Journal of neurosurgery. Pediatrics最新文献

{"title":"The extreme lateral transodontoid approach for large tumors in children in the ventral craniocervical junction.","authors":"Nealen Laxpati, Uma Ramaswamy, Frank Lin, William E Whitehead, Howard L Weiner, David F Bauer, Guillermo Aldave","doi":"10.3171/2024.9.PEDS24305","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24305","url":null,"abstract":"<p><strong>Objective: </strong>Tumors in the ventral craniocervical junction (CCJ) pose unique challenges, particularly in children. The potential constraints with endoscopic approaches to tumors extending inferiorly and laterally and the risk of CSF leakage can be exacerbated in the pediatric population. Here, the authors present their experience with the extreme lateral transodontoid (ELTO) approach in children with large ventral CCJ tumors as an alternative or complement to anterior approaches.</p><p><strong>Methods: </strong>This is a retrospective, single-center study of patients who underwent the ELTO approach from January 2021 to January 2024. Patients with at least 3 months of postoperative follow-up and postoperative MR images were included. Primary outcomes included extent of resection, intraoperative and postoperative complications, and neurological outcome.</p><p><strong>Results: </strong>Six children underwent 8 ELTO approaches (2 children underwent bilateral ELTO). The median age was 8 years (range 3-17 years), with a mean follow-up of 15.8 months. Diagnoses included classic chordoma (n = 3), poorly differentiated chordoma (n = 2), and high-grade undifferentiated sarcoma (n = 1). Gross-total resection (GTR) was achieved in all cases. One patient developed thrombosis of the third segment of the vertebral artery without symptoms or signs of ischemia. One patient with hydrocephalus and significant dysphagia due to bilateral cranial nerve XII palsy at diagnosis and worsening left vocal cord paralysis after the resection required ventriculoperitoneal shunt placement as well as a tracheostomy and gastrostomy after tumor resection. One patient required revision of the occipitocervical fixation due to new onset of dysphagia 4 months after tumor resection, without additional consequences.</p><p><strong>Conclusions: </strong>The ELTO approach is safe and feasible in children with large tumors of the ventral craniocervical junction. GTR was achieved in all the patients, and there were no significant complications or new neurological deficits due to the approach.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869328","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":"Tubular single-port endoscope-assisted surgery for fetal myelomeningocele repair.","authors":"Sergio Cavalheiro, Marcos Devanir Silva da Costa, Mauricio Mendes Barbosa, Patrícia Alessandra Dastoli, Stéphanno Gomes Pereira Sarmento, Ítalo Capraro Suriano, David Pares, Cid Ura Kusano, Antônio Fernandes Moron","doi":"10.3171/2024.9.PEDS24239","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24239","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to describe a low-cost and easily reproducible alteration of the Bruner and Tulipan procedure to preserve uterine muscular fibers. They conducted a retrospective cohort study of 10 pregnant women whose fetuses developed lumbosacral myelomeningocele (MM). The MM was repaired through a fetal neurosurgical procedure using a tubular single-port endoscope-assisted technique.</p><p><strong>Methods: </strong>This study was conducted at the Santa Joana Hospital and São Paulo Hospital between January 2020 and June 2023. The procedure consisted of tubular retraction of circular fibers from the uterine body without excision of the uterine wall. Tubular devices with progressively larger diameters were used for retraction without cutting the uterine muscular fibers, and a 25-mm-diameter tubular retractor was used to allow endoscope-assisted closure of the MM using microsurgical techniques.</p><p><strong>Results: </strong>The average birth age was 36 weeks 3 days. Defect repair was possible in all cases. The mean surgical time was 130 minutes. Two of the patients developed hydrocephalus. One patient underwent a ventriculoperitoneal shunt, and the other underwent endoscopic third ventriculostomy with choroid plexus coagulation.</p><p><strong>Conclusions: </strong>This procedure avoids excision of the uterine wall, promotes a workspace for microsurgical techniques assisted by endoscopy, and is possibly the first step for future single-port correction using robotic techniques.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869331","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":"False alarms and the burden of shunt failure in pediatric patients with hydrocephalus: a longitudinal study.","authors":"Sang Ho Kim, Peter Heppner, Yu Jin Kim, Sarah-Jane Guild, John Windsor, Simon Malpas","doi":"10.3171/2024.9.PEDS24378","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24378","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the burden of CSF shunt failure and false alarms on pediatric patients with hydrocephalus, their caregivers, and the healthcare system.</p><p><strong>Methods: </strong>This retrospective longitudinal study examined pediatric patients who underwent CSF shunt procedures at Auckland City Hospital from January 2014 to December 2019. The study included patients aged 18 years or younger living within the hospital's catchment area. Clinical encounters were recorded from the date of their first shunt insertion until November 1, 2023. Data collected included patient demographics, hospital admissions, acute and elective shunt-related imaging, clinic visits, surgery times, and symptom characteristics. Shunt-related admissions were categorized as either shunt failures or false alarms.</p><p><strong>Results: </strong>The cohort comprised 73 patients with follow-up periods ranging from 4 to 18 years. By the 1st year, 71% had been rehospitalized for shunt-related concerns, with 59% experiencing at least 1 false alarm and 38% experiencing at least 1 shunt failure. By the 4th year, 88% of patients had been rehospitalized for shunt-related concerns, 42% had experienced at least 3 false alarms, 60% had at least 1 shunt failure, and 25% had at least 3 shunt failures. The average accumulated hospital stay was 1 month for shunt failures and 2 weeks for false alarms, compared with 22 days for all other admissions. Frequent clinic interactions from multiple specialties highlighted the complex care needs of these patients. The timing of shunt failure or false alarm, but not symptom duration, significantly predicted their overall frequency.</p><p><strong>Conclusions: </strong>This study details the chronic burden and complex care requirements for pediatric patients with CSF shunts. Shunt-related concerns significantly and disproportionately contribute to the patients' total hospital interactions. The findings highlight the immediate clinical need for novel technologies to enable long-term and accurate detection of shunt failure to optimize patient care. Future efforts should focus on improving shunt systems to lower failure rates.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822203","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 epidemiology and management of spontaneous spinal epidural abscesses in children: a single-center experience.","authors":"Torsten A Joerger, Clara Xi Wang, Nankee K Kumar, Tracy M Flanders, Shih-Shan Lang","doi":"10.3171/2024.9.PEDS24396","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24396","url":null,"abstract":"<p><strong>Objective: </strong>Spinal epidural abscesses (SEAs) are rare infections in children but can lead to significant neurological sequelae. The authors sought to describe the presentation, management, and outcomes of children with these infections at their institution.</p><p><strong>Methods: </strong>This was a retrospective study of pediatric patients admitted with SEA to a quaternary children's hospital between 2013 and 2023. Clinical characteristics including laboratory, surgical, and antimicrobial data were collected and analyzed.</p><p><strong>Results: </strong>Fourteen patients (median age 3.7 years) had SEAs. Thirteen (93%) patients developed the infection in the outpatient setting, and of these 10 (77%) were evaluated by a medical provider prior to the encounter when the diagnosis was made. The most common causative pathogen was Staphylococcus aureus. Thirteen (93%) of 14 patients underwent a surgical procedure, and patients were treated with antibiotics for a median of 38 days. Eleven (79%) of 14 patients received enteral antibiotics for part of their treatment course. All patients recovered with no neurological sequelae.</p><p><strong>Conclusions: </strong>SEAs are rare infections, but good outcomes can be obtained with prompt antimicrobial and surgical management. Enteral antibiotics should be considered as part of therapy. Larger multicenter studies are needed to determine the optimal antibiotic duration and route, and which patients should undergo neurosurgical intervention versus interventional radiology drainage or medical management alone.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822205","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":"Revisiting the Endoscopic Third Ventriculostomy Success Score using machine learning: can we do better?","authors":"Syed M Adil, Andreas Seas, Daniel P Sexton, Pranav I Warman, Benjamin D Wissel, Kennedy L Carpenter, Lacey Carter, Brad J Kolls, Anthony T Fuller, Shivanand P Lad, Timothy W Dunn, Herbert Fuchs, Matthew Vestal, Gerald A Grant","doi":"10.3171/2024.9.PEDS24146","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24146","url":null,"abstract":"<p><strong>Objective: </strong>The Endoscopic Third Ventriculostomy Success Score (ETVSS) is a useful decision-making heuristic when considering the probability of surgical success, defined traditionally as no repeat cerebrospinal fluid diversion surgery needed within 6 months. Nonetheless, the performance of the logistic regression (LR) model in the original 2009 study was modest, with an area under the receiver operating characteristic curve (AUROC) of 0.68. The authors sought to use a larger dataset to develop more accurate machine learning (ML) models to predict endoscopic third ventriculostomy (ETV) success and also to perform the largest validation of the ETVSS to date.</p><p><strong>Methods: </strong>The authors queried the MarketScan national database for the years 2005-2022 to identify patients < 18 years of age who underwent first-time ETV and subsequently had at least 6 months of continuous enrollment in the database. The authors collected data on predictors matching the original ETVSS: age, etiology of hydrocephalus, and history of any previous shunt placement. Next, they used 6 ML algorithms-LR, support vector classifier, random forest, k-nearest neighbors, Extreme Gradient Boosted Regression (XGBoost), and naive Bayes-to develop predictive models. Finally, the authors used nested cross-validation to assess the models' comparative performances on unseen data.</p><p><strong>Results: </strong>The authors identified 2047 patients who met inclusion criteria, and 1261 (61.6%) underwent successful ETV. The performances of most ML models were similar to that of the original ETVSS, which had an AUROC of 0.693 on the validation set and 0.661 (95% CI 0.600-0.722) on the test set. The authors' new LR model performed comparably with AUROCs of 0.693 on both the validation and test sets, with 95% CI 0.633-0.754 on the test set. Among the more complex ML algorithms, XGBoost performed best, with AUROCs of 0.683 and 0.672 (95% CI 0.609-0.734) on the validation and test sets, respectively.</p><p><strong>Conclusions: </strong>This is the largest external validation of the ETVSS, and it confirms modest performance. More sophisticated ML algorithms do not meaningfully improve predictive performance compared to ETVSS; this underscores the need for higher utility, novelty, and dimensionality of input data rather than changes in modeling strategies.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789625","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":"Corpus callosotomy for intractable epilepsy: a contemporary series of operative factors and the overall complication rate.","authors":"Mustafa Motiwala, Sandra Tambi, Ahmed Motiwala, Mallory Dacus, Christopher Troy, Carlos Osorno-Cruz, Andrew J Gienapp, Frederick Boop, Paul Klimo, James Wheless, Stephanie Einhaus","doi":"10.3171/2024.8.PEDS2460","DOIUrl":"https://doi.org/10.3171/2024.8.PEDS2460","url":null,"abstract":"<p><strong>Objective: </strong>Corpus callosotomy is an effective treatment for atonic seizures in patients with medically refractory epilepsy. A large modern series of corpus callosotomies performed via open craniotomy highlights the importance of establishing contemporary complication rates for this operation as a benchmark for comparison with newer methodologies. The authors' study, therefore, examined operative factors and complication rates for a sample of patients who underwent open microsurgical craniotomy for corpus callosotomy to determine current metrics regarding safety and effectiveness for this procedure.</p><p><strong>Methods: </strong>The authors retrospectively reviewed institutional data for patients who underwent first-time open callosotomy from 2005 to 2022. Demographic and clinical variables were collected and analyzed with a focus on operative factors and complication rates.</p><p><strong>Results: </strong>A total of 105 patients were included in the study (mean [range] age 9.39 [0.67-24.17] years); 58.1% (n = 61) were male. One surgeon performed a majority of the operations (n = 80 [76.20%]); 2 other surgeons performed the remaining surgical procedures (21.9% and 1.90%, respectively). In total, 66 complete, 38 subtotal (anterior 70%-99%), and 1 posterior (40%) callosotomies were performed. Blood loss was available for 102 (97.1%) patients (mean [range] 96.67 [10-500] ml). The mean [range] operative time was calculated as 226.76 (45-386) minutes in 76 (72.4%) patients by excluding those patients who underwent concurrent vagal nerve stimulator placement or revision. The operative complication rate was determined to be 6.7% and was comprised of 3 cases of transient pseudomeningocele, 3 wound infections, and 1 delayed intraparenchymal hemorrhage. No venous infarcts were observed on postoperative MRI.</p><p><strong>Conclusions: </strong>This is the largest single-center series of open callosotomy patients thus far in the literature and describes important updated metrics to help evaluate new techniques being developed for the surgical treatment of atonic seizures in medically intractable epilepsy.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789624","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":"Characterizing pediatric cervical fusion in the modern era: indications, complications, and fusion rates.","authors":"Alan R Tang, Tyler Zeoli, Anthony E Bishay, James L Rogers, Georgina E Sellyn, Campbell Liles, Christopher M Bonfield","doi":"10.3171/2024.8.PEDS24122","DOIUrl":"https://doi.org/10.3171/2024.8.PEDS24122","url":null,"abstract":"<p><strong>Objective: </strong>Cervical fusion within the pediatric population presents unique challenges, because pediatric cervical fixation demands careful consideration of anatomical size, physiological differences, and significant prospective growth potential for young patients. In the present systematic review, the authors outline the indications for cervical fusion, summarize patient outcomes in the pediatric population, and characterize the various cervical fixation surgical techniques.</p><p><strong>Methods: </strong>A retrospective literature review of pediatric cervical fusion was conducted in June 2024 via PubMed, in accordance with PRISMA guidelines and using appropriate search syntax and evidence schemes. The initial literature search yielded 1107 articles, with 259 articles undergoing a full-text review. Inclusion criteria included studies examining pediatric populations (age ≤ 18 years) requiring cervical spine surgical fixation between 2000 and 2024. Studies in which patients with cervical pathology were not surgically treated, those examining primarily adult populations > 18 years old (n = 504), case reports (n = 150), and non-English studies (n = 96) were excluded. Outcomes consisted of demographic variables, fusion rates, bone morphogenetic protein (BMP)/graft material used, and complications.</p><p><strong>Results: </strong>In total, 106 studies between 2000 and 2024 examining 2086 patients were included in the review. The most common surgical indications across all studies included atlantoaxial instability (n = 49, 48.5%). Most studies reported cases involving occipitocervical (OC) junction pathology (n = 74, 69.8%) and using iliac crest autograft (n = 53, 50.0%) and rib autograft (n = 28, 26.4%). Allografting was used in 25 studies (23.9%) and BMP was used in 26 studies (24.5%). Overall, the fusion rate for pediatric patients undergoing cervical fusion was 95.8%, with OC fusion having comparable fusion rates (0.95 ± 0.02) to those without OC junction involvement (0.96 ± 0.01, p = 0.703). The overall complication rate was 14.9%. There were similar rates of complications compared to studies with and without OC fusion (OC: 0.15 ± 0.18, non-OC: 0.13 ± 0.17; p = 0.075).</p><p><strong>Conclusions: </strong>Despite efforts to characterize the comparative advantages of different immobilization techniques, such as screw constructs versus wiring, and the use of bone graft materials including BMP, a comprehensive understanding of outcomes remains elusive. The overall fusion rate observed in the analyzed cohort aligns with prior research, yet complications persist, with a notable proportion necessitating reoperation or revision in those with OC pathology. Although the incorporation of BMP alongside autograft and allograft materials remains relatively uncommon, the potential benefits warrant further research, with longitudinal follow-up of fusion rates.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755242","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 importance of timing: evaluating the optimal age for surgical intervention in asymptomatic dermal sinus tracts.","authors":"Kelsi M Chesney, Gregory F Keating, Nirali Patel, Carlos Aguilera, John S Myseros, Chima Oluigbo, Hasan R Syed, Robert F Keating","doi":"10.3171/2024.9.PEDS24149","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24149","url":null,"abstract":"<p><strong>Objective: </strong>Dermal sinus tracts (DSTs) are rare congenital lesions resulting from errors of spinal cord disjunction, leading to a persistent connection between the cutaneous ectoderm and underlying neural elements. As patients are at increased risk of infection and irreversible neurological compromise due to tethering, resection and detethering are recommended as a prophylactic measure. The ideal timing of surgical intervention in an asymptomatic cohort, however, remains unclear.</p><p><strong>Methods: </strong>A retrospective chart review was performed at a single institution from 1998 to 2022 of all patients surgically treated for lumbar DST by 10 different surgeons. Demographic, presentation, operative, and postoperative details were obtained. Five patients who presented with infectious or neurological symptoms were excluded from primary analysis. The age at the time of surgery was then analyzed as a continuous variable against the operative details and postoperative outcomes utilizing Spearman's correlation coefficient and the Mann-Whitney U-test.</p><p><strong>Results: </strong>Fifty-two patients underwent prophylactic surgical excision of their DST as well as detethering. Overall, 65% of patients were female and the median age at diagnosis was 3 months, while the median age at the time of surgery was 7 months. An additional cutaneous finding was identified in 71% of patients, with hemangioma being most frequent (40%). Additional spinal lesions were radiographically identified in 29% of patients, including lipoma (19%), dermoid and epidermoid inclusion cysts (8%), and an arachnoid cyst (2%). Postoperative complications occurred in 8% (n = 4) of patients, primarily related to wound healing (3/4), with significant risk attributed to younger age at time of surgery (mean 3 months, range 1-5 months) (p = 0.01). During 56 months of follow-up, long-term rates of retethering (6%, p = 0.02) and abnormal neurological examinations (8%, p = 0.001) were associated with concurrent lipomas, but not with age at operation.</p><p><strong>Conclusions: </strong>In a series of 52 pediatric patients undergoing prophylactic resection of a DST with detethering, the complication rate was 8% and was significantly associated with age < 6 months at the time of operation. Associated spinal lipomas significantly influenced long-term outcomes. When evaluating asymptomatic infants with DST, patient age is a significant factor in assessing the risks and benefits of surgical timing.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755246","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":"Myelomeningocele repair in Latin America: a systematic review.","authors":"Sima Vazquez, Victor M Lu, Jorge Brun, José M Muller, Toba N Niazi","doi":"10.3171/2024.8.PEDS24265","DOIUrl":"https://doi.org/10.3171/2024.8.PEDS24265","url":null,"abstract":"<p><strong>Objective: </strong>Myelomeningocele (MMC) carries high morbidity and mortality. The Management of Myelomeningocele Study (MOMS) showed improved outcomes after prenatal compared to postnatal repair. However, it is unclear how the MOMS trial affected practice and outcomes in the Latin American region. The objective of this study was to review the literature published by or including patients from the Latin American region and the reported management patterns of MMC.</p><p><strong>Methods: </strong>A systematic review of MMC repair was performed. Articles were included if the senior author or patient population was from a Latin American country or territory. Article characteristics such as senior author, title, year of publication, senior author department, and outcomes studied were extracted. Management of MMC repair was the primary outcome explored.</p><p><strong>Results: </strong>A total of 71 studies satisfied all criteria for selection. Brazil (75%), Mexico (11%), Argentina (8%), Chile (7%), Costa Rica (1%), and Puerto Rico (1%) were represented countries or territories (some studies included patients from multiple countries). Neurosurgery (n = 23) was the most represented senior author department, followed by fetal medicine or fetal surgery (n = 15) and obstetrics (n = 14). Puerto Rico and Costa Rica described postnatal repair, while studies from Brazil, Chile, Argentina, and Mexico described prenatal repair. Brazil was the only country to prospectively study urological outcomes, reporting little to no improvement in urological outcomes with pre- versus postnatal repair. Prospective studies showed the safety and efficacy of endoscopic, microhysterotomy, and microneurosurgical approaches to in utero surgery.</p><p><strong>Conclusions: </strong>Six countries or territories in the Latin American region have published articles on MMC repair. All recent papers describe a prenatal approach. Prospective studies show a trend toward open fetal microhysterotomy and microneurosurgery in the region and a need for more research on long-term urological outcomes following in utero repair.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755244","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 prospective observational study of operating room traffic during shunt surgery: who comes in and why?","authors":"Mallory Saleh, Emal Lesha, C Stewart Nichols, Nir Shimony, John E Dugan, Brandy Vaughn, Randaline Barnett, Paul Klimo","doi":"10.3171/2024.7.PEDS24283","DOIUrl":"https://doi.org/10.3171/2024.7.PEDS24283","url":null,"abstract":"<p><strong>Objective: </strong>Shunt infections are costly and stressful for families, patients, and providers. Many institutions use shunt checklists in an effort to reduce the risk of infection following shunt surgery. Such protocols often aim to limit operating room (OR) foot traffic, but there is little evidence that supports the theory that greater OR traffic increases the risk of acquiring a shunt infection through contamination of the air. The purpose of this study was to quantify foot traffic during shunt surgery at a children's hospital during a time period when a shunt checklist was used.</p><p><strong>Methods: </strong>Starting in 2019, a premedical student was tasked with covertly collecting data on 50 shunt operations. Data were recorded in real time and documented in a prospectively updated database. Recording foot traffic through the OR door began at onset of skin prep; data points included patient and surgical details, operative length, and who entered the room and why. Each operation was followed for a minimum of 180 days for infection. The primary outcome was \"door event,\" defined as any time a door to the OR was opened-fully or partially-with or without someone breaking the plane of the door (i.e., entering or exiting).</p><p><strong>Results: </strong>Fifty operations were observed with no primary shunt infection (mean follow-up 29.8 months, range 6.5-63.3 months). One patient experienced a late secondary infection due to systemic post-COVID-19 inflammatory syndrome causing gastrointestinal bacterial translocation. The average operative time-from applying sterile skin prep until surgery stop time-was 69.8 minutes. Overall, there were 1012 door openings with 1088 personnel entering or exiting. The average number of door openings per operation was 20.24. OR personnel (42.7%) and neurosurgery staff (31.6%) were responsible for the largest number of door events, followed by the anesthesiology service (18.9%). The most cited reasons for door events were for supplies (31.2%) and scrubbing in (26.5%).</p><p><strong>Conclusions: </strong>This study represents the first detailed analysis of OR traffic during pediatric shunt surgery. No patient developed a primary shunt infection. While minimizing OR traffic makes intuitive sense, it remains unknown whether a causal relationship exists. Further investigation is needed.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693193","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}