Journal of neurosurgery. Pediatrics最新文献

{"title":"Association of left ventricular systolic dysfunction with outcome following pediatric traumatic brain injury.","authors":"Vanessa M Mazandi, Kaitlyn Boggs, Kumaran Senthil, Ellie D Gabriel, Nankee Kumar, Christie Glau, Adam S Himebauch, Chong-Tae Kim, Todd J Kilbaugh, Shih-Shan Lang, Thomas Conlon, Jimmy W Huh","doi":"10.3171/2025.3.PEDS24655","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24655","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in children. While left ventricular systolic dysfunction (LVSD) has been observed following TBI in adults, very little is known regarding it in the pediatric TBI population. The aim of this study was to evaluate the frequency and admission risk factors for systolic dysfunction following pediatric TBI. The authors hypothesized that systolic cardiac dysfunction would be associated with morbidity and mortality.</p><p><strong>Methods: </strong>This was a single-center retrospective observational study from a quaternary children's hospital. Pediatric patients with TBI who were younger than 18 years and had a transthoracic echocardiogram obtained by the pediatric cardiology team from January 2011 to December 2021 were evaluated. The primary outcome was in-hospital mortality. The secondary outcome was the Glasgow Outcome Scale-Extended (GOS-E) score at 6 months in survivors.</p><p><strong>Results: </strong>Of 1059 pediatric patients who presented with TBI, 70 had an echocardiogram, all of which were obtained within 72 hours of admission. LVSD on the echocardiogram was observed in 24 of 70 patients (34%). The mortality rate was 47% (33 of 70). Low admission Glasgow Coma Scale (GCS) score, abusive head trauma, and cardiac arrest were independent risk factors associated with a higher odds of LVSD on univariate analysis, while a low admission GCS score was also a risk factor on multivariate analysis (p < 0.05). Systolic cardiac dysfunction increased the odds for in-hospital mortality or worse outcome (low GOS-E score) in survivors at 6 months on univariate analysis (p < 0.05). When accounting for admission GCS scores, abusive head trauma, and cardiac arrest on multivariate analysis, LVSD did not have a significant association with mortality and morbidity.</p><p><strong>Conclusions: </strong>Nearly 35% of pediatric TBI patients who underwent transthoracic echocardiography were found to have LVSD within 72 hours of admission. Low admission GCS score, abusive head trauma, or cardiac arrest significantly increased the risk of LVSD on univariate analysis, while the GCS score was a risk factor on multivariate analysis. The presence of LVSD was associated with an increased risk of mortality and morbidity in survivors on univariate analysis. Future prospective studies are warranted to further characterize myocardial dysfunction in pediatric patients with TBI and determine whether earlier recognition and treatment might improve outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086269","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":"Intrathecal baclofen pump versus combined dorsal/ventral rhizotomy for spastic quadriplegia: healthcare cost and complication analysis.","authors":"Emma Hartman, Marcella Ruppert-Gomez, Amanda Mosher, Kristin Buxton, Ann Morgan, Scellig Stone, Weston T Northam","doi":"10.3171/2025.2.PEDS24576","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24576","url":null,"abstract":"<p><strong>Objective: </strong>Combined dorsal/ventral rhizotomy (CDVR) has emerged as a tone management option for pediatric patients with cerebral palsy and medically refractory spasticity. However, its costs to the patient and the healthcare system compared with those of an intrathecal baclofen (ITB) pump are understudied. The authors aimed to evaluate ITB and CDVR with respect to healthcare cost, resource utilization, and clinical safety.</p><p><strong>Methods: </strong>The records for all pediatric patients who underwent ITB pump placement or CDVR at a single institution between 2003 and 2024 were retrospectively reviewed. Hospital and professional charge data, both inpatient and outpatient, as well as clinical data were collected and analyzed.</p><p><strong>Results: </strong>Seventeen patients underwent CDVR and 392 underwent ITB therapy. There were no clinically significant differences between the two treatment groups in terms of baseline demographics or Gross Motor Function Classification System level, preoperative risk factors, and comorbidities. None of the patients who had undergone CDVR experienced surgical site infection or CSF leakage, whereas 4.1% of patients in the ITB group had surgical site infection and 1.8% had CSF leakage. There were no differences (p ≥ 0.05) between the treatment groups in terms of mean hospital length of stay (6.5 days) and return to the emergency department or readmission within 30 days, although readmissions were longer in the ITB group (3 vs 0 median days). Accounting for professional and hospital charges for surgery, hospitalization, and follow-up care during the 1st postoperative year, patients in the CDVR group saved a median $7907 relative to those in the ITB group. Over a 10-year period, the projected differential would grow and ITB would ultimately be expected to be 4.6 times more expensive than CDVR, yielding a median cost differential of $182,432 per patient (p < 0.005). Additionally, CDVR, as compared to ITB, required less postoperative follow-up, averaging a projected decrease of 15 clinic visits per patient over 10 years, reducing hospital resource utilization, the burden on caregivers, and indirect costs to families associated with lost wages and transport to and from appointments.</p><p><strong>Conclusions: </strong>CDVR offers significantly decreased healthcare costs and resource utilization relative to ITB. CDVR has a comparable clinical safety and complication profile and deserves further study as an alternative to ITB.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086270","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":"Poor surgical outcomes following Paenibacillus infant infectious hydrocephalus.","authors":"Jessica E Ericson, Davis Natukwatsa, Peter Ssenyonga, Justin Onen, John Mugamba, Ronald Mulondo, Sarah U Morton, Mercedeh Movassagh, Kelsey Templeton, Christine Hehnly, Edith Mbabazi-Kabachelor, Abhaya V Kulkarni, Benjamin C Warf, James R Broach, Joseph N Paulson, Steven J Schiff","doi":"10.3171/2025.1.PEDS24254","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24254","url":null,"abstract":"<p><strong>Objective: </strong>The authors previously identified Paenibacillus species in the CSF of 44% of infants presenting for neurosurgical evaluation with findings consistent with postinfectious hydrocephalus (PIH) in Eastern Uganda. Here, they sought to compare outcomes among hydrocephalic infants with and without Paenibacillus detection at the time of hydrocephalus surgery.</p><p><strong>Methods: </strong>In a prospective observational study of 189 infants with PIH who underwent a CSF diversion prior to 90 days of age, 78 had a positive CSF polymerase chain reaction result for Paenibacillus species (PP), and 111 had a negative result (PN). The primary outcome was diversion failure-free survival, defined as being alive without diversion failure at last patient contact. Secondary outcomes included overall survival and diversion success.</p><p><strong>Results: </strong>After a median follow-up period of 35.7 months, the primary outcome was observed in 42 PP patients (54%) and in 76 PN patients (68%) (adjusted hazard ratio [aHR] 2.45, 95% CI 1.42-4.22; p = 0.001). PP patients who underwent endoscopic diversion had a worse primary event rate (aHR 6.47, 95% CI 2.40-17.42; p < 0.001). Death from any cause occurred in 16 PP patients (21%) and 9 PN patients (8%) (aHR 3.47, 95% CI 1.44-8.37; p = 0.006). Diversion failure occurred in 28 PP patients (36%) and 29 PN patients (26%) (aHR 2.24, 95% CI 1.31-3.85; p = 0.003).</p><p><strong>Conclusions: </strong>In this study, Paenibacillus detection in the CSF at the time of hydrocephalus surgery was associated with a significantly increased rate of the composite of diversion failure or death, death, and diversion failure, and was particularly increased for patients who had an endoscopic diversion.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086272","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":"Stereotactic laser ablation for pediatric central nervous system tumors: a systematic review and meta-analysis of the literature.","authors":"Sean O'Leary, Muhammad Ammar Haider, Nina Truong, Dhillon Advano, Sruja Arya, Sruthi Ranganathan, Abigail Jenkins, Preston D'Souza, Anant Naik, Peace Odiase, Umaru Barrie, Bruno P Braga, Angela V Price","doi":"10.3171/2025.1.PEDS24387","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24387","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic laser ablation (SLA) or laser interstitial thermal therapy (LITT) is an emerging alternative to conventional surgery for CNS tumors. Further characterization of its effectiveness and safety in the pediatric population is needed.</p><p><strong>Methods: </strong>A review was conducted according to PRISMA guidelines using the PubMed/MEDLINE, Scopus, Embase, Google Scholar, and Science Direct databases to investigate the effectiveness and safety in the use of LITT to treat pediatric CNS tumors in children.</p><p><strong>Results: </strong>A total of 24 articles met the inclusion criteria. From the 4 retrospective studies comprising 97 patients (mean age 11.4 years, 55.0% males in the pooled prevalence), the most common tumor types were pilocytic astrocytoma (31.5%) and subependymal giant cell astrocytoma (SEGA; 68.5%). Tumors were primarily located in the frontal lobe (29.7%) and thalamus (24.4%). Postoperative complications included transient neurological deficits in 12.1% and permanent deficits in 6.0% of patients. At a mean follow-up of 43.9 months, mass reduction was observed in 68.8% of patients and overall disease improvement in 91.9% of patients, and the mortality rate was 2.6%. From the 20 case reports/series involving 67 patients (mean age 10.8 ± 4.7 years, 52.2% males), the mean tumor size was 15.7 ± 8.7 cm3. Predominant tumor subtypes were pilocytic astrocytoma (29.9%) and SEGA (16.4%). Tumors were located in eloquent areas in 61.3% of cases, notably the thalamus (24.2%) and ventricular system (24.2%). Prior treatments included surgery (78.8%), chemotherapy (51.5%), and immunotherapy (27.3%). Key LITT parameters were duration (7.2 ± 8.8 minutes), dose (10.2 ± 2.4 W), and extent of tumor volume decrease (68.3% ± 30.4%). The most commonly used LITT system was Visualase (95.7%). Postoperative complications were reported in 26.9% of patients, including transient neurological deficits (55.6%), perilesional edema (22.2%), and hydrocephalus (22.2%). Hospital stays were ≤ 3 days in 92.7% of patients. Tumor size reduction was achieved in 86.7% of patients, and 78.9% experienced disease improvement. Comparative analysis showed that a greater extent of ablation was associated with a reduced need for secondary surgery (p = 0.038, OR 0.94) and improved disease outcomes (p = 0.023, OR 1.05). Longer LITT duration was significantly associated with postoperative complications (p = 0.050).</p><p><strong>Conclusions: </strong>LITT appears effective in reducing tumor size and improving disease outcomes in pediatric CNS tumors. The long-term effectiveness of LITT in pediatric brain tumors requires further randomized prospective investigation.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976706","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":"Longitudinal clinical and imaging analysis of hydrocephalus in a single-center study in 57 patients with mucopolysaccharidosis type IH (Hurler syndrome).","authors":"Shiwei Huang, David R Nascene, Ryan Shanley, Minsoo Choi, Troy C Lund, Ashish O Gupta, Paul J Orchard, Julie Eisengart, Daniel Guillaume, Carolina Sandoval-Garcia","doi":"10.3171/2025.2.PEDS24476","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24476","url":null,"abstract":"<p><strong>Objective: </strong>Hurler syndrome (mucopolysaccharidosis type IH [MPS IH]) is the most severe form of MPS type I. Hydrocephalus can be an early manifestation, but currently there are no established guidelines to monitor for its development or progression in these patients, either before or after treatment.</p><p><strong>Methods: </strong>In this retrospective study, the records of 57 patients with MPS IH who received a hematopoietic stem cell transplant at the University of Minnesota were reviewed, and 291 brain MRI studies were analyzed. Ventricular size over the years was measured using the fronto-occipital horn width ratio.</p><p><strong>Results: </strong>Fifty-seven patients were included in the analysis. Fifty-one patients without a shunt showed a decrease in ventricular size and eventual stability of ventricular size about 2 years after transplant. No new cases of hydrocephalus as part of the natural disease process requiring shunt placement were observed after transplant (0%, 95% CI 0%-5.8%).</p><p><strong>Conclusions: </strong>In patients without preexisting hydrocephalus, no new cases of hydrocephalus developed, and ventricular size stabilized within 2 years after transplant. The authors call into question the overall utility of serial brain MRI after transplant in patients with MPS IH.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030304","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":"Time-STAMP MRI of CSF motion for evaluation of Chiari malformation and endoscopic third ventriculostomy.","authors":"Madison E Gutierrez, Isabel Torres, Joseph Ha, Eamon K Doyle, Meghan Drastal, Jacob K Al-Husseini, Matthew Borzage, Tai-Wei Wu, Benita Tamrazi, Marvin Nelson, Shinya Yamada, J Gordon McComb, Stefan Blüml, Peter A Chiarelli","doi":"10.3171/2025.1.PEDS24526","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24526","url":null,"abstract":"<p><strong>Objective: </strong>Assessing abnormal CSF motion at the craniocervical junction (CCJ) and aqueduct of Sylvius (AS) can be clinically useful in the pediatric neurosurgical evaluation. Noninvasive monitoring of CSF flow at these locations can assist in determining the need for surgery or conservative management and in monitoring the outcomes of such interventions. In this retrospective study, the authors investigated the use of noninvasive time static tagging and monocontrast preservation (Time-STAMP) MRI as a diagnostic adjunct for neurosurgical evaluation at a high-volume pediatric institution.</p><p><strong>Methods: </strong>Radiology records were queried to identify Time-STAMP studies conducted from April 2014 to March 2023. Search parameters included patients who had undergone or were undergoing clinical assessment for Chiari decompression or endoscopic third ventriculostomy (ETV). An independent panel performed a quality review of the Time-STAMP studies to determine their interpretability. Patient records were then reviewed to determine the extent to which Time-STAMP scans contributed to clinical decision-making.</p><p><strong>Results: </strong>Screening of the radiology records yielded 175 patients with Time-STAMP studies, of whom 102 had been assessed for Chiari decompression and 73 for ETV. Among this group, 147 patients (84%) had interpretable Time-STAMP studies, which aided in the decision to clinically observe versus perform surgery in 130 of these patients (88%). The Time-STAMP interpretation was not contradicted by later follow-up studies in any of these patients.</p><p><strong>Conclusions: </strong>The authors found that the noninvasive Time-STAMP technique to visualize CSF motion at the CCJ or AS is helpful to the clinician in managing these conditions.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009366","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":"The impact of surgical and medical treatment on headaches in pediatric patients with Chiari malformation type I.","authors":"Benjamin T Lynch, Emma K Hartman, Madeline B Karsten, Anna L Slingerland, Steven J Staffa, Mark R Proctor, Joseph P Cravero","doi":"10.3171/2025.2.PEDS24356","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24356","url":null,"abstract":"<p><strong>Objective: </strong>This study seeks to report the incidence and type of headache in pediatric patients with Chiari malformation type I (CM-I) at a single institution as well as headache outcomes based on management strategy (surgical vs medical).</p><p><strong>Methods: </strong>A single-institution retrospective review from January 2003 to May 2020 identified all consecutive pediatric patients who were diagnosed with CM-I and who experienced headaches. Headaches were classified as typical, some features, and atypical CM-I headaches based on the International Classification of Headache Disorders criteria. Short- (< 6 months) and long-term (> 6 months) headache outcomes were classified as improvement or no improvement based on specific phrases in patient charts.</p><p><strong>Results: </strong>A total of 112 patients met inclusion criteria. Forty patients (35.7%) experienced typical CM-I headache, 42 (37.5%) experienced some features of a CM-I headache, and 30 (26.8%) experienced atypical CM-I headache. Of the 112 total patients, 48 (42.9%) received surgical treatment for CM-I and 64 (57.1%) were managed medically. The decision to perform surgery was made at the discretion of the treating neurosurgeon in discussion with the family, and was influenced by the severity of symptoms, the presence of other neurological findings on examination, and the presence of an associated syrinx. There was no statistically significant difference in headache improvement between surgical and medical treatment regardless of headache classification. Non-White race and the presence of a syrinx were statistically significant predictors of short-term headache improvement, and female gender was a statistically significant negative predictor of long-term headache improvement.</p><p><strong>Conclusions: </strong>In this observational cohort of pediatric patients with CM-I, the authors found no difference in headache outcomes based on management strategy, regardless of the nature of the headache symptoms on presentation.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998097","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":"Analysis of the interaction between sleep quantity and sex in neurocognitive performance testing for sports-related concussion.","authors":"Roshini Kalagara, Eugene I Hrabarchuk, Bahie Ezzat, Zerubabbel K Asfaw, Akhil Rao, Alexander J Schupper, Jack Zhang, Benjamin Rodriguez, Muhammad Ali, Addison Quinones, Matthew T Carr, Hanya M Qureshi, Arielle B Lehman, Alex Gometz, Mark Lovell, Tanvir F Choudhri","doi":"10.3171/2025.2.PEDS24208","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24208","url":null,"abstract":"<p><strong>Objective: </strong>Cognitive testing for sports-related concussion (SRC) has become a critical component in ensuring the health of adolescent athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a validated tool for assessing SRC and guiding subsequent medical management; thus the effect of different variables on ImPACT scoring is of clinical relevance. The aim of this study was to evaluate the influence of sleep quantity and patient sex on the ImPACT performance of athletes at baseline and time points after SRC.</p><p><strong>Methods: </strong>A database containing ImPACT assessments from 11,563 high school athletes gathered from July 2009 to June 2019 in Florida and Colorado was queried. A retrospective analysis that included univariable and multivariable linear regression modeling was performed to evaluate sex and sleep effects on performance, both at baseline and after SRC injury. Patients self-reported the number of hours they slept the night before ImPACT assessment.</p><p><strong>Results: </strong>Multivariable analysis revealed that at baseline, sex and the number of hours of sleep the night before testing had a significant interaction effect with both the symptom score (p < 0.0001) and reaction time (p = 0.0145) ImPACT categories. At postinjury testing, only the symptom score (p = 0.0374) was significantly associated with sex and sleep quantity.</p><p><strong>Conclusions: </strong>Sleep quantity and sex were found to be significantly associated with specific neurocognitive ImPACT composite scores. The results of this study underscore the need for further investigation into these variables in the context of SRC management to provide optimal and personalized treatment for young athletes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988494","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":"Return-to-learn following sport-related concussion: a systematic review.","authors":"Anthony E Bishay, Ousman Jallow, Jacob Jo, Kristen Williams, Eunyoung Hong, Jackson Allen, Scott L Zuckerman, Douglas P Terry","doi":"10.3171/2025.1.PEDS24482","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24482","url":null,"abstract":"<p><strong>Objective: </strong>Return-to-learn (RTL) recommendations and management protocols for athletes after sport-related concussion (SRC) remain heterogeneous. With respect to academics after SRC, the current systematic review evaluated 3 outcome measures in each included study: 1) RTL definition, 2) RTL duration, and 3) factors associated with longer RTL.</p><p><strong>Methods: </strong>Studies published before December 2022 that addressed RTL after an SRC were identified via a compressive literature search of the Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, Educational Resources Information Center, Ovid MEDLINE, and PubMed databases. Studies solely examining nonsport-related concussion/traumatic brain injury studies were excluded. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the Modified Newcastle-Ottawa Scale for risk of bias. For each study included, the design, participants, interventions, outcomes, results, and conclusions were extracted.</p><p><strong>Results: </strong>Of 1838 studies identified, 21 met the inclusion criteria. These studies represented 8475 athletes (aged 5-27 years) who sustained an SRC. A total of 17/21 (81%) provided an RTL definition. Of the studies that defined RTL as any RTL, the median (range) was 5 (2.5-35.3) days, while the median (range) of those that defined RTL as full RTL without accommodations was 17.5 (3-49) days. Female gender (7/9 studies) and initial symptom severity (3/3 studies) were consistently associated with delayed RTL. Single studies identified anxiety, attention-deficit/hyperactivity disorder (ADHD), and integrated performance management as potential factors for delayed RTL. Age (0/5 studies), concussion history (2/6), depression history (0/1), migraine history (0/2), learning disability (0/1), school type (public vs private) (0/2), and early air travel after SRC (0/1) did not appear to have consistent effects on RTL.</p><p><strong>Conclusions: </strong>Across 21 primary studies, RTL definitions varied greatly, and similarly, a wide range of days to RTL was seen at 3-35 days. Female gender and initial symptom severity were most consistently associated with prolonged RTL. Certain factors such as a history of ADHD/anxiety showed potential effects but require further investigation. Management guidelines should consider these findings while recognizing the need for more comprehensive research to confirm and quantify the impact of various factors on RTL duration.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022816","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":"Epidemiology and surgical management of obstetric brachial plexus injury: a national cohort study.","authors":"Tarik Alp Sargut, Kiarash Ferdowssian, Christina Susanne Mark-Sargut, Dörte Huscher, Joan Alsolivany, Anton Früh, Jörg Bahm, Ulrich-Wilhelm Thomale, Nora F Dengler","doi":"10.3171/2025.1.PEDS24626","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24626","url":null,"abstract":"<p><strong>Objective: </strong>Obstetric brachial plexus injury (OBPI) is a serious and complex nerve injury in newborns. To date, large-scale studies and guidelines for managing OBPI are scarce, and there are major regional differences in its epidemiology and clinical management. The authors of this national cohort study aimed to report on OBPI's current epidemiology and surgical management strategies in Germany.</p><p><strong>Methods: </strong>Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with OBPI as their primary diagnosis were identified using the ICD-10 codes P14.0 (Erb palsy), P14.1 (Klumpke palsy), and P14.3 (other brachial plexus birth injuries). Operation and Procedure Classification System codes were used to allow analysis of surgical management.</p><p><strong>Results: </strong>A total of 2069 patients with OBPI who had been hospitalized within their 1st year of life were included in the study. Erb palsy was the most frequent OBPI subtype (66.60%). The total number of live births increased significantly from 685,795 in 2005 to 787,523 in 2018 (p < 0.001), resulting in an overall OBPI rate of 0.21 per 1000 births over the years. The incidence of OBPI per 1000 live births significantly decreased by 47.57%, from 0.28 in 2005 to 0.15 in 2018 (p < 0.001), representing a mean annual decrease of 0.010 ± 0.026. Subgroup analysis also showed a significant (p < 0.001) decrease in all three OBPI subtypes (ICD-10 codes P14.0, P14.1, and P14.3). Simultaneously, the rates of cesarean delivery significantly varied, ranging from 26.73% to 28.08% from 2005 to 2018 (p < 0.001). The most frequent risk factor for OBPI was being large for gestational age (13.83%), followed by instrumental delivery or cephalohematoma (6.30%). Total rates of surgical management ranged from 1.86% to 41.11% and had an increasing proportional trend over time (p = 0.002). Subanalysis of the different surgical treatment modalities demonstrated an increasing trend in surgical explorations and neurolyses (p = 0.001). Length of hospital stay among patients treated for OBPI remained relatively constant throughout the study period with a mean range of 3.57-4.93 days, indicating no significant change (p = 0.52).</p><p><strong>Conclusions: </strong>OBPI is a rare disease, with a decreasing incidence paralleled by an increase in cesarean birth delivery rates between 2005 and 2018 in Germany. Total surgical management rates rose with a significant trend toward increasing microsurgical explorations and neurolyses. Being large for gestational age was identified as the main infantile risk factor for OBPI.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026068","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}