Journal of neurosurgery. Pediatrics最新文献

{"title":"Editorial. The relationship of the box and the package: cortical development in pediatric metopic craniosynostosis.","authors":"David P Perrault, Jesse A Taylor, Gregory G Heuer","doi":"10.3171/2026.4.PEDS26106","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS26106","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110987","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":"Neurosurgical management of achondroplasia: a systematic review.","authors":"Rafael T Tatit, Caroline P Tatit, Nir Shimony, Moise Danielpour, George I Jallo","doi":"10.3171/2026.4.PEDS2675","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS2675","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to synthesize denominator-based evidence on indications, techniques, and postoperative outcomes of cervicomedullary decompression (CMD), spinal canal stenosis surgery, and cerebrospinal fluid (CSF) diversion for hydrocephalus in achondroplasia.</p><p><strong>Methods: </strong>This systematic review followed PRISMA 2020 and was prospectively registered (PROSPERO CRD42025626915). MEDLINE (via PubMed), Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception through November 2025. The authors included observational studies of patients with achondroplasia who underwent CMD, spinal canal stenosis surgery, or CSF diversion for hydrocephalus with extractable outcomes and definable denominators. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I. Random-effects single-arm meta-analyses were performed for prespecified endpoints (any improvement, complete resolution, and mortality) only in cohorts with fully categorizable symptom status.</p><p><strong>Results: </strong>The authors included 38 observational studies (1442 patients): 18 CMD studies with 600 patients, 18 spinal stenosis studies with 686 patients, and 4 hydrocephalus studies with 156 patients. No study was at low risk of bias. For CMD (mean age 3.5 years; mean follow-up 27.8 months), any improvement was observed in 93% (95% CI 84%-97%) of patients and complete resolution in 44% (95% CI 16%-77%), and pooled mortality was 0% (95% CI 0%-5%). For spinal stenosis (mean age 36.6 years; mean follow-up 53.1 months), any improvement was observed in 92% (95% CI 78%-97%) and complete resolution in 30% (95% CI 16%-51%), and pooled mortality was 1% (95% CI 0%-2%). Hydrocephalus management was predominantly ventriculoperitoneal shunting (74.4%), with endoscopic third ventriculostomy in 23.1%, but symptom outcomes were rarely classifiable (9.6%), precluding strategy-level inference.</p><p><strong>Conclusions: </strong>CMD and spinal stenosis surgery were frequently followed by symptom improvement in published series, whereas complete resolution was variably defined and inconsistently reported. Hydrocephalus studies described practice patterns but lacked outcome reporting adequate for comparing diversion strategies. Validated patient-reported outcomes were rarely reported, limiting inference on health-related quality of life.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061910","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 association between greater age at surgery and increased developmental delays and therapy burden in craniosynostosis.","authors":"Andrew Salib, Victoria Kong, Samira Glaeser-Khan, Omar Allam, Martin Kauke-Navarro, Jake Moscarelli, Paula Flores Perez, Michael Alperovich","doi":"10.3171/2026.4.PEDS2617","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS2617","url":null,"abstract":"<p><strong>Objective: </strong>Children with nonsyndromic craniosynostosis (NSC) are at risk for neurodevelopmental delays that often require rehabilitative therapies. Early surgical intervention (before 12 months of age) is believed to support more normal brain development, but prior studies have been constrained by small cohorts and limited follow-up. This study provides the first national, longitudinal analysis of the relationship between age at surgery and subsequent therapy utilization.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study using the Merative MarketScan commercial database (2016-2022). Children with NSC who underwent cranial surgery were identified and stratified by timing of intervention (≤ vs > 12 months). Patients older than 3 years were excluded for surgery, in addition to those with comorbid neurological and genetic conditions. Outcomes included use of speech, occupational, and physical therapy, as well as gross provider payments. A multilevel logistic regression analysis assessed associations between surgical timing, Pediatric Comorbidity Index scores, sex, sociodemographic factors, and therapy utilization.</p><p><strong>Results: </strong>Among 1523 patients with a median follow-up of 4 (interquartile range 2-8) years, 28.6% received speech therapy, 34.9% occupational therapy, and 30.1% physical therapy; 1301 patients (85.4%) underwent surgery under 1 year of age while 222 patients (14.6%) underwent surgery between 1 and 3 years of age. Patients undergoing later surgery had markedly higher therapy utilization across all domains, i.e., speech (48.2% vs 25.3%), occupational (56.3% vs 31.2%), and physical therapy (51.8% vs 26.4%; all p < 0.001). The median number of sessions and payments were also significantly greater in the late cohort for occupational and physical therapy. On multilevel regression, surgery after 12 months was independently associated with increased odds of therapy use (speech OR 1.72, occupational OR 1.61, and physical OR 1.55; all p < 0.05). Patients undergoing surgery after 12 months also had significantly higher rates of developmental delay, including speech delay (40.1% vs 28.1%), motor delay (20.7% vs 9.1%), and global delay (26.6% vs 7.8%) compared with those treated at ≤ 12 months (all p < 0.001).</p><p><strong>Conclusions: </strong>Children undergoing surgery for NSC after 12 months of age demonstrated higher rates of documented developmental delay diagnoses and greater use of rehabilitative services. This work supports multidisciplinary rehabilitative therapy in the long-term management of children with craniosynostosis.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061890","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":"Hemibrain growth as a biomarker for whole-brain growth.","authors":"Utkarsh S Bajaj, Mingzhao Yu, Kelsey Templeton, Srijit Mukherjee, Haichuan Zhang, Nichol Nunn, Abhaya V Kulkarni, John R W Kestle, Vishal Monga, Steven J Schiff","doi":"10.3171/2026.4.PEDS25541","DOIUrl":"10.3171/2026.4.PEDS25541","url":null,"abstract":"<p><strong>Objective: </strong>Accurate estimation of CSF and brain volume is an important component in evaluating hydrocephalus treatments, including shunt and endoscopic third ventriculostomy procedures. While MRI-based segmentation typically provides precise measurements, metallic artifacts from implanted shunts in patients with hydrocephalus can impede accurate volume determination. This study introduces a method for assessing brain growth in hydrocephalus patients using artifact-affected MR images and presents an efficient, automated AI-based pipeline for hemibrain segmentation and subsequent volume assessment.</p><p><strong>Methods: </strong>This study utilizes imaging data from the Endoscopic versus Shunt Treatment of Hydrocephalus in Infants trial. Pre- and postoperative T2-weighted MR images were obtained in 75 patients. Hemibrain growth curves for the artifact-free hemisphere are proposed to assess postoperative brain growth in MR images with metallic shunt artifacts. An AI-based hemibrain volume estimation pipeline was developed, consisting of a brain/CSF segmentation model and a hemibrain mask generator. Segmentation labels, including left/right hemibrain masks and brain/CSF segmentation maps, were created. The AI pipeline was trained and validated using a manually segmented data subset. The volumes of left and right brain hemispheres after surgery were calculated and analyzed.</p><p><strong>Results: </strong>Postoperative hemisphere volume ratios approached the normal ratio and remained constant over time, confirming the feasibility of using hemibrain measurements as proxies for whole-brain volume assessment in the presence of metallic artifacts. Additionally, the AI-based pipeline demonstrated high accuracy in generating hemibrain masks and segmenting brain/CSF, effectively automating the process of hemibrain volume estimation.</p><p><strong>Conclusions: </strong>Hemibrain volume estimation of the unaffected hemisphere offers a feasible method for assessing brain growth over time. This process can be automated using a highly accurate AI pipeline, providing a valuable tool for monitoring brain growth in pediatric hydrocephalus patients with shunts.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001967","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":"Optimizing acquisition of cerebrospinal fluid liquid biopsy for next-generation sequencing in pediatric central nervous system tumors.","authors":"Nicholas Chapman, Peter A Chiarelli, Katrina O'Halloran, Ramon Durazo-Arvizu, Jaclyn A Biegel, Mark D Krieger","doi":"10.3171/2026.4.PEDS2627","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS2627","url":null,"abstract":"<p><strong>Objective: </strong>Best practices for obtaining adequate cell-free DNA (cfDNA) for next-generation sequencing (NGS) are not currently well understood. This study aimed to improve the understanding of appropriate quantities of CSF extraction from an array of tumor types and locations that could be used for diagnosis of pediatric CNS tumors.</p><p><strong>Methods: </strong>CSF was collected from patients in an IRB-approved prospective study to evaluate the collection methodology for downstream NGS. Samples were collected from control (nontumor) patients and patients with CNS tumors at various times: at dura opening during surgery, from the ventricular catheter during CSF diversion procedures (external ventricular drain or shunt surgery), or during ventricular shunt tapping. Clinical, demographic, and pathological data were gathered, as well as quantitative parameters describing cfDNA yield. A predictive model was generated.</p><p><strong>Results: </strong>CSF was obtained from 69 CNS tumor patients and 20 controls. The method of CSF collection included dural opening (n = 56), ventricular catheter (n = 21), and shunt tap (n = 12). The mean volume of CSF extracted for CNS tumors was 4.66 ± 3.2 ml. CNS tumors had significantly greater quantities of cfDNA obtained compared with controls (p < 0.001) with a mean cfDNA quantity of 318.4 ± 1340.7 ng (12.0 ± 14.4 ng in controls). CNS tumors had significantly greater cfDNA concentration in the CSF (mean 84.9 ± 340.9 ng/ml vs 5.7 ± 8.1 ng/ml in controls, p = 0.004). The cfDNA yield and concentration were comparable between the dural opening and ventricular catheter cohorts. CSF samples collected from optic pathway (p = 0.04), supratentorial (p = 0.006), and infratentorial (p = 0.004) tumors had greater quantities of cfDNA, with brainstem tumors demonstrating significantly lower cfDNA. Optic pathway tumors (p = 0.04) and supratentorial tumors (p = 0.01) had the greatest concentration of cfDNA. A regression model with 69 real values was used to calculate an additional 100 predicted values, suggesting that 80%, 85%, and 90% success rates for NGS assay require collection of 0.70 ml, 1.26 ml, 3.35 ml of CSF, respectively (p = 0.3).</p><p><strong>Conclusions: </strong>CSF can be obtained via several methods for NGS analysis, with dural opening and ventricular catheter specimens providing comparable results. The authors show that higher grade tumors, as well as those closest to the CSF space/ventricular compartment, provide increased quantity of cfDNA. They estimate that acquisition of 3.35 ml of CSF has a 90.00% rate of allowing successful processing for NGS.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001949","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":"Cranial expansion as primary surgical treatment in pediatric idiopathic intracranial hypertension.","authors":"Pedro J Millán-Cintas, Otilia A Ramos-Urbina, Jorge Tirado-Caballero, Gloria Moreno-Madueño, Mónica Rivero-Garvía, Javier Márquez-Rivas, Ignacio T Martín-Schrader","doi":"10.3171/2026.4.PEDS25638","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS25638","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure with normal imaging tests and absence of secondary causes. Shunt techniques (ventricular and lumbar) and optic nerve sheath fenestration are surgical options for the treatment of IIH. Cranial expansion techniques have been described in the literature for refractory cases. The aim of this study was to evaluate the chess-table cranial expansion technique as a first-line surgical treatment in pediatric IIH.</p><p><strong>Methods: </strong>The authors retrospectively analyzed patients diagnosed with IIH who were treated at a single institution between 2019 and 2024. All patients were treated using the dynamic chess-table cranial expansion technique as the first surgical approach. Patients with prior shunt placement, suture synostosis, secondary causes of IIH, evidence of venous sinus stenosis, or incomplete follow-up imaging were excluded. Data collection included demographic characteristics, clinical variables, and intracranial volume measurements. Volumetric analysis on CT images was performed using ITK-Snap software.</p><p><strong>Results: </strong>Thirteen patients (9 female, median age 9 years) were analyzed, with a mean follow-up duration of 30 months. Eleven patients (85%) were successfully managed with the chess-table technique, showing significant clinical improvement without the need for a shunt during follow-up. The median 1-year postoperative intracranial volume was 1389 cm3, corresponding to a median volumetric increase of 76 cm3.</p><p><strong>Conclusions: </strong>Cranial expansion techniques, previously used as rescue procedures in refractory cases, can also be considered a therapeutic alternative as a first-line surgical therapy in pediatric IIH, with the potential to improve symptoms of intracranial hypertension and reduce the need for shunt implantation, especially for patients with extremely small ventricles.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945100","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":"Early trajectory of white matter development in nonsyndromic craniosynostosis compared with neurotypical infants: a 3-site diffusion tensor imaging study.","authors":"Jake R Moscarelli, Andrew Salib, Cheryl Lacadie, Victoria Kong, Omar Allam, Katelyn Lewis, Xiawei Ou, Tiffany Howell, Eylem Ocal, Allen T Newton, Michael Golinko, Michael Alperovich","doi":"10.3171/2026.4.PEDS26122","DOIUrl":"https://doi.org/10.3171/2026.4.PEDS26122","url":null,"abstract":"<p><strong>Objective: </strong>Nonsyndromic craniosynostosis (NSC) might disrupt normal white matter maturation, and infant surgical intervention remains the standard of care. The aim of this multisite study was to assess baseline differences in white matter tract development and compare white matter tract development following surgical correction in NSC patients relative to normally developing controls using diffusion tensor imaging (DTI).</p><p><strong>Methods: </strong>Pre- and postoperative DTI was obtained at three centers (Arkansas, Vanderbilt, and Yale) in children who underwent surgical correction for NSC (n = 16), and age-matched control scans (n = 47) were obtained from the Lifespan Baby Connectome Project. Analysis of diffusion parameters was performed for 48 white matter tracts defined by the Johns Hopkins University white matter tractography atlas. Descriptive analyses were used to compare diffusion parameters between the NSC and control cohorts at pre- and postoperative time points. Linear mixed-effects models were fit to assess whether tract development between pre- and postoperative scans differed between patients and controls.</p><p><strong>Results: </strong>Patients with NSC showed greater global mean, axial, and radial diffusivity at the preoperative time point compared with age-matched controls. Following surgical correction, the NSC cohort had greater decreases in mean, axial, and radial diffusivity across multiple association, commissural, and projection tracts (e.g., the inferior and superior longitudinal fasciculi, corpus callosum, corona radiata, cingulum, and internal and external capsules) between pre- and postoperative time points compared with controls. Changes in fractional anisotropy were comparable between patients and controls.</p><p><strong>Conclusions: </strong>Patients with NSC exhibited greater decreases in diffusivity across major white matter tracts following surgery compared with normally developing controls. These decreases might represent accelerated maturation/normalization of white matter following surgical correction of NSC.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945062","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":"Erratum. Variability in selective dorsal rhizotomy surgery: an analysis of the Cerebral Palsy Research Network registry.","authors":"Brandon G Rocque","doi":"10.3171/2026.6.PEDS25497a","DOIUrl":"https://doi.org/10.3171/2026.6.PEDS25497a","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891982","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":"Differences between the anterior fontanelle surface area of term versus premature pediatric patients based on head CT.","authors":"Hannah E Wilding, Michelle Paret, Bao Y Sciscent, Debarati Bhanja, Mason Stoltzfus, Hali Kim, Elias Rizk","doi":"10.3171/2026.3.PEDS24497","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS24497","url":null,"abstract":"<p><strong>Objective: </strong>While studies have investigated normative ranges of anterior fontanelle (AF) closure and surface area (SA), they have focused on full-term children born without significant comorbidities that may impact the AF SA. Understanding the trends of AF SA and closure in patients with common pediatric conditions can help inform guidelines for screening the size of the AF and determining when to intervene. This study aimed to investigate the AF SA in pediatric patients between 0 and 24 months of age born either at term or prematurely.</p><p><strong>Methods: </strong>A retrospective chart review investigated 346 pediatric patients between the ages of 0 and 24 months who underwent head CT imaging between January 2012 and December 2021. Patients with craniosynostosis and hydrocephalus were excluded. Mann-Whitney U-tests and Fisher's exact tests were used to compare the distribution of demographic variables between the term and premature patient cohorts. The length of the AF was measured in the coronal and sagittal planes to calculate SA. Mann-Whitney U-tests were used to compare median AF SA in the premature versus term cohorts of each age group.</p><p><strong>Results: </strong>A total of 346 patients were identified, with an average patient age of 156 days (5.2 months). Most patients were male (53.2%) and White (66.2%). Fifty-six patients (16.2%) in the study cohort were premature, and 290 (83.8%) were born at term. The most common indication for CT of the head/brain was trauma (51.2%). Overall, the median AF SA for children born at term increased until age 2 months, then decreased until closure, while the AF SA for premature children peaked at 5-6 months. The median AF SA was significantly larger in premature compared with term patients at 5-6 and 7-9 months (p < 0.05). With corrected ages for the premature cohort, there were no statistically significant differences in median AF SA between the patients born prematurely and at term.</p><p><strong>Conclusions: </strong>This study provides insight into the hypothesis that AF SA varies, and specifically is larger, in premature children compared with children born at term. An enlarged AF in premature pediatric patients might signify normal development and may not necessitate neurosurgical referral.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892008","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 decade of change in pediatric intracranial abscess surgery: rising volumes and evolving care (2013-2023).","authors":"Cleresa Renee Roberts, Ruyun Jin, Maya Parker, Heather Stevens Spader","doi":"10.3171/2026.3.PEDS25665","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS25665","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric intracranial abscesses are rare, life-threatening infections requiring prompt surgery and coordinated subspecialty care. Reports during COVID-19 described nationwide surges, but national operative trends and equity data remain sparse. Therefore, this study aimed to define decade-long trends in surgical management, outcomes, and racial disparities in children in the US who underwent intracranial abscess surgery, with an emphasis on pandemic-era changes.</p><p><strong>Methods: </strong>This was a retrospective, multicenter cohort study of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric (2013-2023) children undergoing surgery for intracranial abscess/empyema by neurosurgery and/or otolaryngology; outcomes were compared using nonparametric/exact tests (α = 0.05) in R.</p><p><strong>Results: </strong>Among 232 children (median age 11.9 years; 71.6% male), the annual operative volume rose 10-fold. The proportion of indexed operations performed by neurosurgery declined from 75% in 2013 to 7.5% in 2023, while the proportion performed by otolaryngology increased from 0% to 62.5% over the same period. Black children were less likely to undergo neurosurgery-only procedures than they were to undergo otolaryngology surgery with or without neurosurgery (4.3% vs 34.4%, p = 0.008). Black and Hispanic children had longer hospital stays than White children (12.5 and 11 days, respectively, vs 9 days; p = 0.026) and higher mortality (0.5%). Neurological complication rates (0.9%) were uniformly low. During COVID-19, patients were older (median age 12.5 vs 10.9 years, p = 0.014), had more extradural/subdural disease (47% vs 33%, p = 0.044), and had longer operations (median 203 vs 169 minutes, p = 0.020), while admission-to-incision time, readmission, and mortality rates were unchanged.</p><p><strong>Conclusions: </strong>From 2013 to 2023, occurrences of pediatric intracranial abscess surgery increased dramatically, with a marked increase during the later study period (2020-2023), temporally overlapping with the COVID-19 pandemic, and peaking in 2022-2023. Over the same period, the specialty performing the indexed operation shifted progressively from neurosurgery to otolaryngology. Short-term outcomes remained favorable, but Black and Hispanic children experienced reduced neurosurgical access and longer hospitalization, underscoring the need to address structural determinants of pediatric neurosurgical equity.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891973","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}