Authors:Samuel G. McClugage III, Nicholas M. B. Laskay, Brian N. Donahue, Anastasia Arynchyna, Kathrin Zimmerman, Inmaculada B. Aban, Elizabeth N. Alford, Myriam Peralta-Carcelen, Jeffrey P. Blount, Curtis J. Rozzelle, James M. Johnston and Brandon G. Rocque
Authors of this study evaluated functional outcomes in 2-year-old infants treated for posthemorrhagic hydrocephalus at prematurity, using variables present at the time of the initial neurosurgical consult. They attempted to identify the predictors of functional outcomes that were present early in the disease process, which may aid with family discussions and clinical decision-making.
Authors:Sebastian P. Norrdahl, Tamekia L. Jones, Pooja Dave, David S. Hersh, Brandy Vaughn and Paul Klimo Jr.
The authors analyzed patients who required intervention for a pseudomeningocele—an abnormal collection of cerebrospinal fluid in the brain—after a craniotomy or craniectomy and found statistically significant associations of race and use of a dural patch graft (i.e., duraplasty) with the need for intervention. This study is important because a pseudomeningocele, especially in pediatric patients, does not always resolve on its own. To the authors’ knowledge no previous studies have examined risk factors associated with the need for pseudomeningocele treatment.
Authors:Danielle S. Goulding, R. Caleb Vogel, Chirayu D. Pandya, Crystal Shula, John C. Gensel, Francesco T. Mangano, June Goto and Brandon A. Miller
The authors studied how hydrocephalus (increased fluid in the brain) causes inflammation within the brain. They used a genetic model of hydrocephalus and biochemical and histological tests to measure inflammation and tissue injury. The results show that hydrocephalus causes inflammation and white matter injury. These results highlight that, while inflammatory events such as hemorrhage can cause hydrocephalus, hydrocephalus itself can also cause inflammation.
Authors:Vijay M. Ravindra, Stephen F. Kralik, Julius Griauzde, Nisha Gadgil, Melissa A. LoPresti and Sandi Lam
The authors used noninvasive preoperative CT perfusion to assess dynamic imaging of pathological hemispheres in pediatric patients with moyamoya disease. By comparing CT perfusion parameters in the diseased hemisphere with those in the normal hemisphere, they found that CT perfusion can be predictive of the angiographic severity of the disease to identify candidates for cerebral revascularization.
Authors:Ching-Jen Chen, Cheng-Chia Lee, Hideyuki Kano, Kathryn N. Kearns, Dale Ding, Shih-Wei Tzeng, Ahmet Atik, Krishna Joshi, Gene H. Barnett, Paul P. Huang, Douglas Kondziolka, David Mathieu, Christian Iorio-Morin, Inga S. Grills, Thomas J. Quinn, Zaid A. Siddiqui, Kim Marvin, Caleb Feliciano, Andrew Faramand, L. Dade Lunsford and Jason P. Sheehan
The authors’ study provides long-term outcomes data on pediatric AVM patients treated with stereotactic radiosurgery. The study was derived from the largest multicenter observational cohort database, and it provides the best estimates of outcomes and complications in the pediatric population. The authors believe that these estimates will serve as important counseling information for patients and families.
Authors:Robbin de Goederen, Iris E. Cuperus, Robert C. Tasker, Bianca K. den Ottelander, Marjolein H. G. Dremmen, Marie-Lise C. van Veelen, Jochem K. H. Spoor, Koen F. M. Joosten and Irene M. J. Mathijssen
The researchers measured dural sinus volumes in children with syndromic craniosynostosis with and without intracranial hypertension. They found that children with intracranial hypertension had larger volumes in the straight sinus. These findings are a piece of the puzzle in understanding the pathophysiology of intracranial hypertension in craniosynostosis.
Authors:Ranbir Ahluwalia, Chelsea Kiely, Jarrett Foster, Stephen Gannon, Alyssa L. Wiseman, Chevis N. Shannon and Christopher M. Bonfield
In a large retrospective review study, the authors assessed the prevalence and severity of asymmetry of the pediatric skull associated with positional posterior plagiocephaly (PPP) and patient age in 1429 pediatric patients (2 months to 18 years old). The results demonstrated that PPP is prevalent in the pediatric population, most commonly presenting as mild asymmetry, and prevalence and severity decrease with increasing patient age, with no patients in the cohort having severe asymmetry that persisted into adolescence.
Authors:C. Corbett Wilkinson, Nicholas V. Stence, Cesar A. Serrano, Sarah J. Graber, Lígia Batista-Silverman, Emily Schmidt-Beuchat and Brooke M. French
In this study, the authors investigated the normal course of fusion and the prevalence of early fusion of the sagittal, coronal, lambdoid, and metopic sutures. Importantly, the data demonstrated that fusion of the sagittal suture occurs more commonly than generally thought, including in children with normal head shapes. They also demonstrate that the coronal suture normally starts to fuse inferiorly during the 2nd decade of life.
Authors:Lara L. Cohen, Brian W. Yang, Nora P. O’Neill, Mark R. Proctor, Michael P. Glotzbecker and Daniel J. Hedequist
The authors describe the use of recombinant human bone morphogenetic protein (BMP) in children with trisomy 21 and atlantoaxial instability during cervical spine revision to treat nonunion. The ability to obtain fusion in these children is based on both sound biomechanical principles of fixation and optimizing the biologic environment. Rigid fixation ensures proper biomechanics, while the use of BMP optimized the ability to form bone in these patients who have a propensity to develop nonunions.
Authors:Nebras M. Warsi, Jignesh Tailor, Ian C. Coulter, Husain Shakil, Adriana Workewych, Renée Haldenby, Sara Breitbart, Samuel Strantzas, Michael Vandenberk, Michael C. Dewan and George M. Ibrahim
In total, the authors describe 5 published approaches to selective dorsal rhizotomy (SDR), ranging from multilevel laminectomies to laminotomy and foraminotomy approaches. They assess the technical nuances, benefits, and limitations of each of these techniques with regard to bony exposure, identification of nerve roots, and technical difficulty. The operative approach to SDR currently performed at the Hospital for Sick Children in Toronto is also illustrated in detail.
Authors:Ian Mutchnick, Meena Thatikunta, Julianne Braun, Martha Bohn, Barbara Polivka, Michael W. Daniels, Rachel Vickers-Smith, William Gump and Thomas Moriarty
Keeping patients warm in the perioperative phase of care is unambiguously beneficial. However, operating room culture and ergonomics have functionally impeded implementation of protocols aimed at maintaining perioperative euthermia. In this study, the authors demonstrated the efficacy of an ergonomically acceptable protocol that prevents more than 90% of the perioperative hypothermia burden imposed by the current standard of care.
Authors:Brandon G. Rocque, Bradley E. Weprin, Jeffrey P. Blount, Betsy D. Hopson, James M. Drake, Mark G. Hamilton, Michael A. Williams, Patience H. White, Katie O. Orrico and Jonathan E. Martin
This study evaluated the performance of North American pediatric neurosurgeons in health care transition and made suggestions regarding how to improve transitional care through both individual and organizational efforts.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
The authors measured concussion severity by comparing early concussion assessments to patients' baselines. These measurements of severity were then used to predict trends in recovery. Ultimately, patients will be able to calculate this marker of concussion severity for themselves and make inferences about their recovery based on similar injuries.
The authors evaluated blood and tumor tissue samples from pediatric patients with one of the 3 most common brain tumor types and looked for correlations between micro RNA (miRNA) expression levels in the two groups. This information is important in understanding the significance of blood-based miRNA tests in predicting brain tumor presence or behavior.
The authors conducted a retrospective review of 1499 patients ≤ 19 years of age who presented for trauma evaluation with a negative CT scan. The authors determined the overall prevalence of brachycephaly and tried to demonstrate resolution over time. The cranial index (CI) was calculated using CT. Brachycephaly was defined as a CI ≥ 90%. The authors found that the incidence of deformational brachycephaly is common in infants but decreases as the child progresses through early childhood.
The authors investigated the fusion of "minor" lateral sutures (sphenoparietal, squamosal, parietomastoid) on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients to determine the normal course of fusion. They found that these sutures often fuse during childhood and adolescence in a typical sequence, such that fusion in most children and adolescents is normal, does not represent craniosynostosis, and does not require treatment, including surgery.
In this study the authors investigated the safety and pharmacokinetics of direct infusion of the histone deacetylase inhibitor MTX110 (soluble panobinostat) into the fourth ventricle in a nonhuman primate model. Important findings were that MTX110 can be safely infused into the fourth ventricle in nonhuman primates without causing neurological deficits, abnormalities visible on brain MRI, or pathological evidence of brain or other organ injury. These results provide important background data for a pilot clinical trial of this chemotherapeutic agent in patients with recurrent medulloblastoma.
Pediatric cavernous malformations (CMs) are commonly treated vascular anomalies; however, the recurrence rate after resection and long-term risk of requiring subsequent surgeries are unknown. The authors found that patients who presented with a single CM and without acute hemorrhage are highly unlikely to require additional surgery, whereas patients who present with acute hemorrhage or with multiple CMs have a higher risk of requiring subsequent surgery and will continue to need close monitoring.
The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days compared to 8–20 days from injury) in risk for prolonged recovery (> 30 days) in pediatric concussion. These findings highlight the importance of early, specialized medical care and intervention for children and adolescents with recent concussion.
The authors reviewed the safety and efficacy of surgical treatment for epilepsy in infants. Their findings support the safety and efficacy of epilepsy surgery in infants, which may result in better long-term outcomes.
Using data obtained with the Scoliosis Research Society survey (SRS-22r), the authors investigated perioperative factors contributing to low self-image in adolescent idiopathic scoliosis (AIS) patients despite preoperatively mild curves or postoperatively well-corrected main curves. Improved SRS-22r self-image scores were associated with posterior spinal fusion for AIS and perioperative apical vertebral translation of the main thoracic curve (moreso than the Cobb angle), and decreased scores with persistent curvature of the thoracolumbar/lumbar region and higher Risser grade 2 years postoperatively. Informing AIS patients preoperatively of the risk of residual lumbar curvature may help them better accept possible postoperative deformity.
The time course of syrinx resolution after posterior fossa surgery is not well understood. However, understanding it is important because it will allow surgeons to determine the length of follow-up and the need for imaging follow-up, and because it will facilitate evidence-based discussions with the patient and family.
The authors compared outcomes of minimally invasive and open surgery in the correction of lambdoid craniosynostosis to address the paucity of available literature on this rare patient group. The authors found endoscopic suturectomy with helmet therapy to be more benign and efficient than open surgery, and equally safe and efficacious.
The authors present their surgical technique for endoscopic treatment of combined metopic-sagittal craniosynostosis and evaluate the head shape outcomes of 3 patients by using established measurements, comparing patients to normal controls before and after surgery. This study is the first to report outcomes of endoscopic treatment for this rare form of multisuture craniosynostosis, which is traditionally treated with 2 separate open cranial vault reconstructions.
The authors developed and investigated a novel protocol for electrical stimulation mapping (ESM) for use in resective epilepsy surgery in children with focal intractable epilepsy. Although previous methods of ESM frequently fail in children, the authors found their method to be safe and reliable to use in children undergoing epilepsy surgery.
The authors studied outcomes following treatment of a large cohort of children with brain arteriovenous malformations (AVMs). AVMs were treated using a combination of techniques including embolization, surgery and stereotactic radiosurgery. An individualized approach resulted in successful cure of the majority of lower-grade AVMs and nearly half of the complex, higher-grade AVMs.
The authors studied the relationship between the position of the obex and various clinical characteristics of patients with Chiari I malformation (presence of scoliosis, spinal cysts, occipital headaches, whether the patient underwent posterior fossa decompression surgery) and found that the position of the obex was able to predict these traits better than the traditional diagnostic radiological measurement, tonsil position.
The authors provide a review of the history, development, and variation in head immobilization devices and pinning techniques and an overview of the special considerations of pinning in pediatric patients, along with a description of the modified rubber stopper pin technique to diffuse pressure and minimize the risk of injury. This information is important because cranial characteristics of pediatric patients, including open fontanelles, unfused sutures, and thin skulls, must be taken into account to avoid pinning complications, which are more common in the pediatric population.
The authors evaluated preoperative factors related to outcomes of scoliosis after posterior fossa decompression for patients with Chiari malformation–associated syringomyelia. This study will help inform which patients with scoliosis are likely to stabilize or progress after surgery.
Prompt diagnosis and treatment of pediatric TBI is of utmost importance and highly reliant on efficient communication between providers. The authors assessed the SITI scale, previously validated in adults, in the pediatric population to determine its utility. Insights from this study found this scoring system to strongly correlate with operative intervention in pediatric patients, underscoring its potential utility as a communicative tool in the setting of closed head injury TBI.
The authors used a population-based cohort of patients treated over a 15-year period to establish the epidemiology of craniosynostosis in Norway. Given the large variety in epidemiology of craniosynostosis, the authors believe they present important and unique data since Norway has an equal-access healthcare system that results in most individuals seeking medical care when needed. The authors found a high incidence and a high number of familial cases of syndromic and nonsyndromic craniosynostosis, thus highlighting the importance of genetics in craniosynostosis.
The study focuses on seizure outcome in children with extratemporal low-grade tumors undergoing resection. This topic has not received much attention in the literature (as opposed to temporal tumors), and the authors try to answer a basic everyday clinical question regarding the risk of new-onset postoperative epilepsy in children with no prior history of seizure; they also look at the prognosis of epilepsy in children with preoperative seizures.
There is considerable variability among pediatric neurosurgical practices regarding the frequency with which simple spinal cord detethering is performed. The authors found that simple detethering procedures were relatively uncommon in their active, well-established pediatric neurosurgical service and represented less than 5% of the service’s total case volume per year with an average of 5 cases per surgeon per year. No patients with normal MRI studies were operated on during the study period. With this study, the authors contributed to benchmark data regarding the expected frequency of surgery for this condition.