Journal of Neurosurgery: Pediatrics
Volume 27: Pages 1-123

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Authors: Chibawanye I. Ene, Anthony C. Wang, Kelly L. Collins, Robert H. Bonow, Lynn B. McGrath, Sharon J. Durfy, Jason K. Barber, and Richard G. Ellenbogen

In Brief

This study evaluates an obex exploration technique in pediatric patients with Chiari type-I malformation (CM-I). Patients with a syrinx who underwent expansile duraplasty with obex exploration had a significantly greater likelihood of syrinx and symptom resolution compared with bone-only decompression, without a higher risk of CSF-related complications. Risks and benefits associated with surgical options for treatment of CM-I are ill defined; this study may inform these decisions

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Authors: Victor M. Lu, David J. Daniels, Dawit T. Haile, and Edward S. Ahn

In Brief

The authors investigated total opioid use and pain control with a single intraoperative dose of liposomal bupivacaine (LB) after Chiari decompression in pediatric patients. Compared with controls, patients administered LB had reduced pain scores and opioid use in the first 24 postoperative hours. During later hospitalization the effect was less evident, but complete nonopioid analgesia was possible in some LB-treated patients. This study is, to the authors’ knowledge, the first to describe LB as a possibly useful analgesic for severe postoperative pain that frequently follows pediatric Chiari surgery.

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Authors: Rebecca A. Reynolds, Makayla Dixon, Stephen Gannon, CCRP, Shilin Zhao, Christopher M. Bonfield, Robert P. Naftel, John C. Wellons III, and Chevis N. Shannon

In Brief

Hydrocephalus is a lifelong disease that gives pediatric neurosurgeons and patient families the opportunity to develop long-lasting relationships. Surgeons often discuss parents’ concerns and economic issues during clinic visits. The authors sought to understand the interaction between socioeconomic status and parental concern. They found that more engaged parents, regardless of their socioeconomic background, reported better overall child health. While poorer parents were more concerned about their child, this did not affect their child’s current health.

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Authors: Amrita Hari-Raj, Lauren Q. Malthaner, Junxin Shi, Jeffrey R. Leonard, and Julie C. Leonard

In Brief

This manuscript analyzes the demographic trends of emergency evaluations for pediatric patients presenting with suspected shunt malfunctions in the United States between 2006 and 2017. Prior studies have not described these overarching trends or related hospital and patient characteristics associated with receiving surgery to correct a malfunction. Understanding the epidemiology, diagnostic workups, and surgical revision rates of this patient population over time is important for further improving diagnostic and treatment efforts for shunt malfunctions.

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Authors: Melissa M. J. Chua, Ittai Bushlin, Coral M. Stredny, Joseph R. Madsen, Archana A. Patel, and Scellig Stone
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Authors: Thandar Aung, Vineet Punia, Masaya Katagiri, Richard Prayson, Irene Wang, and Jorge A. Gonzalez-Martinez

In Brief

The authors present a novel method of extraoperative stereoelectroencephalography (SEEG) monitoring complemented by subsequent intraoperative recordings, designed to tailor multistaged resections in rolandic and perirolandic cortex in a highly selected group of patients with pharmacoresistant rolandic and perirolandic focal epilepsy. The results testified to the feasibility and demonstrated the value of the combined benefits of both extra- and intraoperative SEEG recordings when resecting the rolandic and perirolandic areas. With the proposed novel hybrid method one can precisely limit the volume of resection necessary to abort epileptic activity while preserving the functional cortex as much as possible.

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Authors: Alexander G. Weil, Natalie Mathews, Jean-Pierre Farmer, Christine St. Martin, Steffen Albrecht, Nada Jabado, and Roy W. R. Dudley
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Authors: Sebastian M. Toescu, Gargi Samarth, Hugo Layard Horsfall, Richard Issitt, Ben Margetts, Kim P. Phipps, Noor-ul-Owase Jeelani, Dominic N. P. Thompson, and Kristian Aquilina

In Brief

The authors looked back at all brain tumors of the fourth ventricle treated at their hospital over the past 17 years to see what the burden of complications was in these children, in the largest such study to date. The authors show that complication rates are high in this type of surgery, and particularly that speech problems are common, but this does not appear to be affected by the surgical approach.

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Authors: Newton Cho, Vincent D. W. Nga, Raheel Ahmed, Jerry C. Ku, Pablo M. Munarriz, Prakash Muthusami, James T. Rutka, and Peter Dirks

In Brief

This study summarizes the authors’ experience using surgery and other related technology to successfully treat ruptured rolandic arteriovenous malformations with minimal neurological morbidity. This study addresses an important gap in understanding the role of surgery for treating these lesions.

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Authors: Nobuhito Morota, Satoshi Ihara, Hideki Ogiwara, Kenichi Usami, Ikkei Tamada, and Tsuyoshi Kaneko

In Brief

The authors reported a retrospective case review of 14 patients with basal encephalocele. Surgical strategy for selection of the approach (transoral transpalatal, transfrontobasal, and endoscopic transnasal) depended on the location, presence of cleft palate, and size of the bone defect. A titanium mesh/plate was recommended material for the skull base reconstruction. The paper provides a comprehensive understanding of the basal encephalocele and its surgical management.

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Authors: Era D. Mikkonen, Markus B. Skrifvars, Matti Reinikainen, Stepani Bendel, Ruut Laitio, Sanna Hoppu, Tero Ala-Kokko, Atte Karppinen, and Rahul Raj

In Brief

The authors investigated the 1-year costs of ICU-treated pediatric traumatic brain injury (TBI) in Finland. Increased injury severity was associated with increased total 1-year cost, and the majority of the total 1-year resources were spent on patients with favorable outcomes, suggesting that ICU treatment of pediatric TBI is cost-effective. This study is important because Finland’s public tax-funded healthcare system allows assessment of costs of the entire treatment chain, making Finland one of the few places where reliable health economics studies can be carried out.

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Authors: Brandon W. Smith, Kate W. C. Chang, Sravanthi Koduri, and Lynda J. S. Yang

In Brief

Primary brachial plexus nerve reconstruction consists of nerve grafting and nerve transfer. There is continued debate among surgeons regarding which of these two options provides the most optimal outcomes. This study examined outcomes for shoulder function in patients with either nerve grafting or nerve transfer. In this study, there appears to be an advantage in external rotation of the shoulder in patients who underwent nerve transfer repair.

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Authors: Ronnie E. Baticulon, Michael C. Dewan, Nunthasiri Wittayanakorn, Philipp R. Aldana, and Wirginia J. Maixner

In Brief

The researchers surveyed pediatric neurosurgeons in Asia and Australasia to get an overview of their training and current clinical practice. Both fellowship-trained and general neurosurgeons provided neurosurgical care to children in the region, and respondents expressed a desire to train further in pediatric epilepsy, spasticity, vascular malformations, craniofacial disorders, and brain tumors. These training needs have to be considered when structuring fellowship programs and teaching courses in pediatric neurosurgery.

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Authors: Ranbir Ahluwalia, Patrick Bass, Laura Flynn, Elizabeth Martin, Heather Riordan, Alice Lawrence, and Robert P. Naftel

In Brief

The objective of this study is to describe a combined dorsal and ventral rhizotomy for patients with concurrent spasticity and dystonia through a technical note. The key finding, and value added by this paper, is to perform the procedure through a conus-level laminectomy rather than an L1–S1 laminoplasty.

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Authors: Morrakot Sae-Huang, Anouk Borg, and Ciaran Scott Hill

In Brief

This systematic review was conducted to compare and evaluate the efficacy and outcome of the nonsurgical management of atlantoaxial rotatory fixation (AARF). The authors found that there is a lack of level I evidence comparing the different nonsurgical management methods in AARF and that the available data come from uncontrolled nonrandomized studies. This highlights the need for well-designed comparative studies to determine the best nonsurgical approach to the management of AARF.

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Authors: Bertrand Mathon, Marc Pineton de Chambrun, Alexandre Le Joncour, and Aymeric Amelot
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Authors: Willem Pondaag, Justus L. Groen, and Martijn J. A. Malessy
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The objective of this paper was to evaluate the clinical and hemodynamic benefits of an occipital artery–middle cerebral artery bypass for patients with pediatric moyamoya disease who had recurrent symptoms after initial revascularization. Cerebrovascular reactivity values in both middle cerebral artery and posterior cerebral artery territories are significantly improved, with clinical improvement after occipital artery–middle cerebral artery bypass despite progression of posterior cerebral artery stenosis in most patients. The occipital artery–middle cerebral artery bypass is an effective rescue therapy for cases of pediatric moyamoya disease.

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In Brief

The objective of this study was to compare the quality of imaging using EOS low-dose radiography to conventional radiography to evaluate peritoneal shunt tubing. The authors found that overall image quality and hardware delineation of EOS radiography did not significantly differ from conventional radiography for the evaluation of cerebral shunts. EOS appears to be a lower-cost and lower-radiation alternative to radiography for shunt evaluation.

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In Brief

The objective of this study was to use resting-state functional MRI to preoperatively map language networks in children with epilepsy. Language networks were identified at the individual level, and more than half of the cases in the study presented with atypical language lateralization, highlighting the need for brain mapping. Preoperatively identifying language networks in pediatric cases is challenging. However, it can help optimize electrode placement.

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In Brief

Researchers conducted a large cross-sectional cohort study pooled in a meta-analysis with existing literature to investigate the etiology of pediatric intracerebral hemorrhage. In all pooled studies, readily identifiable cerebral vascular lesions were the predominant cause, with arteriovenous malformations representing the most frequent subtype. These current data contribute adjusted estimates of the relative prevalence of the various etiologies of intracerebral hemorrhage in children and provide novel data on the increasing prevalence of vascular lesions as age increases during childhood.

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In Brief

The authors explored the functional and structural networks associated with improvement in children undergoing deep brain stimulation (DBS) for dystonia. The area most associated with clinical improvement was located in the posterior globus pallidus pars interna, with structural connectivity with the precentral and postcentral gyri, parietooccipital region, and brainstem. Scant information on the mechanisms of pediatric DBS is available and this study elucidates similarities and differences with the conventional target used for adult dystonia.

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In Brief

The authors conducted a prospective study of isolated pediatric head injury involving analysis of a large cohort (201 children) and demonstrated that initial high blood white cell count has a predictive value for lengthy hospital stay and poor cognitive outcome in these children. This study is important because it represents the first prospective and large cohort study that supports the use of initial white cell count as a predictor of outcome in pediatric head injury.

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Researchers tested whether a noninvasive, non–contrast-based cerebral perfusion MRI technique, called arterial spin labeling (ASL), could detect the epileptogenic zone (EZ) in children with focal epilepsy who did not have obvious, well-defined structural brain lesions on MRI. Focal ASL abnormalities were found in over two-thirds of such cases and were concordant with the surgically proven EZ in 91% of children who underwent surgery. Due to the convenient and noninvasive nature of ASL, it may be reasonable to include this sequence in all routine MRIs done for focal epilepsy in children.

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In Brief

The authors evaluated their series of vacuum-assisted elevation of skull fractures in pediatric patients and the variables affecting procedural outcomes. This study will add to the growing literature on the use of nonsurgical management of depressed skull fractures in pediatric patients and help practitioners with decision-making and patient counseling.

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In Brief

The authors reviewed the literature to evaluate folate fortification and supplementation policies and their impact on reducing folate-sensitive neural tube defects (NTDs). Mandatory fortification was more effective than voluntary supplementation. Policies incorporating fortification and supplementation may optimally reduce folate-sensitive NTDs. Reductions in NTDs are cost-effective over time. A multimodal approach incorporating mandatory fortification, appropriate supplementation, and improved infrastructure and access to prenatal care to lead to decreased incidences of NTDs worldwide is optimal. This approach should be context-specific and culturally appropriate, with emphasis on education and consideration for local access to healthcare and social determinants of health.

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In Brief

The goal of this study was to spread word of a new alternative for endovascular treatment of high-flow fistulas in children. This adjuvant maneuver provides safer coil placement. The value of this study is based on a cheap, simple, and relatively low-risk option for flow arrest during embolization of high-flow fistulas.

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In Brief

The authors sought to compare the accuracy of boltless electrode placement with that of standard placement. Placing stereotactic EEG (SEEG) electrodes without anchor bolts is technically feasible. The accuracy of boltless electrodes was similar to that of electrodes placed with standard techniques. This technique allows electrodes to be placed in areas not amenable to standard techniques that utilize an anchor bolt, such as in very thin bone or the back of the head. This is the first description, to the authors’ knowledge, of such a technique being used in SEEG.

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In Brief

The objective of the study was to characterize and understand risk factors of rapid shunt failure in pediatric hydrocephalus. Age at shunt insertion and etiology of hydrocephalus are key risk factors of fast and ultrafast shunt failure. Fast shunt failure is an unfortunately common event in pediatric hydrocephalus. This study has been an important step in defining the phenomenon and trying to understand risk factors for children who experience fast shunt failure.

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In Brief

In this study, the authors defined a new variable, shunt failure cluster, to perform the first analysis of multiple and frequent shunt failures. They found that 6% of children with ventriculoperitoneal shunts have a cluster of shunt failures, and that these patients account for 30% of all shunt revisions. Risk factors for shunt failure cluster include prematurity and history of shunt infection.

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In Brief

The authors examined trends in the surgical treatment of pediatric hydrocephalus over an 8-year period and found that important changes in the treatment of this condition have occurred over a very short time frame. This work represents the first study using high-quality registry data to examine changes in the surgical care of pediatric hydrocephalus in North America.

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In this study the authors compared the survival between pediatric patients with high-grade gliomas who underwent gross-total resection after one or more reoperations versus those with subtotal resection. The authors found that median overall survival was 17 months, and progression-free survival was 10 months for all patients. The authors also found no differences in survival between patients with gross-total resection after reoperation when compared with those who achieved subtotal resection. These findings highlight the importance of the first attempt to remove the tumor, because the second surgery aiming to achieve gross-total resection may not provide the patient with longer survival.

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In Brief

The authors investigated the use of a validated instrument, the Chiari Health Index for Pediatrics (CHIP), for measuring health-related quality of life (HRQOL) in pediatric patients with Chiari malformation type I (CM-I). The CHIP instrument was effective in measuring postoperative changes and effectively captured significant improvements in patient HRQOL as well as symptomatology after surgical decompression. Widespread use of this questionnaire can offer physicians more insight into the impact of CM-I on HRQOL, which may guide a more holistic approach to care.

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In Brief

The authors developed an artificial intelligence tool to consistently and objectively measure cerebral ventricular volume, over time, for patients with hydrocephalus. This clinical tool is reliable across different institutional scanners as well as small variations in slice thickness and head angulation. It is faster and more accurate than currently available research tools and will serve as a useful clinical adjunct to standardize and improve patient care.

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In Brief

Investigators applied a screening tool to estimate the proportion of children evaluated at an epilepsy referral clinic that may be considered for epilepsy surgery in Haiti. Of the subset of children who underwent imaging, a majority met criteria for surgical evaluation. This work suggests that children with epilepsy in Haiti could benefit from being evaluated at a center with the capacity to perform basic brain imaging and neurosurgical treatments.

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In Brief

The objective of the study was to evaluate a relatively novel brain target of deep brain stimulation surgery for acquired dystonia in a rigorous scientific fashion to set the stage for future larger controlled trials. The key finding was that bilateral thalamic neuromodulation for severe acquired dystonia in children and young adults was well tolerated, and that while improvements in quality of life and disability were noticed, these were not fully captured in usual disease severity rating scales. This study adds value by expanding the knowledge of potential brain targets in pediatric patients with severe acquired medication-refractory dystonia.

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Enhanced recovery after surgery protocols have gained a significant foothold in adult general surgery populations for their ability to improve outcomes and reduce costs. In this study the authors systematically review the application of enhanced recovery after surgery protocols to pediatric scoliosis populations and find that these protocols may shorten hospitalizations, reduce complication rates, and reduce postoperative pain. This is the first quantitative analysis of the pediatric enhanced recovery after surgery literature, and it highlights the need for additional, high-quality studies.

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The objective of this paper was to document the largest available series of pediatric patients with skull base chordomas undergoing endoscopic endonasal resection. Endoscopic endonasal resection was associated with a high rate of tumor control and a low rate of permanent neurological deficits. The authors demonstrate the feasibility, value, and complications associated with adding endoscopic endonasal resection to the treatment armamentarium for pediatric chordomas of the skull base. The findings also suggest that pediatric chordomas are not, as a whole, as aggressive as previously thought.

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There is limited evidence as to the risk of abnormalities on CT or clinically important traumatic brain injury (ciTBI) in children with ventricular shunts (VSs) who sustain mild TBI. The authors sought to determine the frequency of these outcomes in children with VSs in a prospective multicenter study. Of 20,137 children with TBI, 35 (0.2%) had a VS. One patient had a CT abnormality, but none required neurosurgery. The rate of ciTBI in children with and without VSs was similar. Congruent with existing evidence, this study provides reasonable grounds to support a more restrictive approach to imaging than current practice.

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Using finite element modeling techniques, the authors investigated craniocervical biomechanics in a pediatric patient with Down syndrome (DS). Two age-matched models with identical material properties, one of a patient with DS and one of a child without DS, were created and tested. The authors found increases in craniocervical motion with the DS model, supporting the hypothesis that bony geometry plays a large part in the excessive craniocervical motion that occurs in DS patients and calling into question the role of ligamentous laxity.

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In Brief

This investigation is aimed at gaining a better understanding of the factors that lead to the mechanical failure of ventriculoperitoneal shunts used for the treatment of hydrocephalus. Our study demonstrates a correlation between shunt mechanical stiffness and shunt disconnection, that catheters that are more flexible are secured for longer periods to their valve counterpart and have a decreased propensity to disconnect. These findings may be utilized to decrease shunt disconnection due to mechanical failure.

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In Brief

Researchers evaluated differences in blood loss between racial groups undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). There is no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

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In Brief

The authors present a novel method of extraoperative stereoelectroencephalography (SEEG) monitoring complemented by subsequent intraoperative recordings, designed to tailor multistaged resections in rolandic and perirolandic cortex in a highly selected group of patients with pharmacoresistant rolandic and perirolandic focal epilepsy. The results testified to the feasibility and demonstrated the value of the combined benefits of both extra- and intraoperative SEEG recordings when resecting the rolandic and perirolandic areas. With the proposed novel hybrid method one can precisely limit the volume of resection necessary to abort epileptic activity while preserving the functional cortex as much as possible.

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In Brief

Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with a high surgical morbidity and mortality due to their eloquent location. The authors describe a novel technique of endoscope-assisted microsurgery for managing symptomatic lesions and recommend a strategy of conservative surgery with resection of as much of the tumor capsule as is safely possible.

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In Brief

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.