Journal of neurosurgery. Pediatrics最新文献

{"title":"Exploring the impact of spontaneous intestinal perforation and necrotizing enterocolitis treatment modality on shunt outcomes in premature infants.","authors":"Katherine Chandler, Goeto Dantes, Olivia A Keane, Karissa McCright, Michael Sawvel, Amina Bhatia","doi":"10.3171/2026.3.PEDS25507","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS25507","url":null,"abstract":"<p><strong>Objective: </strong>Spontaneous intestinal perforation (SIP), necrotizing enterocolitis (NEC), and posthemorrhagic hydrocephalus (PHH) are common complications in premature infants. SIP and NEC may require surgery, including peritoneal drainage (PD) and/or laparotomy. PHH typically requires shunting, generally using either a ventriculoperitoneal (VPS) or ventriculoatrial (VAS) shunt. The authors hypothesized that prior abdominal instrumentation with possible adhesion formation in patients undergoing laparotomy may affect VPS placement and longevity. This study examined the impact of SIP or NEC treatment on shunt outcomes in 43 premature infants.</p><p><strong>Methods: </strong>A retrospective review of infants treated for SIP or NEC and PHH at the authors' institution from 2007 to 2024 was conducted. SIP/NEC treatment modality and shunt outcomes were extracted from the electronic medical record. Categorical variables were analyzed using the chi-square or Fisher's exact test and nonparametric variables were analyzed using the Mann-Whitney U-test.</p><p><strong>Results: </strong>Forty-three eligible patients were identified (23.3% female, 76.7% Black), the majority of whom were diagnosed with SIP (72.1%). Most patients were treated with laparotomy (65.1%), with only 34.9% receiving definitive PD. A VPS was the predominant shunt type (81.4%), with a VAS being less common (18.6%). Among patients with VPS placement, 51.4% required distal (peritoneal catheter) revision. When comparing shunt outcomes between infants treated with laparotomy versus PD, primary shunt type selection was significantly different, with all cases of initial VAS placement occurring in the laparotomy group (p = 0.04). Patients who underwent laparotomy were also significantly older at initial shunt placement (median 126.5 vs 94 days, p < 0.01) and had a longer period between SIP/NEC treatment and shunt placement (median 100 vs 77 days, p = 0.04). There was no significant difference in the rate of distal VPS revision (p = 0.63), number of VPS revisions required (p = 0.38), or rates of conversion from a VPS to a VAS (p = 0.14) between the laparotomy and PD cohorts. However, infants who underwent definitive PD were significantly more likely to have a VPS maintained, even if revision was required, without conversion to a VAS (80.0% vs 39.3%, p = 0.01).</p><p><strong>Conclusions: </strong>In this retrospective review of 43 premature infants with SIP or NEC and PHH, definitive PD was associated with higher rates of initial VPS placement and long-term maintenance compared with laparotomy. Although limited by a small sample size, these findings suggest that initial SIP/NEC treatment type may influence VPS longevity. Recognizing the role of prior abdominal surgery may inform neurosurgical decision-making and minimize shunt revisions.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207017","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":"Short-term outcomes after suturectomy and cranial remodeling orthosis treatment for craniosynostosis in infants 5 months and older.","authors":"Amir Kershenovich, Chen Amichay, Tomer Lagziel, Ivan Novitski, Ido Ben Zvi, Dafna Shilo Yaacobi, Seth Sheckartze, Ella Gurevich, Asaf Olshinka","doi":"10.3171/2026.4.PEDS261","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS261","url":null,"abstract":"<p><strong>Objective: </strong>Suturectomy followed by cranial remodeling orthosis (CRO) is traditionally performed in infants younger than 4 months. The authors aimed to evaluate the effectiveness of this technique in patients aged 5 months and older.</p><p><strong>Methods: </strong>A single-institution retrospective chart review of all patients undergoing nonendoscopic suturectomy for craniosynostosis between January 2018 and June 2023 was performed. Demographic and operative data and remodeling outcomes assessed by cranial measurements from head scans were analyzed. Patients were stratified into 2 groups based on age: age ≥ 5 months and ≤ 4 months at surgery. A literature review was performed to contextualize outcomes.</p><p><strong>Results: </strong>A total of 61 patients were included: 22 aged ≥ 5 months (mean 6.3, range 5-10 months) and 39 aged ≤ 4 months (mean 3.4, range 2-4.5 months). Overall, 50.8% had sagittal craniosynostosis. There were no intraoperative complications. Blood loss, transfusion needs, and postoperative hemoglobin levels were comparable. The mean hospital length of stay for older infants was 1.68 compared with 1.51 days for younger patients. Remodeling outcomes were assessed in 46 patients with pre- and post-treatment scans. In sagittal cases, the parietal mediolateral (ML) distance improved by 15.5 mm (15.7% improvement) in older infants and by 20.4 mm (15%) in younger infants (p = 0.150). Anteroposterior growth was 8.4 and 13.8 mm, respectively (p = 0.017). Cephalic index (CI) improvements were similar (6.1% in older vs 7.1% in younger infants). In metopic cases, the frontal ML distance improved by 9.4 mm (10.3% improvement) in older patients and 12.3 mm (14.5%) in younger patients (p = 0.563), with CI improvements of 2.8% and 7.6%, respectively (p = 0.347), and respective interfrontal angle improvements of 5.2° (4%) and 8.7° (6.5%) (p = 0.21). Coronal cases demonstrated marked ML and cranial vault asymmetry index improvements in both groups. By 15 months after surgery, full reossification of the suturectomy site was observed in 81.2% of older versus 57.1% of younger infants (p = 0.14, OR 3.25). A literature review revealed limited detailed published data (72 infants ≥ 5 months of age with specified age and compared outcomes); authors described less favorable results in older patients.</p><p><strong>Conclusions: </strong>Suturectomy with CRO in infants aged 5-10 months achieves favorable and satisfactory cranial remodeling outcomes, nearly comparable to those of younger patients. These findings support extending the age eligibility for suturectomy to include infants up to around 10 months old.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207022","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":"Editorial. Go with the gut or the heart? Toward an optimal CSF diversion strategy.","authors":"Sanjana R Salwi, Kamila M Bond, Gregory G Heuer","doi":"10.3171/2026.4.PEDS26126","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS26126","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207006","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":"Pediatric intracranial infections complicating bacterial sinusitis in Canada.","authors":"Christy Richards, Annika Weir, Isabella Watson, Olufemi Ajani, Annie Drapeau, Samuel Molot-Toker, Vivek Mehta, Julia Radic, Sandrine de Ribaupierre, Matea Zuljevic, Jay Riva-Cambrin, Ruksana Rashid, Albert Tu, Sharini Sam Chee, Dominic Venne, Alexander G Weil, Marine Venne, Simon Walling, Mandeep S Tamber","doi":"10.3171/2026.5.PEDS25668","DOIUrl":"https://doi.org/10.3171/2026.5.PEDS25668","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial infections complicating bacterial sinusitis are rare in children; however, an increase in these complications after the start of the COVID-19 pandemic has been suggested in certain geographies. Herein, the authors sought to describe the epidemiology of pediatric intracranial infections complicating bacterial sinusitis before and after the onset of the COVID-19 pandemic in Canada.</p><p><strong>Methods: </strong>In this retrospective observational study, authors assembled a cohort of children with intracranial infective complications of bacterial sinusitis that were treated operatively and nonoperatively from 2016 to 2022. Case counts over time were tabulated and compared (January 2016-March 2020, before the COVID-19 pandemic [preonset] vs April 2020-December 2022, after the onset of the COVID-19 pandemic [postonset]). Patient demographic, clinical, microbiological, operative, and outcome data were analyzed.</p><p><strong>Results: </strong>Two hundred sixteen cases (106 preonset and 110 postonset) from 10 pediatric neurosurgical centers across 7 Canadian provinces were analyzed. Overall median quarterly case counts were similar in the period before (6 [IQR 5-8] cases/quarter) and after (6 [IQR 5-13.5] cases/quarter) pandemic onset (p = 0.51). However, examining the postonset period in smaller increments revealed a redistribution of cases, with fewer cases observed in the 18 months comprising the early pandemic period and a statistically significant and sustained increase in case counts in the subsequent 15 months of the late pandemic period. After pandemic onset, a significant increase in the proportion of children with intracranial infections secondary to sinusitis requiring neurosurgical intervention was observed (OR 2.35, 95% CI 1.30-4.27, p = 0.005), without a change in the distribution of risk factors for severe disease between preonset and postonset periods. No pandemic-related differences in the microbiological profile or outcomes were observed, and there was no evidence of disruption to the functioning of the healthcare system.</p><p><strong>Conclusions: </strong>After a short period of reduced counts of intracranial infection cases due to bacterial sinusitis following the onset of the COVID-19 pandemic, Canadian centers experienced a sustained rise in case numbers until the end of the study period (December 2022). This increase together with a greater requirement for neurosurgical intervention appears to be responsible for the perception among members of the pediatric neurosurgical community of an increase in the incidence of suppurative intracranial complications of bacterial sinusitis. Additional observational data are required to determine whether case counts return to prepandemic norms.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149816","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":"Postoperative kyphosis following resection of pediatric intramedullary spinal tumors: a systematic review and meta-analysis of laminoplasty versus laminectomy.","authors":"Matthan Tharakan, David B Barkyoumb, Piper Tingleaf, Michael Machiorlatti, Sixia Chen, Kiana Prather, Peter G Passias, Steven W Hwang, Angela Downes, Hakeem J Shakir, Andrew Jea, John F Burke, M Burhan Janjua","doi":"10.3171/2026.5.PEDS2637","DOIUrl":"https://doi.org/10.3171/2026.5.PEDS2637","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postoperative kyphosis remains a significant complication following intramedullary spinal tumor resection in pediatric patients, occurring in up to 50% of cases. Laminoplasty, rather than laminectomy, theoretically prevents this complication by preserving the integrity of the posterior column. This study aimed to evaluate the incidence of postoperative kyphosis following laminectomy versus laminoplasty in pediatric intramedullary spinal tumor resection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across the PubMed, Embase, and MEDLINE databases for studies describing pediatric patients (&lt; 18 years) undergoing intramedullary spinal tumor resection. The ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) tool was used to assess risk of bias. A generalized linear mixed model with random intercepts was used to estimate pooled proportions of postoperative kyphosis using a logit transformation. For comparative analyses, studies reporting both laminectomy and laminoplasty arms were pooled using random-effects odds ratios. Heterogeneity was assessed using I2 statistics and Cochran's Q test, and prediction intervals were calculated for pooled estimates. Meta-regression was used to evaluate study-level predictors of postoperative kyphosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 385 records identified, 32 studies met inclusion criteria for systematic review, consisting of 280 pediatric patients undergoing intramedullary spinal tumor resection via laminectomy (n = 175) or laminoplasty (n = 105) with a mean follow-up of 78.4 months. Case reports were included in the qualitative synthesis and descriptive summaries but were excluded from quantitative pooling; 12 studies with extractable postoperative alignment outcomes contributed to meta-analysis (260 patients). In random-effects meta-analysis, the pooled prevalence of postoperative kyphosis was 36% (95% CI 19%-58%; prediction interval 2%-94%). Subgroup analysis showed a prevalence of 46% (95% CI 30%-62%) after laminectomy and 20% (95% CI 2%-73%) after laminoplasty. Comparative meta-analysis of 5 studies showed no significant difference between approaches (OR 1.24, 95% CI 0.32-4.83; I2 = 23.5%; prediction interval 0.25-6.14). In meta-regression, a higher rate of preoperative spinal deformity was linked to postoperative kyphosis (p = 0.0001), while age, sex, and number of levels exposed were not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Postoperative kyphosis frequently occurs following pediatric intramedullary spinal tumor resection, and no significant difference was found between laminectomy and laminoplasty. Higher study-level rates of preoperative deformity were associated with postoperative kyphosis. Higher-quality comparative studies and standardized postoperative reporting are needed to more confidently assess the relationship between su","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148634","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":"Systematic review of pediatric cerebral proliferative angiopathy.","authors":"Vitor Nagai Yamaki, Anoushka Alwis, Samyami Sangeeta Chowdhury, Laura L Lehman, Sanjay Bhate, Vijeya Ganesan, Fergus Robertson, Adam Rennie, Prakash Muthusami, Darren B Orbach, Peter B Dirks, Edward R Smith, Greg James, Alfred P See, Adikarige Haritha Dulanka Silva","doi":"10.3171/2026.4.PEDS25435","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS25435","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral proliferative angiopathy (CPA) is a rare, low-flow, diffuse vascular malformation distinct from a classic cerebral nidal arteriovenous malformation. Its clinical course, imaging features, and optimal management in pediatric patients remain unclear, and existing evidence is limited to small case series. The authors performed a systematic review to characterize the presentation, radiological findings, treatment, and outcomes in children with CPA.</p><p><strong>Methods: </strong>They performed a systematic search of the MEDLINE, Scopus, and Web of Science databases for English-language studies published between January 2008 and June 2024 and reporting angiographically confirmed CPA in patients with an age ≤ 18 years. Two reviewers independently screened and extracted data on demographics, symptoms, imaging (angiography, perfusion imaging), management (conservative methods, endovascular therapy, cerebral revascularization, resection, radiosurgery), and outcomes. Descriptive statistics were applied for detailed clinical insights into pediatric CPA.</p><p><strong>Results: </strong>The search yielded 557 studies, with 25 papers eligible for study inclusion and a final total of 29 pediatric patients with CPA (median age 11 years, 54% female). Presentations included headaches in 59% of cases (including stroke and transient ischemic attacks), followed by new neurological deficits (55%), hemorrhage (38%), and seizures (28%). Eleven patients (65%) were initially managed conservatively; of these, 5 (45%) later underwent treatment because of lesion progression or clinical deterioration. Forty-eight percent of the patients required intervention (12/25; note that management and follow-up data were available for 25/29 patients), including indirect surgical revascularization (ISR; 5/12), ISR plus radiosurgery (1/12), endovascular therapy (1/12), endovascular therapy plus radiosurgery (1/12), resection (3/12), and microsurgical clipping (1/12). During an overall median 36-month follow-up, 73% (8/11 patients initially managed conservatively) of patients presented with clinical deterioration; ISR led to clinical and perfusion improvement in 66% (4/6) of patients.</p><p><strong>Conclusions: </strong>Pediatric CPA exhibits a dynamic, progressive course in which conversative management often leads to clinical deterioration. ISR was the most effective treatment for improving ischemic symptoms, highlighting the role of hypoperfusion in CPA. Collaborative prospective studies are needed to determine optimal management strategies for pediatric CPA.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147594","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":"Outcomes of neonatal brachial plexus reconstruction using the supraclavicular nerve as a donor graft.","authors":"Esperanza Mantilla-Rivas, Nicole C Episalla, Liara S Ortiz-Ocasio, Md Sohel Rana, Daniela Duarte-Bateman, Athena Zhang, Theodore S Hyman, Robert F Keating, Albert K Oh, Gary F Rogers","doi":"10.3171/2026.5.PEDS25571","DOIUrl":"https://doi.org/10.3171/2026.5.PEDS25571","url":null,"abstract":"<p><strong>Objective: </strong>Interposition nerve grafting is widely used for reconstructing neonatal brachial plexus palsy (NBPP). While the sural nerve graft has historically been the gold standard, the supraclavicular nerve offers the advantage of plentiful donor nerve graft within the operative field. This study reports the outcomes of using supraclavicular nerve grafts for NBPP reconstruction.</p><p><strong>Methods: </strong>A retrospective review was conducted on the medical records of patients with NBPP who underwent supraclavicular nerve grafting at the authors' institution between January 2011 and January 2023. Patients with a minimum of 18 months of follow-up were included. Demographic characteristics, injury location, surgical details, preoperative and postoperative Active Movement Scale (AMS) scores, and additional therapies were recorded.</p><p><strong>Results: </strong>Thirty-three patients met the inclusion criteria. Reconstruction was performed at a median of 9.7 [IQR 5.9, 17.8] months of age. The majority of patients (87.9%) had upper trunk injuries, primarily affecting the right brachial plexus (69.7%). The mean operative time was 5.48 ± 1.2 hours. At a median follow-up of 25.5 months, > 60% of patients achieved initial motor recovery (> 2-point AMS improvement) in shoulder and elbow flexion, and > 50% of patients achieved antigravity motor function (AMS score ≥ 5) in most, but not all, movements. Patients operated on after 12 months had less favorable outcomes, including reduced movement in some cases. The complication rate was low, with 2 wound infections (6.1%) and 1 case of transient elevated hemidiaphragm (3.0%).</p><p><strong>Conclusions: </strong>The supraclavicular nerve graft is an effective donor for NBPP reconstruction, providing favorable motor recovery and antigravity strength. The timing of surgery plays a crucial role in optimizing functional outcomes, with earlier repairs showing the best results. Secondary procedures may be performed to maximize functional recovery.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110966","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":"Shunt-induced craniosynostosis with craniocerebral disproportion: a new way of thinking about an old problem.","authors":"Kendall Snyder, Christopher Troy, Camille Milton, Nir Shimony, Asim F Choudhri, Robin Evans, Paul Klimo","doi":"10.3171/2026.2.PEDS25547","DOIUrl":"https://doi.org/10.3171/2026.2.PEDS25547","url":null,"abstract":"<p><strong>Objective: </strong>Shunting during infancy can precipitate premature closure of one or more cranial suture. Shunt-induced craniosynostosis (SIC) may in turn result in craniocerebral disproportion (CCD). The authors present a single-institution series and offer a pragmatic diagnostic and treatment framework.</p><p><strong>Methods: </strong>This study was a retrospective case series of patients with SIC-CCD who underwent surgical correction between 2018 and 2025 at a single institution.</p><p><strong>Results: </strong>Eighteen patients were identified. The mean (range) age at initial shunt placement was 2 (0-9) months, and the mean age at CCD corrective surgery was 5.6 (1.1-18.4) years. Eleven patients (61%) presented with headaches and 14 (78%) had one or more symptoms attributable to CCD. All patients underwent surgery for CCD: 16 underwent cranial vault expansion (12 with distractors), and 2 underwent suturectomy. Three patients required a delayed secondary salvage expansion. The mean follow-up was 3.47 (0.56-8.28) years. At the last follow-up, more than two-thirds of patients reported symptom improvement and all had significantly less radiographic intracranial crowding. Emergency department visits for shunt concerns and shunt revisions decreased after vault expansion.</p><p><strong>Conclusions: </strong>Pediatric neurosurgeons, craniofacial plastic surgeons, and neuroradiologists must maintain a high suspicion for SIC-CCD in every child that was shunted early in life. Once CCD is diagnosed, early surgical expansion is recommended. Contemporary craniofacial techniques, aided by computer-assisted surgical planning (CAS), can safely achieve meaningful intracranial volume expansion with symptomatic improvement for most patients.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109834","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":"Editorial. Shunts and craniosynostosis: the importance of updating old opinions.","authors":"David P Perrault, Shih-Shan Lang, Jordan W Swanson, Gregory G Heuer","doi":"10.3171/2026.4.PEDS26101","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS26101","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110921","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":"Cortical development in patients with metopic craniosynostosis.","authors":"Pauline A E Tio, Meike C Tjaberinga, Diede C Wijnbergen, Linda Gaillard, Marjolein H G Dremmen, Mieke M Pleumeekers, Marie-Lise C van Veelen, Henri A Vrooman, Irene M J Mathijssen","doi":"10.3171/2026.2.PEDS25473","DOIUrl":"https://doi.org/10.3171/2026.2.PEDS25473","url":null,"abstract":"<p><strong>Objective: </strong>Patients with metopic synostosis have an increased risk of neurodevelopmental disorders, despite a minimal risk of intracranial hypertension. While mechanical constraint due to premature suture fusion has been proposed as a contributing factor, evidence suggests intrinsic brain malformations may play a more significant role. Cortical thickness, volume, and surface area alterations have been implicated in neurodevelopmental disorders, yet their role in metopic synostosis remains unclear. In this retrospective study, authors investigated whether these cortical parameters are altered in patients with metopic synostosis compared with those in healthy controls.</p><p><strong>Methods: </strong>3D T1-weighted MRI brain scans from patients 0-2 years of age with metopic synostosis were reviewed. Children born preterm or with a syndromic condition were excluded. MRI brain scans of patients and age-matched controls were processed using the Infant FreeSurfer pipeline to quantify cortical thickness, cortical volume, cortical surface area, and intracranial volume. Linear regression models adjusted for age, sex, and intracranial volume were used to compare global cortical thickness, cortical volume, and cortical surface area between the groups, with secondary analyses of these metrics at the lobular level.</p><p><strong>Results: </strong>Sixty-four patients with metopic synostosis and 32 controls (median age at MRI 8.4 months [IQR 4.84] and 12.4 months [IQR 9.68], respectively) were eligible for inclusion. Patients with metopic synostosis had a significantly increased cortical surface area compared to that in controls (p = 0.029). No significant differences were found in global cortical thickness (p = 0.281) or total cortical volume (p = 0.141) between patients and controls.</p><p><strong>Conclusions: </strong>Increased cortical surface area is observed in patients with metopic synostosis; however, there are no significant differences in cortical thickness and volume. Similar developmental trajectories have been observed in infants with neurodevelopmental disorders. These findings shift the focus from mechanical deformation to fundamental brain development pathways in patients with metopic synostosis.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110950","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}