Journal of neurosurgery. Pediatrics最新文献

{"title":"Neuropsychological outcome, magnetic resonance imaging findings, and health-related quality of life of pediatric victims of traumatic brain injury: a prospective study.","authors":"Daniele S J Volpe, Hohana G Konell, Carlos E G Salmon, Antonio C Dos Santos, Ana P C P Carlotti","doi":"10.3171/2025.3.PEDS24605","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24605","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to evaluate the neuropsychological outcome of pediatric victims of traumatic brain injury (TBI) and its association with trauma severity and MRI findings, and to investigate health-related quality of life (HRQOL) of patients and their families after trauma.</p><p><strong>Methods: </strong>This was a prospective cohort study of pediatric patients (≤ 16 years) who sustained TBI and were admitted to the emergency department of a tertiary care university hospital in Brazil from June 2018 to December 2019. Trauma severity was determined by Glasgow Coma Scale (GCS), neurological outcome by King's Outcome Scale for Childhood Head Injury (KOSCHI), neuropsychological outcome by the Wechsler Intelligence Scale for Children-Fourth Edition, and HRQOL by the Pediatric Quality of Life Inventory 4.0. Patients also underwent MRI examinations. Neurological outcome was assessed twice at a median of 6 months and 13 months after trauma. Neuropsychological and HRQOL assessment and MRI were performed at a median of 13 months after trauma.</p><p><strong>Results: </strong>Thirty-seven patients were included. According to the neurological outcome categorized by KOSCHI, 25 (67.6%) patients made a good recovery and 12 (32.4%) had a disability. The neurological status did not change between the two assessments. Patients in the disability group had lower GCS scores (median 11 vs 15, p = 0.0006) and lower median values of full-scale intelligence quotient (67 vs 86, p = 0.0002), perceptual reasoning index (75 vs 92, p = 0.03), verbal comprehension index (72 vs 84, p = 0.02), working memory index (74 vs 88, p = 0.003), and processing speed index (68 vs 86, p = 0.01). The presence of MRI alterations was associated with TBI severity (median GCS score 7 vs 15, p < 0.0001). Mean, axial, and radial diffusivity were higher, and fractional anisotropy was lower in patients with TBI compared with controls. HRQOL was worse in the disability group.</p><p><strong>Conclusions: </strong>Pediatric patients sustaining TBI with a KOSCHI outcome classified as having a disability had poorer neuropsychological testing performance and worse HRQOL compared with patients with a good recovery. MRI metrics abnormalities suggest diffuse white matter disruption associated with pediatric TBI.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715134","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":"Transarticular atlantooccipital and condylar screw fixation with neuronavigation for occipital cervical stabilization in pediatric patients: a case series.","authors":"Hudin N Jackson, Rita Snyder, David F Bauer","doi":"10.3171/2025.4.PEDS24670","DOIUrl":"https://doi.org/10.3171/2025.4.PEDS24670","url":null,"abstract":"<p><strong>Objective: </strong>Surgical fixation for occipitocervical instability can be challenging due to limitations in occipital instrumentation that include prominent hardware, limited fixation points on the occiput, and the risk of intracranial injury. Occipital instrumentation is particularly difficult in pediatric patients with thinner skull osteology and smaller bony surface area. Transarticular atlantooccipital and occipital condyle screw placement are newer techniques that have been described as alternative strategies for occipitocervical fixation. Cadaveric studies have demonstrated the feasibility and biomechanical equivalence to traditional plating systems for both techniques, however their clinical application has been limited. The authors present the largest case series of pediatric patients who underwent either transarticular atlantooccipital or direct occipital condyle screw fixation for the treatment of occipital cervical instability. The authors report their early postoperative outcomes, fusion rates, and feasibility of the surgical procedure in pediatric patients.</p><p><strong>Methods: </strong>Three patients underwent transarticular atlantooccipital screw fixation, and 3 patients underwent direct occipital condyle screw fixation. Clinical presentation, complications, fusion rates, and postoperative outcomes were reviewed.</p><p><strong>Results: </strong>The age range was 2 to 20 years old. Occipitocervical instability was secondary to congenital skeletal dysplasia and neuromuscular scoliosis. Presenting symptoms included dysphagia, dysphonia, headaches, and neck pain. All patients underwent instrumentation guided by neuronavigation. There were no intra- or postoperative complications, and all patients demonstrated evidence of fusion with an average (range) follow-up of 24.1 (15-36) months. The authors observed an excellent fusion rate with low morbidity.</p><p><strong>Conclusion: </strong>Transarticular atlantooccipital and direct occipital condyle screw fixation are alternative techniques to occipital plate fixation. These novel techniques can be performed safely in pediatric patients and provide adequate fixation for successful arthrodesis.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715136","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":"Predictors for delayed presentation to a specialty concussion clinic following sport-related concussion.","authors":"Avi N Albert, Jacob Jo, Anthony E Bishay, Kristen L Williams, Natasha C Hughes, Douglas P Terry, Scott L Zuckerman","doi":"10.3171/2025.5.PEDS24657","DOIUrl":"https://doi.org/10.3171/2025.5.PEDS24657","url":null,"abstract":"<p><strong>Objective: </strong>Limited literature exists on predictors for delayed presentation to a specialty concussion clinic following sport-related concussions (SRCs). The current study aimed to 1) describe demographics, injury characteristics, and recovery timelines for athletes presenting to a concussion clinic at least 30 days after SRC; and 2) identify predictors of delayed presentation ≥ 30 days postinjury.</p><p><strong>Methods: </strong>The current retrospective cohort study examined 14- to 18-year-old athletes who sustained SRCs from November 2017 to April 2022 and presented to a specialty sports concussion clinic. Presentation time was categorized as < 30 days or ≥ 30 days postinjury. Univariate analyses included chi-square, Mann-Whitney U-, and t-tests. Multivariable logistic regression was performed controlling for age, sex, on-field evaluation, distance from the clinic, psychiatric conditions, migraines, and family history of psychiatric conditions/migraines.</p><p><strong>Results: </strong>Of 923 athletes (mean age 16.2 ± 1.2, 66.2% male), 872 (94.5%) presented within 30 days of their concussion, and 51 (5.5%) presented ≥ 30 days after injury. Delayed presenters (≥ 30 days) lived farther away (U = 29,941.5, p < 0.001), had higher proportions of psychiatric history (χ2 = 17.23, p < 0.001), family migraine history (χ2 = 17.23, p < 0.001), family psychiatric history (χ2 = 26.52, p < 0.001), prior healthcare visits to nonspecialty sites (χ2 = 6.44, p = 0.012), and had lower rates of on-field evaluations (χ2 = 14.28, p < 0.001). In the multivariable logistic regression predicting delayed presentation, significant predictors included psychiatric history (OR 1.40, p = 0.022), family migraine history (OR 1.39, p = 0.007), and absence of on-field evaluation (OR 0.23, p < 0.001). Not surprisingly, late presenters had longer times to symptom resolution (median 54.0 vs 15.5 days, U = 13,470.5, p < 0.001) and return to play (median 55.5 vs 20.0 days, U = 14,822.0, p < 0.001).</p><p><strong>Conclusions: </strong>In high school-aged athletes with SRCs, psychiatric history, family history of migraine, and absence of on-field evaluation were predictors of delayed presentation to a specialty concussion clinic presentation. These findings highlight opportunities to improve timely access to a dedicated sports concussion center, which may improve outcomes through early intervention.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715135","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":"Psychological functioning in children with hydrocephalus: a scoping review.","authors":"Abhishek Kamath, Garrett W Thrash, Brandon G Rocque, Elizabeth M McRae","doi":"10.3171/2025.3.PEDS24533","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24533","url":null,"abstract":"<p><strong>Objective: </strong>This scoping review aimed to assess themes and gaps in the existing scope of literature regarding psychological outcomes and quality of life in children with hydrocephalus.</p><p><strong>Methods: </strong>Using the search criteria \"pediatric AND hydrocephalus AND (psychological OR behavioral OR emotional OR cognitive),\" the authors imported articles from SCOPUS, PubMed, PsycINFO, PsycArticles, and independent citation searches into Covidence, and duplicates were removed (n = 372). After the abstract and full text were screened, the remaining articles (n = 44) underwent data extraction to identify key psychological outcomes and themes in the literature. Findings were quantified using descriptive statistics in SPSS software, and themes were analyzed to interpret knowledge trends and gaps in current studies.</p><p><strong>Results: </strong>These studies examined psychological outcomes in pediatric hydrocephalus, focusing on neuropsychological (56%), behavioral and emotional (32%), academic (13.6%), and developmental (11.4%) outcomes. Most studies were cross sectional (56.8%), with sample sizes ranging from 6 to 467 participants. Neuropsychological impairments, particularly in intelligence, memory, and attention, were prevalent, as were behavioral and emotional problems, especially internalizing behaviors. The literature supported diminished quality of life in pediatric hydrocephalus populations, and several medical factors such as severity of hydrocephalus and treatment type were found to influence psychological functioning and outcomes.</p><p><strong>Conclusions: </strong>This scoping review highlights neuropsychological, behavioral, and emotional challenges in children with hydrocephalus, with deficits observed primarily in intelligence, memory, attention, and quality of life. Limitations in standardization of follow-up with patients made a systematic review difficult to conduct. Nonetheless, findings reveal the need for targeted interventions in these areas, as well as further research on the influence of medical factors, treatment type, and severity of hydrocephalus on long-term outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-17"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663945","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":"Unplanned readmission after cranial tumor surgery in the pediatric National Surgical Quality Improvement Program.","authors":"Amanda N Stanton, Chloe DeYoung, Megan E H Still, Rachel S F Moor, Michael Sun, Muhammad A B Chowdhury, Lance S Governale","doi":"10.3171/2025.5.PEDS24606","DOIUrl":"https://doi.org/10.3171/2025.5.PEDS24606","url":null,"abstract":"<p><strong>Objective: </strong>Hospital readmissions are commonly considered an indicator of healthcare quality. The key assumption is that readmissions are preventable, which is especially important in a pediatric population heavily reliant on Medicaid. The aim of this study was to understand the rate, demographics, and independent predictors of unplanned 30-day readmission after pediatric craniotomy for tumor.</p><p><strong>Methods: </strong>A review of the prospective pediatric National Surgical Quality Improvement Program database was performed to identify patients who underwent craniotomy for tumor from 2012 to 2021. The primary outcome was unplanned 30-day readmission, with secondary outcomes of 30-day reoperation or 30-day death. Multivariable logistic regression models were applied to patient characteristics, comorbidities, and surgical factors to identify independent predictors.</p><p><strong>Results: </strong>Overall, 9845 patients (55% male, mean age 9 years) were included, of which 9.8% had unplanned readmission, 10.8% underwent reoperation, and 0.8% died within 30 days. The cohort was predominantly of White race and primarily underwent elective surgery. Not surprisingly, reoperation was a strong predictor of readmission; however, other predictors included steroid use and nutritional support. Notably, operative factors such as the duration of surgery or the need for blood transfusion were not predictors of any outcome measured. Independent predictors of reoperation included patient comorbidities, as well as preoperative characteristics and case type. Predictors of 30-day death included emergency surgery, ventilator dependence, nutritional support, and hematological disorders.</p><p><strong>Conclusions: </strong>There were identifiable factors associated with readmission, reoperation, and death among pediatric patients who underwent craniotomy for tumor. Attention to these factors during clinical care could contribute to risk stratification, patient and family education, and transitional care advising.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663955","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":"Efficacy and safety of local and general anesthesia for diagnostic cerebral angiography in children.","authors":"Wenlong Gao, Fenglin Xu, Xuanxuan Wu, Zengpeng Yu, Ping Liang","doi":"10.3171/2025.3.PEDS24406","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24406","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the efficacy and safety of diagnostic cerebral angiography in children under local anesthesia (LA) versus general anesthesia (GA).</p><p><strong>Methods: </strong>This retrospective cohort study included children who underwent diagnostic cerebral angiography between September 2018 and September 2021. Medical records were reviewed to identify eligible patients and assign them to the LA or GA group. Baseline demographics, procedural metrics, medical expenses, image quality, pain scores, vital signs (mean arterial pressure and partial oxygen pressure), and complications were compared between the groups.</p><p><strong>Results: </strong>In total, 128 children (mean age 10.38 ± 2.28 years; 56 [43.8%] males) underwent diagnostic cerebral angiography. The LA and GA groups comprised 40 and 88 children, respectively. No significant differences were observed in baseline characteristics, contrast agent volume, fluoroscopy time, radiation exposure, scanning duration, image vascular contrast and integrity, diagnostic efficacy, length of hospital stay, and pain scores between the groups (p > 0.05). Although the LA group had significantly shorter anesthesia duration, postanesthesia care unit stay, and lower medical expenses, this group exhibited more motion artifacts and poorer image clarity compared with the GA group (p < 0.05). In addition, the mean arterial pressure decreased in both groups during the procedure. Complications included inguinal hematoma in both groups, whereas skin rash, headache, and vomiting occurred only in the general anesthesia group.</p><p><strong>Conclusions: </strong>Diagnostic cerebral angiography under LA can safely be used to obtain images with comparable visualization of vascular contrast and integrity and diagnostic yield to those obtained under general anesthesia. Notably, local anesthesia offers the advantages of shorter anesthesia duration and reduced healthcare costs.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612206","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":"Effects of shortening distal shunt catheters in children as relates to patient age and valve type: a simulation study with clinical implications.","authors":"Sandra Fernandes Dias, Elisabeth Jehli, Martin U Schuhmann, Marianne Schmid Daners","doi":"10.3171/2025.3.PEDS24409","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24409","url":null,"abstract":"<p><strong>Objective: </strong>In children treated with a ventriculoperitoneal shunt (VPS), the growing body length increases the negative hydrostatic pressure within the shunt. At initial shunt insertion in neonates, infants, and small children, some surgeons traditionally shorten the distal catheter, although full length is generally well tolerated. Authors of this study investigate the effect of shortening distal shunt catheters on intracranial pressure (ICP) and cerebrospinal fluid (CSF) drainage rates in a bench test model set for different ages and with particular valve types.</p><p><strong>Methods: </strong>Using a hardware-in-the-loop test bench, three different VPS settings were evaluated with both a standard 120-cm-long distal catheter and a short distal catheter (SDC) of 60 cm: a miniNav differential pressure valve with a 10-cmH2O opening pressure (MN10) and adjustable proGAV valves with a 25-cmH2O gravitational unit set at 5-cmH2O (PG5) and 10-cmH2O (PG10) opening pressures. The hardware was adjusted for the body length of 1-, 5-, and 10-year-old children. The software simulated the age-adapted physiological conditions of intracranial and intra-abdominal pressures. All valve and catheter combinations were tested 5 times, each in 1-hour runs in three positions: first horizontal, vertical, and second horizontal. Flow through the VPS and intracranial pressure were measured.</p><p><strong>Results: </strong>The use of an SDC, as compared to the standard catheter, led to a significant ICP decrease in the vertical position using the PG5 across all age groups, PG10 for 5 year olds, and MN10 for 10 year olds. Using the SDC also resulted in a significantly higher drained CSF volume in the vertical position across all age groups with the MN10 and PG5.</p><p><strong>Conclusions: </strong>Shortening the distal catheter leads to increased drainage rates with significant ICP decreases in a 1-year-old child model setup. This effect is more pronounced for low opening pressure valves, unprotected valve systems, and model setups for older children. These results suggest that an SDC may promote overdrainage of variable magnitude depending on the age and height of the child and the valve setting. Therefore, an SDC should be avoided.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612205","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":"Assessment of neuroendovascular needs in pediatric neurosurgery fellowship training.","authors":"Michael J Feldman, Garrett A Dyess, Anastasia Arynchyna-Smith, Jodi Smith, Douglas Brockmeyer, Susan Durham, James M Johnston","doi":"10.3171/2025.4.PEDS24461","DOIUrl":"https://doi.org/10.3171/2025.4.PEDS24461","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612203","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. Neuroendovascular needs in pediatric neurosurgery fellowship training: a question of access.","authors":"Edward R Smith, Alfred P See","doi":"10.3171/2025.5.PEDS25181","DOIUrl":"https://doi.org/10.3171/2025.5.PEDS25181","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-3"},"PeriodicalIF":2.1,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612204","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":"Molecular diagnostic factors, prognostic implications, and long-term outcomes in pediatric pilocytic astrocytoma.","authors":"Julia N Grigorian, Katherine E Chandler, Vivek A Pisharody, Zvipo Mutsa Chisango, Jocelyn Chow, Shuting Mao, Tianwen Ma, Arman Jahangiri, Joshua J Chern, Kimberly Hoang","doi":"10.3171/2025.3.PEDS24568","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24568","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric pilocytic astrocytoma (PPA) is the most common pediatric brain tumor, accounting for more than 15% of brain tumors in children. BRAF alterations, including KIAA1549-BRAF (K-B) fusion and BRAF V600E mutation, are prevalent in pilocytic astrocytoma (PA) and have shown mixed prognostic outcomes in previous studies. In this study, the authors outline the clinical course for patients with PPA and examine factors that may aid in predicting disease trajectory.</p><p><strong>Methods: </strong>This retrospective study included pediatric patients who underwent biopsy or resection of PA between 2009 and 2023 at the authors' institution. Clinical data, tumor genomics, and disease course outcomes were collected, and analysis included stratification by BRAF gene status.</p><p><strong>Results: </strong>The study cohort included 112 pediatric patients, 58 of whom had the K-B fusion and 12 of whom had the BRAF V600E mutation. Significantly lower rates of recurrence/progression were noted with gross-total resection (GTR) (hazard ratio [HR] 0.27, 95% CI 0.13-0.53; p < 0.001). The K-B fusion was associated with worse progression-/recurrence-free survival (PRFS) compared to wildtype (WT) (HR 2.3, 95% CI 1.1-4.3; p = 0.03), although among patients with K-B fusion, GTR was associated with a significantly longer time to recurrence/progression (4.5 vs 0.8 years, p < 0.001). The BRAF V600E mutation was not associated with significantly different PRFS than WT (HR 1.4, 95% CI 0.4-4.5; p = 0.56). Neither the use of adjuvant therapy for incompletely resected tumors nor tumor location affected the rate of recurrence/progression.</p><p><strong>Conclusions: </strong>Several clinical and genomic factors were identified that may affect prognostication for patients with PPA. K-B was the most common genomic alteration identified and was associated with worse PRFS, while the BRAF V600E mutation conferred no difference in PRFS when compared to the BRAF WT. GTR should be pursued when possible because it is associated with a longer time to recurrence/progression, including for tumors with the K-B fusion.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564886","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}