Journal of neurosurgery. Pediatrics最新文献

{"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}

{"title":"Autologous rib graft augmentation for occipitocervical fusion in pediatric patients and a novel radiographic grading scale.","authors":"Maryam N Shahin, Brandi W Pang, Jordan L Smith, Michael F Regner, Jaclyn Thiessen, Christina M Sayama","doi":"10.3171/2025.3.PEDS24530","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24530","url":null,"abstract":"<p><strong>Objective: </strong>Occipitocervical fusion (OCF) in children fails at a rate of up to 20% despite multiple technical advances; while the literature reports multiple grading scales of radiographic fusion, none function independently of the surgical technique or type of osseous graft used. In this study, the authors sought to establish 1) a novel reproducible surgical technique with low failure rates and 2) a new, easily applied radiological scoring system to objectively evaluate arthrodesis.</p><p><strong>Methods: </strong>The authors conducted a single-institution retrospective cohort study of 21 patients who underwent OCF with and without rib autograft fixation from January 2015 to May 2022. OCF includes any fusion from the occiput to the cervical spine. Cohort 1 patients underwent OCF with standard instrumentation and allograft/bone morphogenetic protein (BMP) onlay from January 2015 to July 2016. Cohort 2 patients underwent OCF with standard instrumentation and rib autograft screw fixation from August 2016 to May 2022. Primary evaluation of arthrodesis with CT at ≥ 3 months postoperatively was performed by two blinded board-certified neuroradiologists. Radiological criteria utilized a 0- to 2-point scale: nonfused graft resorption, pseudarthrosis, or hardware failure (grade 0); unilateral fusion (grade 1); or bilateral fusion (grade 2).</p><p><strong>Results: </strong>From cohort 1, 7 cases underwent OCF, with 42.9% requiring revision surgery for complete/significant bony resorption. In cohort 2, 17 cases underwent OCF (including 3 revisions from cohort 1) with standard instrumentation and rib autograft using the new arthrodesis technique. One case was excluded because CT imaging was not available. Using a novel arthrodesis radiographic grading system, the authors found that 16 cases (100%) achieved a solid bony fusion. OCF augmented by rib autograft screw fixation significantly increased fusion rates (p = 0.0066). No significant differences were observed in arthrodesis rates by use of BMP (p = 0.2880), presence of congenital syndromes (p = 0.3639), or halo use (p = 0.2329).</p><p><strong>Conclusions: </strong>Rib autograft augmentation using screw fixation as the primary grafting technique for standard OCF significantly improved the rate of arthrodesis at 3 months, without any observed fusion failure in a > 5-year period. This novel objective neuroradiology fusion score standardizes the classification of arthrodesis regardless of instrumentation or bone graft material, improving assessment and objective generalizability of future fusion research.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564884","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":"Primary pediatric brain tumors in Africa: a systematic review and comparative meta-analysis.","authors":"Sukul Mittal, Ali Ebada, Kwadwo Darko, Ishav Y Shukla, Sean O'Leary, Muhammad Ammar Haider, Michael Farid, Mazin E Khalil, Umaru Barrie, Salah G Aoun, Megan E H Still, Bruno P Braga, Mabel Banson, Teddy Totimeh","doi":"10.3171/2025.2.PEDS24301","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24301","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric brain tumors (PBTs), a significant cause of childhood mortality, remain underexplored in Africa. The authors analyzed the existing African literature on PBTs to determine their prevalence, assess treatment effectiveness, and report overall outcomes.</p><p><strong>Methods: </strong>A systematic review of the literature using the PubMed, Google Scholar, Embase, and Web of Science databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review included meta-analysis using random-effects modeling to quantitatively summarize patient demographic characteristics, diagnostics, treatments, and outcomes, in addition to qualitative descriptions of challenges and solutions in managing PBTs in Africa.</p><p><strong>Results: </strong>The authors included 5256 pediatric patients from 35 retrospective/prospective studies across 10 African countries in their analysis. Among 28 articles reporting sex, 56.3% (2431/4312) of patients were male. Regarding tumor grading, World Health Organization (WHO) low-grade tumors prevailed at 63.5% of cases (714/1125) in 16 studies. According to the included studies, the most commonly reported tumor types included astrocytoma (18.6%, 95% CI 11.2%-29.3%), medulloblastoma (15.6%, 95% CI 8.8%-26.0%), craniopharyngioma (13.4%, 95% CI 6.1%-27.0%), and ependymoma (7.0%, 95% CI 4.8%-10.1%). In 11 studies, 55.4% of tumors were supratentorial (739/1335) and 43.7% (584/1335) were infratentorial. Of the 13 articles detailing management, surgical management was adopted in 86.1% (95% CI 66.7%-95.0%) of cases. At a mean follow-up period of 32.2 months (95% CI 10.5-53.8), the mortality rate at last follow-up was 30.3% (341/1126). Across the included studies, North Africa had a higher reported rate of surgical intervention at 97.4% (95% CI 39.4%-100.0%) compared to sub-Saharan Africa at 77% (95% CI 59.4%-88.5%), with a corresponding lower mortality rate of 18.8% (95% CI 7.0%-41.4%) compared to 36.7% (95% CI 19.2%-58.5%) in sub-Saharan Africa. These figures represent estimates based on the reported values in the published literature. Challenges and proposed solutions were reported in 13 studies: 6 indicated the need for a childhood cancer registry, whereas 7 identified obstacles in healthcare resources and infrastructure while advocating for comprehensive strategies to enhance multidisciplinary care and modernize facilities.</p><p><strong>Conclusions: </strong>The authors' study sheds light on the prevalence of PBTs in Africa and highlights significant gaps in diagnosis, management, and outcomes. Disparities between sub-Saharan Africa and North Africa in cancer burden, diagnostic methods, treatment management, and survival outcomes suggest the need for targeted interventions. The reported mortality rates emphasize the urgency of improving brain tumor management and postoperative care for pediatric patients in Africa.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564891","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":"Endoscopic treatment of isolated unilateral lambdoid craniosynostosis: preoperative craniofacial metrics and ongoing postoperative improvement in craniofacial deformity over time.","authors":"Ziyad Makoshi, Vincent Aquino, Alondra Arias, David Yates","doi":"10.3171/2025.3.PEDS24357","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24357","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;There is a paucity of data on the treatment options and long-term outcomes of isolated unilateral lambdoid craniosynostosis. The authors aimed to present a 28-year experience treating isolated unilateral lambdoid craniosynostosis with endoscopy-assisted strip craniectomy treatment and postoperative cranial orthotic therapy for various age groups, and provide objective craniofacial measurements and long-term outcomes of this approach to help guide management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of all children with craniosynostosis treated endoscopically for isolated lambdoid involvement from 1996 to 2024 was performed. The surgical technique involved two 2-cm incisions, one of which was lateral to the lambda on the affected side and another medial and superior to the asterion. Using endoscopy-assisted visualization, a strip craniectomy was performed between the aforementioned anatomical landmarks. Following surgery, cranial orthoses were used to assist in the correction of craniofacial deformities. Pre- and postoperative photographs were analyzed for correction of 3 craniofacial deformities: facial twist, posterior cranial scoliosis, and mastoid tilt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-two children (17 male, mean age 7 months) with isolated unilateral lambdoid craniosynostosis who were followed up from 5 months to 11 years after surgery were included in the analysis. The mean ± SD preoperative facial twist was 9.12° ± 3.48° (range 5°-17.5°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 6.26° ± 4.09°, percentage difference of -57.04%, p &lt; 0.001). The mean preoperative posterior cranial scoliosis was 12° ± 3.71° (range 3°-17.75°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 8.45° ± 3.68°, percentage difference of -57.88%, p &lt; 0.001). The mean preoperative mastoid tilt was 11.31° ± 2.52° (range 7°-17.5°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 7.52° ± 3.63°, percentage difference of -64.67%, p &lt; 0.001). The mean estimated blood loss was 13.13 mL, and no patient required blood transfusion. The mean craniectomy width and length were 5 mm and 91 mm, respectively. Complications included 1 infection (3.13%), and all children were discharged home on the 1st postoperative day.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Endoscopy-assisted strip craniectomy for treatment of unilateral lambdoid craniosynostosis was associated with excellent long-term results, with ongoing improvement in all 3 craniofacial measurements over time. The procedure had short operative times, minimal blood loss, and minimal complications. Moreover, the craniofacial measurements presented herein are more specific to lambdoid craniosynostosis, provide more accurate diagnosis, and allow for comparati","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564885","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 art of the (w)rap.","authors":"Adam Ammar, Robin Yang, Rachel Pruitt, Kurt Lehner, Shenandoah Robinson, Alan R Cohen","doi":"10.3171/2025.3.PEDS2597","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS2597","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564892","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":"Application and outcomes of a standardized, evidence-based institutional approach to simple tethered cord management.","authors":"Thomas M Moriarty, William C Gump, Ian S Mutchnick, Joy Comingore, Michael Daniels, Dennis S Peppas, Eran Rosenberg, Jeffrey T White, Erin R Sizemore, Karen K Moeller","doi":"10.3171/2025.2.PEDS24457","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24457","url":null,"abstract":"<p><strong>Objective: </strong>There is significant evidence in the literature and decades of practice experience that support filum terminale sectioning as an effective intervention to improve the symptoms of simple tethered cord (sTC). The diagnosis of sTC and indications for sTC surgery vary widely across the US and Canada, although the overall incidence of sTC surgery has been increasing across the US. This study sought to create and evaluate an evidence-based algorithm for the management of sTC.</p><p><strong>Methods: </strong>An institutional standard for sTC management was established, based on an evidence-based medicine analysis of 93 papers from the literature. A prospective, IRB-approved study of all patients treated with these strictly delimited indications in 2019 was undertaken. Demographic, clinical, diagnostic, consultative, and outcome data were collected for all patients. Operated patients were seen at 6 weeks and 6 months for follow-up. Postoperative outcomes were recorded on a 4-point ordinal scale (worse, same, better, resolved) for analysis.</p><p><strong>Results: </strong>Seven hundred twenty-nine unique patients were evaluated for possible sTC in 1 calendar year. One hundred fifty-one operations were performed. Two minor complications were noted (surgical wound breakdown and upper extremity deep vein thrombosis). All operated patients were clinically symptomatic, 79% of whom had 3 or more symptoms of sTC syndrome. Patients were seen by 3 or more subspecialists before surgery in 60% of the cases; no patient had fewer than 2 subspecialists involved in diagnosis. Postoperative results recorded by neurosurgery were strongly concordant with results observed by consultants. Significant improvement of symptomatic sTC was found across all symptoms (bladder/bowel/back pain/leg pain/gait/headache/tone) in the majority of patients.</p><p><strong>Conclusions: </strong>Filum terminale release for patients with sTC is a low-morbidity, high-impact intervention that can be beneficial to many children. A standardized set of operative indications driven by a multidisciplinary, evidence-based algorithm for sTC had high accuracy in identifying patients who benefit from a filum terminale release.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512056","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":"Effectiveness of single-stage shunt replacement for Cutibacterium acnes CSF shunt infection.","authors":"Anas Abou Merhi, Roy Chebel, Joyce Koueik, Alex Pinto, Ambar Haleem, Bermans J Iskandar","doi":"10.3171/2025.3.PEDS24539","DOIUrl":"https://doi.org/10.3171/2025.3.PEDS24539","url":null,"abstract":"<p><strong>Objective: </strong>Cutibacterium acnes is a commensal skin and mucosal bacterium that causes CSF shunt infections. The traditional management of C. acnes shunt infections aligns with the treatment of infections caused by more serious bacteria and consists of shunt removal, external ventricular drainage, and systemic antibiotic administration. Given the relatively benign nature of C. acnes, such extensive measures may not be required for infection eradication. This study compares the efficacy of a one-stage surgical shunt replacement, omitting the interim external ventricular drainage phase, with the traditional two-stage approach.</p><p><strong>Methods: </strong>A retrospective data analysis was conducted on the medical records of patients diagnosed with C. acnes shunt infection between 1997 and 2023. Clinical and diagnostic data were collected.</p><p><strong>Results: </strong>Forty-three patients with C. acnes shunt infection were identified. Of these patients, 26 underwent traditional two-stage shunt replacement with intervening external ventricular drainage, and 14 underwent one-stage shunt replacement without an interim external drainage period. Nine patients underwent endoscopic third ventriculostomy in an attempt to achieve shunt independence. C. acnes shunt infection was cleared in all patients with no recurrence at median follow-up periods of 7.08 years and 9.05 years for the one-stage and two-stage replacement groups, respectively.</p><p><strong>Conclusions: </strong>The findings indicate that one-stage shunt replacement surgery without intervening externalization is an effective treatment option for C. acnes shunt infections. In addition to eliminating the need for multiple surgical interventions, this approach shortens hospital stays, thereby reducing healthcare costs and minimizing patients' exposure to hospital-associated risks. This study supports a reevaluation of current guidelines for treating shunt infections, advocating for more flexible, patient-centered approaches that consider the pathogenicity of offending organisms such as C. acnes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512057","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}