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Sarah T. Garber, Robert J. Bollo, and Jay K. Riva-Cambrin

P ilomyxoid astrocytoma (PMA) is a rare, aggressive myxoid variant of pilocytic astrocytoma. In 2007, PMA was recognized as a variant of astrocytoma and classified as WHO Grade II. 13 Typically, PMAs present in the suprasellar/hypothalamic region, although they have been reported throughout the neuraxis. These tumors represent approximately 1% of all astrocytomas, whereas 85% of pediatric astrocytomas are pilocytic (WHO Grade I) in nature. 6 Pilocytic astrocytomas tend to present in slightly older children (mean age 6 years), but PMAs are largely seen in

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Brian K. Owler, Kathryn A. Browning Carmo, Wendy Bladwell, T. Arieta Fa’asalele, Jane Roxburgh, Tina Kendrick, and Andrew Berry

care for patients with acute neurosurgical conditions. The Newborn and Paediatric Emergency Transport Service (NETS) is a dedicated intensive care retrieval service, using road and rotary and fixed wing vehicles ( http://www.nets.org.au ). Over 254 hospitals in NSW/ACT call on NETS to assist children up to 16 years of age. The retrieval team normally comprises a specialist intensive care nurse and doctor. While this model works well for the majority of patients, for some patients, outcome has been compromised by the lack of timely access to specialized

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David C. Lauzier, Joshua W. Osbun, Arindam R. Chatterjee, Christopher J. Moran, and Akash P. Kansagra

thoughtful consideration of risks and benefits. In addition to risk factors for periprocedural complications common in adults, such as hypertension and transient ischemic attack, children may carry additional risk due to lower vessel-to-catheter size ratios that may elevate the possibility of vascular injury or complicate intracranial navigation. 12 – 14 Despite these challenges, retrospective series of pediatric cerebral angiography have suggested low rates of complications, with recent studies reporting a thromboembolic complication rate of 0%. 14 – 17 However, some of

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Nataly Raviv, Nicholas Field, and Matthew A. Adamo

P ostoperative fevers in the days following surgery are common in both the adult and pediatric populations. 1 , 2 Most are the result of the inflammatory and pyrogenic cytokine response to surgery and resolve spontaneously; however, a workup is often performed, as a postoperative fever can be a sign of a significant underlying clinical process. 3 Therefore, patients frequently undergo an often invasive and costly workup to rule out infectious etiologies. The differential for postoperative fever includes both infectious and noninfectious causes, such as the

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Korak Sarkar, Krista Keachie, UyenThao Nguyen, J. Paul Muizelaar, Marike Zwienenberg-Lee, and Kiarash Shahlaie

.1089/089771502753754037 23 Ommaya AK , Goldsmith W , Thibault L : Biomechanics and neuropathology of adult and paediatric head injury . Br J Neurosurg 16 : 220 – 242 , 2002 10.1080/02688690220148824 24 Ong L , Selladurai BM , Dhillon MK , Atan M , Lye MS : The prognostic value of the Glasgow Coma Scale, hypoxia and computerised tomography in outcome prediction of pediatric head injury . Pediatr Neurosurg 24 : 285 – 291 , 1996 10.1159/000121057 25 Pfenninger J , Santi A : Severe traumatic brain injury in children— are the results improving

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Da Li, Shu-Yu Hao, Jie Tang, Xin-Ru Xiao, Gui-Jun Jia, Zhen Wu, Li-Wei Zhang, and Jun-Ting Zhang

C erebral cavernous malformations (CMs) are occult low-pressure vascular lesions, and 9%–35% of CMs are located in the brainstem. 2 Pediatric brainstem CMs are rare and account for approximately 13.3%–14.5% of all brainstem CMs according to prior studies. 1 , 2 , 36 Due to the eloquent location of brainstem CMs, hemorrhage ictus can lead to acute deterioration of neurological function and induce severe symptoms. Although adult brainstem CMs have been widely investigated, 1 , 2 , 16 , 22 , 26 , 27 , 30 , 36 , 49 surgical treatment of pediatric brainstem

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Alexander P. Landry, Vincent C. Ye, Kerry A. Vaughan, James M. Drake, Peter B. Dirks, and Michael D. Cusimano

Trigeminal schwannoma (TS) is a rare entity, representing less than 0.5% of intracranial neoplasms and approximately 0.8% to 8% of intracranial schwannomas overall. 1 , 2 Peak incidence occurs in the third and fourth decades of life; pediatric cases are exceedingly rare, with only a handful having been reported in the literature. 3–7 Patients may present with trigeminal nerve dysfunction, headaches, dysphagia, or diplopia (although many cases are discovered incidentally). 4 These tumors exhibit considerable anatomical heterogeneity and can originate from

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Geoffrey Appelboom, Stephen D. Zoller, Matthew A. Piazza, Caroline Szpalski, Samuel S. Bruce, Michael M. McDowell, Kerry A. Vaughan, Brad E. Zacharia, Zachary Hickman, Anthony D'Ambrosio, Neil A. Feldstein, and Richard C. E. Anderson

A n estimated 1 in 10 (5.3 million) of the 54 million Americans living with disabilities have a disability caused by TBI ( www.hhs.gov ). 49 Approximately 475,000 TBIs occur among children ages 0–14 years old every year in the US ( www.cdc.gov ), and the current leading cause of death in children more than 1 year old is TBI. Different pediatric age groups experience different causes for their injury. In infants, the most common causes are falls and physical assaults. In toddlers and young children, car accidents and falls are most common. In children and

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Charles E. Mackel, Brent C. Morel, Jesse L. Winer, Hannah G. Park, Megan Sweeney, Robert S. Heller, Leslie Rideout, Ron I. Riesenburger, and Steven W. Hwang

of resources, including neurosurgical coverage, 11 , 13 with the mean cost of interfacility overtriage ranging between $9206 to $12,549 per transfer. 41 , 43 Overutilization of neurosurgical coverage may be particularly acute in the pediatric transfer population. In one study, 64% of preventable transfers in the pediatric population implicated traumatic brain injury (TBI). 15 Additional studies identified that one quarter to one half of unnecessary pediatric interfacility transfers utilized neurosurgical evaluation, 15 , 24 and a neurological consult request

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Recent advances in the neurosurgical treatment of pediatric epilepsy

JNSPG 75th Anniversary Invited Review Article

Jarod L. Roland and Matthew D. Smyth

D espite the development of several new antiepileptic drugs (AEDs) over the last 30 years, there has been little change in the overall effectiveness of the treatment of epilepsy with medication. 11 However, there have been numerous advances in the neurosurgical treatment of epilepsy that have expanded treatment options for patients and reduced morbidity via less-invasive procedures. Herein we review some of the most recent advances and trends in the neurosurgical treatment of pediatric epilepsy. Expanding the Evidence in Support of Epilepsy Surgery Before