors aimed to ascertain whether insular resection results in cognitive or developmental decline after epilepsy surgery in children with focal cortical dysplasia. Insular epilepsy surgery did not carry a significant reduction in intellectual/developmental quotient. This study provides additional evidence on cognitive and developmental risks in pediatric epilepsy surgery involving the insula.
A neurodevelopmental outcome analysis and brain volumetry study was performed in children who underwent neuroendoscopic lavage due to hydrocephalus after interventricular hemorrhage in the neonatal period. This is the first outcome analysis for a cohort of patients who underwent neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates.
The authors used survey methodology to elicit information regarding what treatment-related factors are important and how they are prioritized in order to arrive at a treatment preference when a family is confronted with a decision regarding the initial surgical treatment for childhood hydrocephalus. The authors believe that patient/parental preferences and how they impact treatment choice is an underexplored yet vitally important topic, and the information presented here is valuable from many perspectives.
The authors analyzed whether intraoperative electrocorticography (ECoG) has an effect on epilepsy surgery outcomes in children. They established that patients who underwent ECoG-guided modification of the surgical plan achieved significantly higher rates of seizure freedom than those in whom the modification was not feasible, and the long-term complication rate was not higher in this group of patients. Based on this study, intraoperative ECoG is a reliable tool to guide resection and predict seizure outcomes in pediatric patients undergoing epilepsy surgery.
The objective of this study was to seek explanations for racial disparities in trauma-related mortality after traumatic brain injury (TBI) in childhood. The study succeeded in narrowing the field of possible explanations to factors recorded in the Trauma Quality Improvement Program (TQIP) registry. After statistical adjustment for the clinical and system factors recorded in the registry, mortality among Black children was no worse than among White children. There is no need to invoke dietary, environmental, genetic, or epigenetic factors to explain this racial disparity in trauma outcomes. Efforts to eliminate disparities in TBI outcomes must focus first on processes recorded in the TQIP registry.
The authors redefine the morbidity and yield of biopsy procedures in the modern era of frameless navigation, advanced preoperative imaging, and intraoperative MRI (iMRI) and demonstrate that brainstem biopsies can be accomplished with a high degree of safety and efficacy. A multidisciplinary approach to target selection is critical to a successful outcome.
The authors performed a retrospective single-center study to evaluate the safety of responsive neurostimulation (RNS) in pediatric patients with drug-resistant epilepsy. The results suggested that RNS is a safe and efficacious treatment, with infections being the main complication.
The authors studied anxiety, depression, fatigue, and headache burden in the pediatric hydrocephalus population. This study is important because knowing the prevalence of these factors in this population provides an opportunity to potentially increase the quality of life by addressing these psychosocial comorbidities.
The authors report on the first prospective case series of children (n = 14) with different brain lesions involving motor- or language-eloquent locations who were scheduled for transcranial magnetic stimulation (TMS) motor and/or language mapping and consecutive diffusion tensor imaging fiber tracking of motor- and language-related white matter tracts. They analyzed the feasibility of TMS and its influence on counseling and surgical strategy. In 6 patients the surgical strategy was adapted according to navigated TMS data, and in 6 patients the extent of resection was redefined.
The authors instituted a new shunt protocol utilizing intraventricular and topical vancomycin and describe their shunt infection rates over a prolonged period of time. Their results are hypothesis generating, and the authors propose that intraventricular and topical administration of vancomycin as part of a standardized shunt operation protocol may be an appropriate option for preventing pediatric shunt infections.
In this study, the authors introduce a novel method that describes the relationship of the occiput–C1 joint to the subaxial cervical spine. This will aid in identifying high-risk children with Chiari malformation type I who may require reoperation or ventral brainstem decompression or occipitocervical fusion. This will help practitioners identify the high-risk Chiari phenotype when evaluating children; however, further validation of the measure is needed.
In this study, the authors analyzed the outcomes of patients with Rasmussen encephalitis who had undergone hemispherectomy in order to help guide therapeutic strategies and inform patient counseling for treatment of this rare disease.
Most pediatric management strategies are extrapolated from adult studies, including the standard practice of maintaining the head of bed (HOB) at a 30° elevation to minimize the risk of elevated intracranial pressure (ICP). In this prospective study of pediatric patients with severe TBI, the authors investigated the effect of different head positions on ICP, cerebral perfusion pressure, and cerebral venous outflow through the internal jugular veins on postinjury days 2 and 3, days considered as the peak risk for intracranial hypertension. They show that the optimal HOB needs to be individualized for each TBI patient, even on a daily basis.
The authors analyzed the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a cerebrospinal fluid shunt malfunction in the presence of stable ventricular size. The findings demonstrated that the RP shunt flow study is of definite clinical value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size has occurred.
The objective of this study was to measure quality of life (QOL) of children with hydrocephalus, as assessed by caregivers and patients themselves. Using a convenience cross-sectional sample of children with hydrocephalus and their parents, the authors evaluated QOL using standardized survey instruments. This study is important because in order to improve the QOL of children with hydrocephalus, risk factors for lower QOL must be identified.
The optimal management of children with syndromic, multisuture, and lambdoid craniosynostosis remains uncertain. The authors’ group pioneered the posterior calvarial distraction procedure for craniosynostosis just over a decade ago. In this study, they showed that posterior calvarial distraction increased both posterior fossa and supratentorial volume, which in turn improved cerebellar tonsillar herniation and syringomyelia. The authors showed that posterior calvarial distraction was a safe and efficacious first-line, single-stage treatment. This study supports a new management paradigm.
Pediatric hydrocephalus is routinely managed with endoscopic third ventriculostomy (ETV). Choroid plexus cauterization (CPC) has been introduced as an adjunct treatment to ETV that helps prevent the requirement of a CSF diversion procedure. This systematic review and meta-analysis found no statistically significant difference between patients managed with ETV alone and in combination with CPC. A subgroup analysis in African cohorts found a significant increase in success rate with ETV combined with CPC.
The authors studied children treated with endoscopic aqueductal stenting (EAS) during the last decade at Necker Enfants Malades Hospital in Paris. EAS is an accepted treatment to reestablish normal CSF pathways between supra- and infratentorial spaces and thus to reequilibrate the transtentorial pressures. No studies in the literature analyze how this procedure could change the clinical course of hydrocephalic patients. Interestingly, the authors found a significant decrease in the number of surgeries after EAS, and they also found that posthemorrhagic hydrocephalus predicted a favorable outcome in multivariate analysis.
The authors report a series of 49 pediatric brain biopsies for cryptogenic neurological disease. The paper adds value to the current evidence base by demonstrating the utility and safety of brain biopsy. Histopathological analysis enabled the authors to inform and modify clinical management, improving patient outcomes. Furthermore, it provides insight into the spectrum of diagnoses encountered in a busy 21st century urban neurosurgical center.
The authors' study is the first to evaluate predictors of early obliteration of brain arteriovenous malformations (AVMs) in an exclusively pediatric cohort. It is well known that pediatric AVMs are distinct from their adult counterparts and therefore data regarding adult brain AVMs cannot be generalized to the pediatric population. Similarly, hemorrhage secondary to pediatric brain AVMs causes considerable morbidity and mortality. The results of the present study help identify particularly radiosensitive pediatric AVMs, which may facilitate prognostication and management decisions in this unique patient population.
The authors studied the seizure and cognitive outcomes of a relatively new surgical procedure called multiple hippocampal transections in the treatment of refractory epilepsy in a group of 3 pediatric patients. This paper will add to the limited existing literature and help expand the indications of multiple hippocampal transections as it highlights the new procedure's effectiveness in pediatric patients.
This study compares the magnitude of surgical resource utilization between 3 different treatments of hydrocephalus: shunt insertion, endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization. Results of this study contribute important information for families and physicians in the decision between treatments for hydrocephalus.
This article represents the authors' evaluation of the impact of a multidisciplinary quality-improvement protocol to reduce and attempt to eliminate the need for blood transfusion in patients undergoing open calvarial vault remodeling for craniosynostosis. The authors found that the multidisciplinary stakeholder input allowed consideration of preoperative, intraoperative, and postoperative strategies to reduce blood transfusion with a resulting decrease in estimated blood loss and total transfused blood volume upon adoption of a formal protocol.
The authors set out to determine whether there are any relationships between pediatric cranial deformations and patient demographics, including sex, race, and ethnicity. The authors’ main finding was that sex does not play a significant role in regard to cranial deformations; however, race was found to have strong associations that are likely multifactorial in nature. This finding will give physicians a clearer understanding of patient populations and which patients may be at risk for symmetric and asymmetric cranial deformations.