Journal of neurosurgery. Pediatrics最新文献

{"title":"Safety profile of intracranial neuromodulation for drug-resistant epilepsy in children.","authors":"Shikha Singh, Caren Armstrong, Susan E Melamed, Kathleen Galligan, Michelle Han, Marissa DiGiovine, Sudha K Kessler, Benjamin C Kennedy","doi":"10.3171/2025.1.PEDS24463","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24463","url":null,"abstract":"<p><strong>Objective: </strong>Children with drug-resistant epilepsy (DRE) in whom resection or disconnective surgeries are not recommended can still benefit from neurostimulation. Vagus nerve stimulation (VNS) is FDA approved for those aged 4 years and older, but intracranial stimulators, that is, responsive neurostimulation (RNS) and deep brain stimulation (DBS) devices, are only approved for those aged 18 years and older. Studies in adults and early experience in children suggest that intracranial stimulation may be more effective than VNS but with higher risk. This risk has not been examined in large pediatric cohorts. This study aimed to evaluate the safety profile of RNS and DBS for pediatric DRE as well as the possible risk factors for wound-related complications.</p><p><strong>Methods: </strong>This retrospective study examined the records of DRE patients who underwent RNS or DBS at Children's Hospital of Philadelphia from November 2017 to March 2024 with at least 6 months of follow-up. DBS electrodes were placed in the anterior or centromedian nucleus of the thalamus. RNS electrodes were placed in seizure foci.</p><p><strong>Results: </strong>A total of 54 patients, aged 6-22 years, underwent intracranial stimulator implantation for DRE (24 DBS, 30 RNS). The mean follow-up was 24.4 ± 15.3 months (median 21 months, range 6-69 months). Five (9.3%) patients returned to surgery, 3 (5.6%) of whom required explant and 1 (1.9%) of whom required explant and also had a surgical site infection (SSI). Prior craniotomy was a significant risk factor for wound-related complications (p = 0.0046 in all patients, p = 0.0375 in patients < 18 years). No patient experienced hemorrhage, lead malposition, device malfunction, or long-term stimulation-induced paresthesia, depression, or memory loss. The overall responder rates, defined by achieving 50% or greater reduction in seizure frequency, were 54% in the RNS cohort and 73% in the DBS cohort at the 12-month follow-up.</p><p><strong>Conclusions: </strong>To the best of the authors' knowledge, this study represents the largest single-center series of intracranial stimulation for pediatric DRE. In comparison with established rates of SSI and explant in adults (12% and 7.0% in the RNS pivotal trial and 13% and 8.6% in the DBS SANTE [Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy] trial, respectively), the present cohort demonstrated favorable rates of 1.9% and 5.6%, respectively. Studies with larger pediatric DRE cohorts are needed with longer follow-up and seizure outcomes to elucidate the risk/benefit balance of intracranial stimulation in children.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997170","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":"Complex shunt system comparison: an observational study by the Hydrocephalus Clinical Research Network.","authors":"Eric M Jackson, Hailey Jensen, Ron W Reeder, Peter A Chiarelli, Jason Chu, Todd C Hankinson, Jason S Hauptman, Albert M Isaacs, Abhaya V Kulkarni, David D Limbrick, Patrick J McDonald, Jonathan A Pindrik, Ian F Pollack, Brandon G Rocque, Curtis J Rozzelle, Jennifer M Strahle, Mandeep S Tamber, John C Wellons, John R W Kestle, William E Whitehead, Jay Riva-Cambrin","doi":"10.3171/2025.2.PEDS24622","DOIUrl":"https://doi.org/10.3171/2025.2.PEDS24622","url":null,"abstract":"<p><strong>Objective: </strong>Treatment of multiloculated hydrocephalus can require multiple procedures and shunt catheters. This study aimed to determine whether there are differences in shunt survival or complications in patients with complex shunt systems based on whether they have separate systems or multiple intracranial catheters with a single distal catheter and a Y- or T-connector.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the Hydrocephalus Clinical Research Network (HCRN) Core Data Project, a prospective multicenter registry. Patients undergoing first-time placement of a complex ventriculoperitoneal shunt or first-time conversion to a complex shunt were identified and included in the analysis. Propensity-weighted Cox regression was used to control for HCRN center and etiology using the rate of shunt failure (shunt malfunction or shunt infection) as the primary outcome. The final regression model was also adjusted for age and complex chronic conditions.</p><p><strong>Results: </strong>In total, 369 patients were included. One hundred fifty-one patients had separate systems and 218 had Y/T-connectors. After adjustment for age and comorbidities, the rate of shunt failure for systems with Y/T-connectors was not significantly different than that for separate shunt systems: 62% versus 55% (HR 1.20, 95% CI 0.91-1.59, p = 0.197). There was a statistically significant difference in operative time with separate systems having shorter operative times (mean time 63.0 vs 80.0 minutes; mean difference 16.32, 95% CI 7.53-25.10, p < 0.001).</p><p><strong>Conclusions: </strong>There were no differences in the shunt failure rates or complications between the separate shunt systems and Y/T-connector systems used to treat complex shunts. However, surgical time was significantly shorter with separate shunt systems. These findings suggest that surgeons can tailor the shunt system on the basis of individual patient characteristics.</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":"144009137","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":"Clinical phenotypes among patients with familial forms of Chiari malformation type 1.","authors":"Kedous Y Mekbib, William Muñoz, Garrett Allington, Shujuan Zhao, Neel H Mehta, Carla Fortes, John P Shohfi, Baojian Fan, Carol Nelson-Williams, Tyrone DeSpenza, William E Butler, Seth L Alper, Eric M Jackson, Kristopher T Kahle","doi":"10.3171/2025.1.PEDS24187","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24187","url":null,"abstract":"<p><strong>Objective: </strong>Chiari malformation type 1 (CM1) is the most common neurological disorder of the craniocervical junction. CM1 is characterized by cerebellar tonsillar herniation below the foramen magnum, causing CSF obstruction and neural compression. Patients with CM1 suffer from highly variable symptoms, progression, comorbidities, and outcomes, partly due to poor understanding of CM1 pathogenesis. In this paper, the authors present the only familial CM1 cohort study to statistically assess intrafamilial clinical phenotypes to date.</p><p><strong>Methods: </strong>Comprehensive medical, surgical, and family histories and neuroimaging were collected from families with multiple CM1-affected family members. Univariate analysis was performed for each symptom, comorbidity, or surgery to compare observed versus expected frequencies of affected patients with another CM1-affected family member with the same clinical characteristic.</p><p><strong>Results: </strong>Twenty-four new familial CM1 cases (totaling 57 patients with CM1) are presented. Intrafamilial similarities were identified for age of onset, symptoms such as headaches (p = 0.007) and neck pain (p = 0.018), neurological comorbidities such as syringomyelia (p = 0.003) and hydrocephalus (p = 0.0001), neurodevelopmental conditions such as dyslexia (p < 0.0001), and connective tissue disorders (CTDs) such as Ehlers-Danlos syndrome (p < 0.0001).</p><p><strong>Conclusions: </strong>These results suggest that CM1 and its associated clinical phenotypes, including age of onset, clinical symptoms, neurological comorbidities, neurodevelopmental conditions, and CTDs, are genetically influenced. Whole-exome sequencing of CM1 patient-parent trios has the potential to identify the genetic determinants of CM1, with implications for neurosurgical management.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064034","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":"Five-year outcomes after surgical treatment of infant postinfectious hydrocephalus in sub-Saharan Africa: results of a randomized trial.","authors":"Edith Mbabazi-Kabachelor, Mallory R Peterson, John Mugamba, Peter Ssenyonga, Justin Onen, Esther Nalule, Joshua Magombe, Venkateswararao Cherukuri, Vishal Monga, Steven J Schiff, Abhaya V Kulkarni, Benjamin C Warf","doi":"10.3171/2025.1.PEDS24417","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24417","url":null,"abstract":"<p><strong>Objective: </strong>Postinfectious hydrocephalus (PIH) in infants is a major public health burden in sub-Saharan Africa. In a previously reported randomized trial, the authors found no significant differences in outcome between endoscopic versus shunt treatment, with stagnation in brain growth at 2 years after treatment. They now present the 5-year follow-up results of this cohort, assessing detailed developmental, quality of life, and brain volume outcomes.</p><p><strong>Methods: </strong>The authors performed a trial at a single center in Mbale, Uganda, involving 100 infants (< 180 days of age) with PIH randomized to endoscopic third ventriculostomy plus choroid plexus cauterization (ETV/CPC) or ventriculoperitoneal shunt (VPS) treatment. After 5 years, they assessed developmental outcomes with the Vineland Adaptive Behavior Scales, Third Edition (VABS-3), quality of life with the Health Utilities Index Mark 3 (HUI-3) and Hydrocephalus Outcome Questionnaire (HOQ), and brain volume derived from CT scans.</p><p><strong>Results: </strong>Sixty-three infants were assessed for 5-year outcomes (35 ETV/CPC and 28 VPS, by intention to treat). There were no significant differences between the two surgical treatment arms in treatment failure (p = 0.39), VABS-3 scores (p > 0.52), HUI-3 utility scores (p > 0.37), HOQ scores (p > 0.18), or brain volume (raw p = 1.0, adjusted p = 0.24). There were strong correlations between VABS-3, HUI-3, and HOQ scores with brain volume adjusted for age and sex, and weaker correlations when adjusted for anthropometric measurements.</p><p><strong>Conclusions: </strong>These results suggest that ETV/CPC and VPS treatment have comparable long-term outcomes for infants in medically resource-constrained environments. Furthermore, brain volume strongly correlates with developmental and quality of life metrics, emphasizing the need to focus on optimizing brain volume growth potential in infants with severe perinatal neurological insults such as infection and hydrocephalus.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970505","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":"Robotic radiosurgery for the treatment of pediatric arteriovenous malformations.","authors":"Lily H Kim, Teeradon Treechairusame, Jennifer Chiang, Zachary White, Scott Jackson, Jennifer L Quon, Geoffrey Appelboom, Steven D Chang, Scott G Soltys, Raphael Guzman, Samuel Cheshier, Robert L Dodd, Gerald A Grant, Michael S B Edwards, Iris C Gibbs","doi":"10.3171/2024.12.PEDS24211","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24211","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric intracranial arteriovenous malformations (AVMs) have a greater cumulative lifetime risk of rupture than those in adults. Although obliteration after radiation occurs in a dose-dependent manner, increasing radiation doses must be balanced against the risk of adverse radiation effects (AREs). The authors aimed to assess the efficacy of robotic radiosurgery for pediatric AVMs.</p><p><strong>Methods: </strong>The authors performed a retrospective review of pediatric patients with AVMs at a single institution who underwent robotic radiosurgery between 2005 and 2021 with one of 3 radiosurgery dosing schedules: 1) single-stage unfractionated (SSU), 2) single-stage fractionated (SSF), and 3) volumetrically multistaged (VMS) treatment. Cox proportional hazards regression was performed to identify predictors of AREs and obliteration.</p><p><strong>Results: </strong>Ninety-five patients with 100 intracranial AVMs were identified. Median (range) follow-up time was 4.5 (1.8-15.2) years. Forty-four (46.3%) presented with ruptured AVMs. The mean ± SD AVM volume was 10.0 ± 11.88 cm3. A plurality of AVMs were Spetzler-Martin grade III (36.2%). The overall rate of total obliteration was 52.6% (78.8% of SSU-treated, 24.2% of SSF-treated, 10% of VMS-treated patients) with a median (range) obliteration time of 3.25 (2.8-4.1) years. Partial obliteration was achieved in 23.2% of patients. In the univariate analysis, the higher obliteration rate was associated with small volume (HR 0.876, 95% CI 0.812-0.945) (p = 0.001), no prior embolization (HR 0.472, 95% CI 0.254-0.876) (p = 0.017), lower Spetzler-Martin grade (HR 0.437, 95% CI 0.320-0.597) (p ≤ 0.001), and higher single-fraction equivalent dose (HR 1.160, 95% CI 1.020-1.198) (p = 0.015). Pretreatment hemorrhage was found in 51 patients (59.6% of SSU-treated, 45.5% of SSF-treated, and 50% of VMS-treated patients). Thirteen patients experienced posttreatment hemorrhage (3.8% of SSU-treated, 12% of SSF-treated, and 60% of VMS-treated patients). AREs were found afterward in 31.6% of patients. The correlations of male sex (HR 0.447, 95% CI 0.199-1.004) (p = 0.051) and volume of brain tissue that received a single-fraction equivalent dose of 12 Gy or greater (HR 1.020, 95% CI 1.000-1.041) (p = 0.053) with AREs did not reach significance.</p><p><strong>Conclusions: </strong>SSU treatment was effective for treating smaller AVMs with an obliteration rate of 79%. Although SSF treatment was less effective in achieving total obliteration (24%), this approach significantly reduced the posttreatment hemorrhage rate by nearly 75% (46% of patients had pretreatment hemorrhage vs 12% with posttreatment hemorrhage). Unfortunately, only 10% of AVMs in the VMS cohort were obliterated and posttreatment hemorrhage rates were not reduced.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030822","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 role of preoperative chemotherapy in pediatric neuro-oncology: a single-center experience and a systematic review of the literature.","authors":"Roboan Guillen Arguello, Michelle Masayo Kameda-Smith, Nisha Gadgil, Mehmet Fatih Okcu, Murali Chintagumpala, Guillermo Aldave","doi":"10.3171/2025.1.PEDS24512","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24512","url":null,"abstract":"<p><strong>Objective: </strong>Brain tumors in infants and young children may constitute a challenge to achieve a gross-total resection (GTR) due to their large size, high vascularity, and patient's low vascular reserve. Preoperative (neoadjuvant) chemotherapy has been reported to increase rates of GTR, reduce complications, and improve long-term tumor-free survival outcomes by decreasing tumor size and vascularity. This study evaluates the role of preoperative chemotherapy in pediatric patients with brain tumors through a systematic review and a single tertiary center experience.</p><p><strong>Methods: </strong>A systematic review was conducted using three databases (i.e., MEDLINE, Embase, and Web of Science) to identify reported cases of pediatric brain tumor treated with preoperative chemotherapy. Furthermore, the records of 6 pediatric brain tumor patients treated with preoperative chemotherapy at Texas Children's Hospital between 2018 and 2023 were reviewed. Descriptive characteristics and clinical outcomes were assessed in compliance with the local ethics committee protocol.</p><p><strong>Results: </strong>Twenty-one studies with 124 patients were included in the systematic review. The mean age at presentation was 32 months (range 0.17-144 months), with a male predominance (n = 73, 58.9%). The mean age of the current single-center cohort was 50.3 months (range 2-180 months), with a mean follow-up of 45 months (range 4-45 months). Within the systematic review, 10 different tumor pathologies were identified, the most common being medulloblastoma (n = 61), followed by choroid plexus carcinoma (n = 26). Overall, 82.3% (102/124) of the patients showed any radiographic tumor reduction after chemotherapy in the literature review versus 50% (3/6) in the current case series. GTR after preoperative chemotherapy was achieved in 78.2% (97/124) of the patients, similar to the current patient series experience in which GTR was achieved in 80% (4/5). No complications from preoperative chemotherapy that impacted the surgery or the immediate postoperative course were identified.</p><p><strong>Conclusions: </strong>Preoperative chemotherapy is a safe and effective strategy to increase maximum and safe resection rates in children and infants with pediatric brain tumors.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022817","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":"Adverse outcomes in child abuse: a 7-year analysis of patients with traumatic brain injury.","authors":"Foad Kazemi, Kelly Jiang, Shenandoah Robinson, Alan R Cohen","doi":"10.3171/2025.1.PEDS24499","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS24499","url":null,"abstract":"<p><strong>Objective: </strong>Child abuse is a critical public health issue that profoundly affects pediatric health and well-being. Child abuse patients who have sustained traumatic brain injuries (TBIs) present with a unique subset of injuries with complex medical and social implications. This study aims to explore the socioeconomic disparities, injury characteristics, and outcomes in child abuse patients who have sustained TBIs.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of their institutional emergency department (ED) database (June 2016-June 2023) to identify pediatric TBI cases (patient age ≤ 18 years) using ICD-10 codes based on a modified Centers for Disease Control and Prevention framework. Documented cases of child abuse, neglect, or inadequate supervision with investigations by a multidisciplinary child protection team were identified by reviewing the records of ED admissions. Patient demographics, zip codes, injury characteristics, and clinical outcomes were collected. The Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS), with higher ISSs and lower TRISSs indicating more severe injuries, respectively, were obtained. The Social Deprivation Index was used to assess neighborhood disadvantage, with higher scores indicating adverse health outcomes. Standard bivariate and multivariate regression analyses were performed.</p><p><strong>Results: </strong>This study included 2954 patients with TBI, whose mean age was 7.05 ± 5.50 years; 36.6% of the patients were female and 40.4% were White. Among the overall cohort of TBI cases, 86.6% were non-child abuse cases, while 13.4% were child abuse cases. The child abuse cohort had a significantly lower average age (2.02 vs 7.83 years, p < 0.001) than the non-child abuse group. In multivariate regression models, child abuse patients had higher odds of being conveyed to the hospital via private transport (adjusted odds ratio [aOR] 2.201, p < 0.001); had higher odds of residing in a deprived neighborhood, as indicated by the SDI (aOR 1.009, p < 0.001); and had sustained more severe injuries on admission, as indicated by the ISS and TRISS (aOR 1.064, p < 0.001; aOR 0.970, p < 0.001, respectively). Child abuse patients had higher odds of a prolonged hospital stay (aOR 4.061, p < 0.001), a nonroutine discharge (aOR 6.186, p < 0.001), ED transfer to the intensive care unit (aOR 2.696, p < 0.001), and death on admission (aOR 3.131, p < 0.001).</p><p><strong>Conclusions: </strong>This study highlights neighborhood disadvantage, more severe injuries, and adverse outcomes in child abuse-related TBI, emphasizing the need for targeted interventions to address socioeconomic disparities and improve healthcare for this vulnerable population.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014798","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":"Prediction of seizure risk after repetitive mild traumatic brain injury in childhood.","authors":"Michael C Jin, Karthik Ravi, Adela Wu, Cesar A Garcia, Adrian J Rodrigues, Solomiia Savchuk, Gabriela D Ruiz Colón, Bina W Kakusa, Jonathon J Parker, Gerald A Grant, Laura M Prolo","doi":"10.3171/2025.1.PEDS2436","DOIUrl":"https://doi.org/10.3171/2025.1.PEDS2436","url":null,"abstract":"<p><strong>Objective: </strong>Despite the known negative physiological impact of repeated mild head trauma events, their multiplicative impact on long-term seizure risk remains unclear. The objective of this study was to evaluate how multiple mild traumatic brain injuries (mTBIs) impact long-term seizure risk by testing 3 distinct machine learning approaches. Baseline and injury-specific characteristics were incorporated to enhance prognostication of individual seizure risk.</p><p><strong>Methods: </strong>Children with at least 1 mTBI event without prior evidence of seizure or antiepileptic drug treatment, from 2003 to 2021, were identified from a nationally sourced administrative claims database. The primary outcome of interest was a seizure event after mTBI, defined by qualifying principal diagnosis codes. Time-varying multivariable Cox regression was used to assess the impact of repeated mTBI.</p><p><strong>Results: </strong>A total of 156,118 children (mean age 11.7 ± 4.7 years) were included, with a median follow-up duration of 22.6 months (IQR 9.2-45.4 months). Among patients who experienced seizure after mTBI, the median time to seizure was 306 days. Seizures among those with radiographic findings and/or loss of consciousness occurred earlier (median time to seizure 112.5 days [imaging findings only, IQR 5-526.25 days], 80 days [loss of consciousness only, IQR 7-652 days], 22 days [both, IQR 5-192 days]). Both mTBI without and with short-term loss of consciousness resulted in increasing seizure risk with repeated trauma (HR 1.196, 95% CI 1.082-1.322; HR 2.025, 95% CI 1.828-2.244; respectively). The random survival forest approach achieved fixed-time areas under the receiver operating characteristic curve of 0.780 and 0.777 at 30 and 90 days after mTBI, and children predicted at high risk by the final model experienced a significantly higher burden of early seizure after mTBI (46.7% within the first 30 days vs 17.7% and 19.9% of children at low and medium risk). A simplified model using the top 12 contributing features achieved 95% of the full model's performance in the validation set.</p><p><strong>Conclusions: </strong>A novel machine learning model was developed and validated for personalized prediction of long-term seizure risk following multiple mTBIs. Model performance remained robust with a limited feature set, suggesting the feasibility of real-time incorporation into clinical workflows for individualized prognostication following each repeat mTBI event. In children predicted to be at high risk, early intervention should be considered.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unplanned shunt readmission: what does it really look like?","authors":"Emal Lesha, Kaan Yagmurlu, Nir Shimony, Brandy Vaughn, David G Laird, John E Dugan, Paul Klimo","doi":"10.3171/2024.12.PEDS24260","DOIUrl":"https://doi.org/10.3171/2024.12.PEDS24260","url":null,"abstract":"<p><strong>Objective: </strong>Readmission after an operation has garnered considerable attention within the neurosurgical literature. In this study, the authors sought to analyze the reasons why children are readmitted after shunt surgery and to identify key population characteristics and potential drivers.</p><p><strong>Methods: </strong>The authors' single-institution shunt surgery administrative database was used to identify procedures performed from January 1, 2018, to December 31, 2021. Only de novo or revision cranial shunt operations were included. Each surgery within the database represents an index case, and each patient was followed for a 90-day period. The authors categorized an unplanned readmission after shunt surgery as falling into one of 4 groups: 1) definitely unrelated to the index surgery; 2) possibly related but ultimately deemed unrelated; 3) directly related but no return to the operating room; and 4) directly related and requiring repeat surgery. Groups 3 and 4 were combined for statistical purposes.</p><p><strong>Results: </strong>A total of 715 shunt operations were performed with 148 (20.7%) unplanned readmissions within 90 days in 139 patients. The median age was 3.2 years with 58%, 53%, and 58% being male, Caucasian, and having some form of public health insurance, respectively. The majority of African-American children had government insurance (80%) compared to Caucasian (41%) and Hispanic/other (55%) children (p < 0.001). The proportion of new versus revision surgical procedures was 45% versus 55%. Surgeon C did the most operations (n = 52 [37%]). The median number of days to readmission and length of readmission were 26.5 (IQR 9.5-47.0) days and 3.0 (IQR confidence interval 1.0-5.0) days, respectively. Multinomial analysis found that public insurance, revision surgery, and prior admission to the neonatal intensive care unit (NICU) were associated with definitely unrelated readmissions. Private insurance, no prior NICU admission, and an individual surgeon were associated with directly related readmissions. Survival analyses showed no differences in time to readmission among all patients and among only those who had prior NICU admission.</p><p><strong>Conclusions: </strong>The 90-day readmission rate after index shunt surgery was 21%. Drivers of readmission-including socioeconomic status and hydrocephalus severity-were a function of the type of readmission.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997416","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":"Global variability in fetal spina bifida surgery: a survey of neurosurgical strategies.","authors":"Charlotte C Kik, Yada Kunpalin, Abhaya V Kulkarni, Philip L J DeKoninck, Jochem K H Spoor, Tim Van Mieghem","doi":"10.3171/2024.10.PEDS24412","DOIUrl":"https://doi.org/10.3171/2024.10.PEDS24412","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the global variability in intraoperative neurosurgical management strategies for fetal spina bifida surgery.</p><p><strong>Methods: </strong>All prenatal fetal spina bifida surgery centers identified through the International Society of Prenatal Diagnosis website and previous literature were invited to participate in an online survey addressing various aspects of the surgery, including fetal selection criteria, surgical technique, and common intraoperative challenges.</p><p><strong>Results: </strong>Thirty-four centers (72%) responded to the survey, more than half of whom perform fewer than 10 surgeries annually (56%). The most common earliest gestational age (GA) for fetal surgery was 23 (36%, n = 12/33), ranging from < 21 weeks (9%, n = 3) to > 24 weeks (9%, n = 3). The latest GA for surgery varied from < 26 weeks (24%, n = 8) to 30 weeks (3%, n = 1), with the majority setting a cutoff at 26 weeks (50%, n = 17). Open fetal surgery is the predominant method in 76% of centers (n = 26), followed by a hybrid approach (laparotomy with fetoscopy on the uterus; 29%, n = 10) and fully percutaneous fetoscopic surgery (15%, n = 5). Filum terminale dissection is performed in 58% (n = 19/33) of centers and placode tubularization in 46% (n = 15/33). Myofascial flaps are routinely used in 55% of the centers (n = 18/33). When primary skin closure is not possible, 39% (n = 13/33) will use releasing side cuts and one-third of all centers will use acellular dermal matrix grafts (33.3%, n = 11/33). Extensive skin defects and suboptimal fetal access were commonly cited as the most significant intraoperative challenges.</p><p><strong>Conclusions: </strong>There is variability in the fetal inclusion criteria and intraoperative management of fetal spina bifida across centers. This variability emphasizes the need for more research on best practices as well as standardized outcome reporting (ideally through \"core outcomes\") to allow for comparison between centers. Identified challenges, such as difficulties in skin closure, highlight specific areas for future innovations in the field.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030397","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}