Journal of neurosurgery. Pediatrics最新文献

{"title":"Erratum. Variability in selective dorsal rhizotomy surgery: an analysis of the Cerebral Palsy Research Network registry.","authors":"Brandon G Rocque","doi":"10.3171/2026.6.PEDS25497a","DOIUrl":"https://doi.org/10.3171/2026.6.PEDS25497a","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences between the anterior fontanelle surface area of term versus premature pediatric patients based on head CT.","authors":"Hannah E Wilding, Michelle Paret, Bao Y Sciscent, Debarati Bhanja, Mason Stoltzfus, Hali Kim, Elias Rizk","doi":"10.3171/2026.3.PEDS24497","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS24497","url":null,"abstract":"<p><strong>Objective: </strong>While studies have investigated normative ranges of anterior fontanelle (AF) closure and surface area (SA), they have focused on full-term children born without significant comorbidities that may impact the AF SA. Understanding the trends of AF SA and closure in patients with common pediatric conditions can help inform guidelines for screening the size of the AF and determining when to intervene. This study aimed to investigate the AF SA in pediatric patients between 0 and 24 months of age born either at term or prematurely.</p><p><strong>Methods: </strong>A retrospective chart review investigated 346 pediatric patients between the ages of 0 and 24 months who underwent head CT imaging between January 2012 and December 2021. Patients with craniosynostosis and hydrocephalus were excluded. Mann-Whitney U-tests and Fisher's exact tests were used to compare the distribution of demographic variables between the term and premature patient cohorts. The length of the AF was measured in the coronal and sagittal planes to calculate SA. Mann-Whitney U-tests were used to compare median AF SA in the premature versus term cohorts of each age group.</p><p><strong>Results: </strong>A total of 346 patients were identified, with an average patient age of 156 days (5.2 months). Most patients were male (53.2%) and White (66.2%). Fifty-six patients (16.2%) in the study cohort were premature, and 290 (83.8%) were born at term. The most common indication for CT of the head/brain was trauma (51.2%). Overall, the median AF SA for children born at term increased until age 2 months, then decreased until closure, while the AF SA for premature children peaked at 5-6 months. The median AF SA was significantly larger in premature compared with term patients at 5-6 and 7-9 months (p < 0.05). With corrected ages for the premature cohort, there were no statistically significant differences in median AF SA between the patients born prematurely and at term.</p><p><strong>Conclusions: </strong>This study provides insight into the hypothesis that AF SA varies, and specifically is larger, in premature children compared with children born at term. An enlarged AF in premature pediatric patients might signify normal development and may not necessitate neurosurgical referral.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of change in pediatric intracranial abscess surgery: rising volumes and evolving care (2013-2023).","authors":"Cleresa Renee Roberts, Ruyun Jin, Maya Parker, Heather Stevens Spader","doi":"10.3171/2026.3.PEDS25665","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS25665","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric intracranial abscesses are rare, life-threatening infections requiring prompt surgery and coordinated subspecialty care. Reports during COVID-19 described nationwide surges, but national operative trends and equity data remain sparse. Therefore, this study aimed to define decade-long trends in surgical management, outcomes, and racial disparities in children in the US who underwent intracranial abscess surgery, with an emphasis on pandemic-era changes.</p><p><strong>Methods: </strong>This was a retrospective, multicenter cohort study of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric (2013-2023) children undergoing surgery for intracranial abscess/empyema by neurosurgery and/or otolaryngology; outcomes were compared using nonparametric/exact tests (α = 0.05) in R.</p><p><strong>Results: </strong>Among 232 children (median age 11.9 years; 71.6% male), the annual operative volume rose 10-fold. The proportion of indexed operations performed by neurosurgery declined from 75% in 2013 to 7.5% in 2023, while the proportion performed by otolaryngology increased from 0% to 62.5% over the same period. Black children were less likely to undergo neurosurgery-only procedures than they were to undergo otolaryngology surgery with or without neurosurgery (4.3% vs 34.4%, p = 0.008). Black and Hispanic children had longer hospital stays than White children (12.5 and 11 days, respectively, vs 9 days; p = 0.026) and higher mortality (0.5%). Neurological complication rates (0.9%) were uniformly low. During COVID-19, patients were older (median age 12.5 vs 10.9 years, p = 0.014), had more extradural/subdural disease (47% vs 33%, p = 0.044), and had longer operations (median 203 vs 169 minutes, p = 0.020), while admission-to-incision time, readmission, and mortality rates were unchanged.</p><p><strong>Conclusions: </strong>From 2013 to 2023, occurrences of pediatric intracranial abscess surgery increased dramatically, with a marked increase during the later study period (2020-2023), temporally overlapping with the COVID-19 pandemic, and peaking in 2022-2023. Over the same period, the specialty performing the indexed operation shifted progressively from neurosurgery to otolaryngology. Short-term outcomes remained favorable, but Black and Hispanic children experienced reduced neurosurgical access and longer hospitalization, underscoring the need to address structural determinants of pediatric neurosurgical equity.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YES1, a plasma-based biomarker for cavernous malformations.","authors":"Yousef Hattar, Julie Sesen, Tyra Martinez, Adrien Lupieri, Shih-Shan Lang, Gregory G Heuer, Alexander M Tucker, Edward R Smith, Aram Ghalali","doi":"10.3171/2026.4.PEDS2681","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS2681","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral cavernous malformations (CCMs) are low-flow vascular malformations commonly found in the central nervous system with the potential to cause neurological deficits, seizures, and headache through bleeding and growth. CCMs are typically assessed with imaging such as MRI or CT. However, there is a clinical need to reduce the cost, risk (with sedation/anesthesia in children), and travel associated with these imaging studies. Prior work from the authors' group and others have highlighted the potential utility of noninvasive biomarkers as tools to potentially complement the use of imaging. Here, the authors present YES1, a member of the Src family kinases, as a potential plasma-based biomarker associated with the presence of CCM.</p><p><strong>Methods: </strong>Plasma samples from symptomatic patients with pathology-confirmed CCM (n = 16) (aged 1-22 years) and healthy matched control subjects (n = 24) (aged 1-19 years) were obtained and compared after institutional review board approval. Protein levels of CCM and control plasma were analyzed using the Olink Proximity Extension Assay (PEA), and ELISA was used to confirm findings. Patient-derived primary cells and CCM tissues were stained for YES1. CCM tissues were sequenced to evaluate the mutational profile of YES1.</p><p><strong>Results: </strong>Compared to healthy controls, patients with CCM showed significantly higher levels of plasma YES1 (approximately 4.5-fold higher, p = 0.002). Analysis confirmed the presence of YES1 in the source CCM tissue, linking pathology with putative biomarker expression. Whole exome sequencing (WES) revealed functional mutations in the gene encoding for YES1, providing an avenue of investigation to explore and to explain the overexpression of YES1.</p><p><strong>Conclusions: </strong>Here, for the first time, the authors present a putative diagnostic biomarker for CCM, YES1, that was demonstrated to be significantly elevated in the plasma of affected patients, with high correlative expression in the source tissue. Together, these data further support the development of CCM-related noninvasive biomarkers and may add insight into their pathogenesis.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of congenital heart disease with hydrocephalus and shunt dysfunction in early childhood: a comparative cohort study.","authors":"Barbara Buccilli, Sean O'Leary, Srivats Srinivasan, Ariadna Robledo, Aditi Manjrekar, Diogo Haddad Santos, Brett A Whittemore","doi":"10.3171/2026.3.PEDS25692","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS25692","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to quantify risks of hydrocephalus, cerebrospinal fluid (CSF) shunt placement, and shunt malfunction in children < 3 years of age with congenital heart defect (CHD) versus matched controls.</p><p><strong>Methods: </strong>This was a multicenter retrospective cohort study conducted using TriNetX. Children < 3 years with CHD were propensity score matched 1:1 to controls on the basis of demographic characteristics and comorbidities. Outcomes were hydrocephalus (ICD-10 code G91), CSF shunt placement, and shunt malfunction (ICD-10 T85.0). Associations were reported as risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 83,258 children with CHD and 418,476 controls, matching yielded 64,413 per group with excellent balance (all standardized mean differences < 0.02). Compared to matched controls, CHD patients were associated with higher rates of hydrocephalus (1.1% vs 0.2%, RR 4.98, 95% CI 4.15-5.97), shunt placement (0.4% vs 0.04%, RR 9.11, 95% CI 6.12-13.55), and shunt malfunction (2.5% vs 0.4%, RR 5.75, 95% CI 5.07-6.53) (all p < 0.001). Across physiology, elevations were consistent; within CHD, the rate of shunt malfunction was higher in patients with cyanotic defects than those with acyanotic defects (4.6% vs 2.5%, RR 1.86, 95% CI 1.61-2.14, p < 0.001). The strongest associations were observed in defect types most frequently encountered during the first 3 years of life. Hydrocephalus risk was increased in patients with patent ductus arteriosus (PDA) (2.2% vs 0.4%, RR 5.12, 95% CI 3.93-6.68), atrial septal defect (ASD) (1.1% vs 0.3%, RR 4.47, 95% CI 3.65-5.47), atrioventricular septal defect (AVSD) (1.0% vs 0.2%, RR 4.32, 95% CI 3.57-5.23), ventricular septal defect (VSD) (0.9% vs 0.3%, RR 2.79, 95% CI 2.01-3.88), and coarctation (2.1% vs 0.6%, RR 3.50, 95% CI 1.74-7.05). Shunt placement was likewise more common in patients with PDA (0.8% vs 0.1%, RR 9.14, 95% CI 5.27-15.87), ASD (0.4% vs 0.1%, RR 7.84, 95% CI 5.17-11.89), AVSD (0.4% vs 0.05%, RR 7.85, 95% CI 5.22-11.80), and VSD (0.3% vs 0.1%, RR 4.33, 95% CI 2.31-8.11) (all p < 0.001). Shunt malfunction was most pronounced in patients with tetralogy of Fallot (7.4% vs 0.7%, RR 11.30, 95% CI 5.94-21.49) and coarctation (6.8% vs 0.6%, RR 11.60, 95% CI 6.10-22.05) and remained elevated across septal lesions (AVSD 2.5%, ASD 2.4%, and VSD 3.1%) and PDA (3.8%) (all p < 0.001).</p><p><strong>Conclusions: </strong>CHD is associated with increased risk of hydrocephalus, shunting, and shunt malfunction in early childhood. Risks increase with septal lesions, PDA, and coarctation, with a higher rate of shunt malfunction in patients with cyanotic physiology. These findings support early cardiology-neurosurgery surveillance and care.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laterality of fat distribution and its impact on tethered cord symptoms and surgical outcomes in pediatric spinal lipoma.","authors":"Kusawadee Juengsirakulwit, Jiraphorn Amornfa","doi":"10.3171/2026.4.PEDS2651","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS2651","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate whether MRI-based anatomical factors, including fat lateralization and spinal cord rotation, are associated with postoperative retethering in pediatric spinal lipoma.</p><p><strong>Methods: </strong>This retrospective cohort study included pediatric patients (< 18 years old) who underwent spinal lipoma resection at King Chulalongkorn Memorial Hospital between 1999 and 2024, with a minimum follow-up of 12 months. Fat lateralization was graded on axial MRI based on the extent of lipomatous involvement relative to the dorsal and ventral nerve roots and dichotomized as nonlateralized (grades 0-1) or lateralized (grades 2-3). Spinal cord rotation was measured on axial MRI and categorized as < 20° or ≥ 20°. The cord-sac ratio (CSR) was classified as < 0.3, 0.3-0.5, or > 0.5. Associations with extent of resection and retethering were analyzed using appropriate statistical tests and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Eighty-six patients were included, with a mean follow-up of 9.7 years. Subtotal resection was significantly associated with spinal cord rotation ≥ 20° (p = 0.0003) and fat lateralization (p < 0.001). Both rotation and lateralization were correlated with higher CSR categories (p = 0.012 and p = 0.0095, respectively). Retethering occurred in 22.1% of patients and was significantly associated with cord rotation ≥ 20° (36.7% vs 14.3%, p = 0.028) and CSR > 0.5 (p = 0.0003). Extent of resection showed a trend toward lower retethering rates after total or near-total resection. Dorsal lipomas demonstrated the highest retethering rate, although this did not reach statistical significance.</p><p><strong>Conclusions: </strong>Preoperative MRI features, particularly spinal cord rotation and CSR, are important imaging markers associated with surgical complexity and postoperative retethering in pediatric spinal lipoma. Fat lateralization is strongly associated with limited extent of resection and unfavorable anatomy. Incorporating these anatomical parameters into preoperative assessment may improve risk stratification, surgical planning, and patient counseling.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgical intervention and outcomes in pediatric sinogenic intracranial infection.","authors":"Yan Zhou, Torin Karsonovich, Bamidele Adebayo, Jessa Hoffman, Emily Jue Wang, Julia Pazniokas, Eric Y Montgomery, Keanu Chee, Susan Staulcup, Gavin R Hoffman, Ross Moseley, Amanda Moon Owens, Pavan Guttipatti, Callista Tran, David Mirsky, Kenny H Chan, Todd C Hankinson","doi":"10.3171/2026.3.PEDS2614","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS2614","url":null,"abstract":"<p><strong>Objective: </strong>Sinogenic intracranial abscess is a severe complication of sinusitis. Timely identification of patients requiring neurosurgical intervention can be challenging. This study aimed to evaluate preoperative clinical and radiographic variables to identify features that correlate with neurosurgical intervention and outcomes in pediatric patients with sinogenic intracranial infection.</p><p><strong>Methods: </strong>This was a single-center retrospective study of pediatric patients who were surgically treated for sinogenic intracranial infection. Patients were grouped into an otolaryngological treatment (ENT)-only cohort and neurosurgical treatment (NSGY) cohort, with the latter including those who underwent neurosurgery alone or neurosurgery plus otolaryngology treatments. Variables included abscess volume, peri-infection T2-weighted hyperintensity volume and thickness, inflammatory marker levels (white blood cells, neutrophils, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]), Lund-Mackay sinus disease severity score, clinical symptoms, and infectious organisms. Outcomes included radiographic residual disease, length of stay, reoperation, readmission, and neurological deficits. Univariate and multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify and evaluate significant factors.</p><p><strong>Results: </strong>Ninety patients met the inclusion criteria (mean ± SD age 11.43 ± 3.33 years; 61.11% of patients were male), with 56 in the ENT group and 34 in the NSGY group. In univariate analysis, larger abscess volume, larger perilesional T2-weighted hyperintensity, older age, elevated ESR and CRP level, and lower Lund-Mackay scores were associated with NSGY. In multivariate analysis, abscess volume (OR 1.11, 95% CI 1.03-1.19, p = 0.0055) and CRP level (OR 1.10, 95% CI 1.00-1.20, p = 0.048) remained the only independent correlates. ROC analyses showed that abscess volume had excellent discriminatory power (area under the curve 0.89) with an optimal threshold at 7.57 cm3. Streptococcus anginosus was the most common microorganism and was more prevalent in the NSGY group (p = 0.017). There were no significant differences in radiographic outcomes, length of stay, reoperation or readmission rates, or neurological deficits between the NSGY and ENT cohorts after adjusting for baseline disease severity.</p><p><strong>Conclusions: </strong>Preoperative abscess volume was best correlated with neurosurgical intervention. While neurosurgical patients had more severe baseline disease, it was not associated with worse outcomes. Given the retrospective and single-center design, these findings likely reflect appropriate patient selection and institutional practice rather than causality. Future prospective studies are needed to further investigate the relationship among clinical variables, interventions, and outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarker-informed prediction of neurosurgical intervention in pediatric traumatic brain injury: a proof-of-concept study.","authors":"Andrew Reisner, Ali M Alawieh, Jacob R Lepard, Anna V Baer, Youssef M Zohdy, Joshua J Chern, Stefania Mondello, Laura M Johnson, Adrianna L Westbrook, Kevin K Wang, Firas Kobeissy, Rebekah Mannix, Geoffrey T Manley, Laura S Blackwell","doi":"10.3171/2026.4.PEDS25694","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS25694","url":null,"abstract":"<p><strong>Objective: </strong>Emerging traumatic brain injury (TBI) guidelines increasingly recognize the role of blood-based biomarkers in improving diagnostic and triage accuracy, yet their integration into pediatric care remains limited and underexplored. This study examined the performance of a blood-based biomarker panel in predicting which pediatric patients with TBI received neurosurgical intervention (NSI).</p><p><strong>Methods: </strong>This was a prospective cohort study of 425 children (aged 0-17 years) treated at a pediatric tertiary hospital between March 2017 and June 2021 with nonpenetrating TBI (Glasgow Coma Scale [GCS] score 3-15). Standard of care was rendered. NSI included craniotomy, craniectomy, external ventricular drain (EVD) placement, and intracranial pressure (ICP) monitor placement. Blood samples collected within 24 hours of injury were measured for plasma glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neurofilament light (NfL), and total tau (t-tau) with the Quanterix Simoa platform, as well as osteopontin (OPN) quantification via ELISA. Logistic regression and area under the curve (AUC) analysis with 95% confidence intervals (CI) were used to measure predictive discrimination.</p><p><strong>Results: </strong>NSI occurred in 14.35% of patients. These children were younger (mean age 6.0 vs 10.1 years) with more severe injury (median GCS score 9.0 vs 15.0) than those who did not require NSI. All median biomarker concentrations were higher in NSI compared with non-NSI patients (p < 0.001). After age and GCS score were controlled for, GFAP significantly predicted NSI (AUC 0.83, 95% CI 0.75-0.90), defining the best predictive model for NSI.</p><p><strong>Conclusions: </strong>Blood-based biomarkers predicted NSI following pediatric TBI, independent of age and admission GCS score. These findings support further prospective trials to determine whether integrating blood-based biomarkers into clinical triage algorithms and TBI guidelines can improve neurosurgical decision-making and patient outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes after intracranial nidal arteriovenous malformation resection in children: the Hospital for Sick Children experience.","authors":"Jessica Youngkyung Jung, Prakash Muthusami, Carmen Parra-Farinas, Abhaya V Kulkarni, Peter B Dirks, Jennifer L Quon","doi":"10.3171/2026.3.PEDS25582","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS25582","url":null,"abstract":"<p><strong>Objective: </strong>Recurrence after angiographically confirmed microsurgical obliteration of brain arteriovenous malformations (bAVMs) is considered rare but occurs more frequently in children than in adults. Reported recurrence rates vary widely. The authors aimed to determine recurrence rates at a high-volume pediatric referral center and identify clinical and radiographic predictors of recurrence.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 129 children with bAVMs who presented to the Hospital for Sick Children between 1998 and 2023 and underwent complete resection. These cases were partitioned into recurrence and no recurrence groups with subsequent univariate and multivariable Cox proportional hazards regression. Given the relatively small number of recurrences (n = 14), a parsimonious model with key predictors (arteriovenous malformation [AVM] size, venous drainage) was constructed, and Firth's penalized Cox regression was applied to reduce bias from sparse events. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported.</p><p><strong>Results: </strong>The recurrence rate after surgical cure was 10.9% (14/129), with a mean time to recurrence of 30.4 ± 21.6 months; the most delayed recurrence occurred at 11.6 years. On univariate Cox analysis, deep venous drainage (HR 9.7, 95% CI 2.8-33.1; p = 0.0005) and AVM size (HR 1.4 per cm, 95% CI 1.1-1.6; p = 0.0007) were significantly associated with recurrence. Eloquence approached significance (HR 2.2, 95% CI 0.7-6.6; p = 0.1). In multivariable and Firth-penalized models, deep venous drainage remained an independent predictor of recurrence, with AVM size demonstrating a trend toward increased recurrence risk. Age, sex, hemorrhagic presentation, AVM location, and embolization were not associated with recurrence.</p><p><strong>Conclusions: </strong>Children and adolescents develop recurrent AVMs at a higher rate than adult patients despite angiographic cure after initial resection. On multivariable analysis, deep venous drainage was independently associated with recurrence. Further work can help elucidate clinical and radiographic predictors of disease recurrence.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost analysis of nonsedated fast-spine magnetic resonance imaging in pediatric patients.","authors":"Parker Dhillon, Noah L A Nawabi, John Hurst, Steven Lin, Molly Somogyi, Brian F Saway, Maria V Spampinato, Ramin Eskandari","doi":"10.3171/2026.3.PEDS2669","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS2669","url":null,"abstract":"<p><strong>Objective: </strong>MRI is a cornerstone of pediatric spinal evaluation but frequently requires sedation or general anesthesia in young children due to prolonged scan times. This use of anesthesia introduces periprocedural risks and logistical barriers that can delay care and increase burden for families. Fast-spine MRI (fsMRI) protocols offer a motion-tolerant, abbreviated alternative that may allow nonsedated imaging for selected pediatric indications. This study evaluates the clinical feasibility and operational impact of nonsedated fsMRI compared with routine pediatric spine MRI, with secondary analysis of institutional cost.</p><p><strong>Methods: </strong>All pediatric spine MR studies obtained between January 1, 2023, and December 31, 2024, at the authors' institution were retrospectively reviewed. Imaging protocol, scan duration, and patient age were recorded. Patients were stratified into younger (≤ 6 years) and older (≥ 7 years) cohorts. Financial data, including direct institutional cost, charge amount, payment received, and collection rate, were analyzed to assess economic impact.</p><p><strong>Results: </strong>A total of 2358 pediatric spine MR images were included (643 fsMRI, 1715 routine MRI). Across all patients, fsMRI reduced the mean table time from 100.2 ± 51.3 minutes to 34.6 ± 12.5 minutes (p < 0.0001). The time reduction was most pronounced in the younger cohort (105.9 ± 54.8 minutes vs 35.7 ± 12.7 minutes, p < 0.0001). The mean direct institutional cost for fsMRI was $133.59 lower per scan ($284.12 vs $417.71), with a significantly higher collection rate (53.9% vs 47.4%, p = 0.0054).</p><p><strong>Conclusions: </strong>Fast-spine MRI substantially reduces scan time, effectively removing the barrier of sedation for many young children. By serving as a rapid, nonsedated screening tool, this protocol offers a safer alternative to routine MRI that significantly expands appointment availability and improves access to care for all pediatric patients.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}