Journal of neurosurgery. Pediatrics最新文献

{"title":"The association between the degree of intraoperative bisynchronization blockade and drop attack freedom after corpus callosotomy in pediatric patients: a comparative cohort study.","authors":"Jeffrey P Turnbull, Daniel W Griepp, Ethan Wood, Joshua Caskey, Shivum Desai, Alexander I Helfand, Anna T K Griepp, Heather Heitkotter, Neena I Marupudi, Sandeep Sood, Eishi Asano, Michael Cools","doi":"10.3171/2026.4.PEDS2682","DOIUrl":"10.3171/2026.4.PEDS2682","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the prognostic value of intraoperative EEG during corpus callosotomy (CC) in pediatric patients with drug-resistant epilepsy (DRE), with a particular focus on bisynchronization blockade and its correlation with long-term seizure outcomes.</p><p><strong>Methods: </strong>A retrospective review was performed of pediatric patients with DRE and injurious drop attacks who underwent CC between 2005 and 2024. Patients were stratified into three groups based on intraoperative scalp EEG findings: 1) > 50% bisynchronization blockade, 2) < 50% blockade, and 3) absent bisynchronization. Baseline clinical characteristics, surgical approach, and extent of CC were recorded. Seizure outcomes were assessed using Engel and International League Against Epilepsy (ILAE) classifications with a minimum follow-up of 1 year. Whether atonic seizures resolved postoperatively was also evaluated. Group comparisons were performed using Fisher's exact test and Kruskal-Wallis rank-sum testing.</p><p><strong>Results: </strong>Forty-six patients met the inclusion criteria. The majority underwent complete CC (65%), most via an open approach (67%). At 1 year, freedom from atonic seizures (ILAE class 1Engel class I) was highest in the > 50% blockade group (70.0%) compared with the < 50% blockade (40.0%) and absent bisynchronization (25%) groups (p = 0.042). At last follow-up (mean 5.3 years), the > 50% blockade group similarly achieved significantly higher rates of atonic seizure freedom (ILAE class 1/Engel class I, 76%) compared with 0% in the < 50% blockade and 25% in the absent bisynchronization groups (p < 0.001). Outcomes for total seizure freedom varied and did not reach statistical significance between groups.</p><p><strong>Conclusions: </strong>Achieving > 50% intraoperative bisynchronization blockade during CC was strongly associated with improved long-term atonic seizure freedom. These findings support the role of intraoperative EEG as a prognostic marker of effective seizure control.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"449-455"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689402","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":"Letter to the Editor. Anatomy as a hidden determinant of shunt survival after ETV.","authors":"Demet Evleksiz","doi":"10.3171/2026.4.PEDS26191","DOIUrl":"10.3171/2026.4.PEDS26191","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"619-621"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689373","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":"Safety, feasibility, and outcomes of deep brain stimulation in young children excluded from the FDA Humanitarian Device Exemption: analysis of the CHILD-DBS registry.","authors":"Suna Jung, Samuel Molot-Toker, Thiemo F Dinger, Arjun Balachandar, Birra Taha, Karim Mithani, Sara Breitbart, MyLoi Huynh, Fay Kisteroff, Seetha Sriharan, Lindsey M Vogt, Andrea LeBlanc-Millar, Darius Ebrahimi-Fakhari, Kathryn Yang, Marcella Ruppert-Gomez, Scellig S Stone, Weston T Northam, Nisha Gadgil, Jeffrey S Raskin, Alexander G Weil, Aristides Hadjinicolaou, Inge A Meijer, Alfonso Fasano, Carolina Gorodetsky, George M Ibrahim","doi":"10.3171/2026.2.PEDS25517","DOIUrl":"10.3171/2026.2.PEDS25517","url":null,"abstract":"<p><strong>Objective: </strong>In the US, deep brain stimulation (DBS) is accessible to pediatric patients with dystonia who are 7 years of age and older through an FDA Humanitarian Device Exemption (HDE). The aim of this study was to assess the safety, feasibility, and outcomes of DBS for dystonia in children younger than 7 years of age who are excluded from the FDA HDE.</p><p><strong>Methods: </strong>Data were collected (February 2015-December 2025) through The Child & Youth Comprehensive Longitudinal Database for DBS, which is a prospective registry of pediatric DBS from 5 tertiary pediatric hospitals in North America. Participants younger than 7 years of age who underwent DBS targeting the globus pallidus internus for the treatment of dystonia were included. Demographics, operative details, and postoperative outcomes and complications were analyzed.</p><p><strong>Results: </strong>Twelve children underwent 14 DBS-related surgeries, with a mean follow-up duration of 2.66 years (range 0.50-10.85 years). The mean age at the time of surgery was 4.72 years (range 2.96-6.83 years), and the mean weight was 16.5 kg (range 9.3-30.8 kg). Half of the children had prior ICU admissions for status dystonicus, and 9 DBS surgeries (64.3%) were performed urgently. Three children had transgression of stereotactic frame pins beyond the inner table of the skull, while 4 other children had wound complications requiring surgical intervention. No patients experienced neurological sequelae, and those requiring explantation of infected hardware were reimplanted successfully once the infections were treated. Overall, there was a mean reduction of 40.1% in the Burke-Fahn-Marsden movement subscale at 6 months postoperatively (p < 0.05), which persisted to 12 months. Three children died due to underlying conditions > 6 months from their respective surgeries.</p><p><strong>Conclusions: </strong>DBS had demonstrable benefits in children younger than 7 years of age with severe refractory dystonia, albeit with higher surgical risks compared with older children. Further research is warranted to better inform treatment decisions and regulatory oversight.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"430-441"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689343","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":"Factors influencing time of presentation among children with myelomeningocele in Zambia: a prospective study.","authors":"Kutha Banda, Allison Dodds, Linder Wendt, J Brooks Jackson, Marie-Renee Mala Wa Mpoyi, Humphrey Kunda, Rebecca A Reynolds","doi":"10.3171/2026.4.PEDS2659","DOIUrl":"10.3171/2026.4.PEDS2659","url":null,"abstract":"<p><strong>Objective: </strong>Although myelomeningocele (MMC) remains a leading cause of infant disability and death in many low- and middle-income countries, data regarding access to timely neurosurgical care remain limited. The goal of this study was to characterize sociodemographic and clinical factors associated with delayed presentation for neurosurgical repair of MMC in Zambian infants.</p><p><strong>Methods: </strong>Infants with MMC presenting to a major tertiary academic hospital in Lusaka, Zambia, for MMC repair between May 1, 2024, and October 21, 2025, were enrolled in a prospective cohort study. The primary outcome was delayed patient presentation for postnatal neurosurgical care, defined as > 72 hours from birth. Univariate and multivariate logistic regression models were fit to assess the impact of demographic and clinical factors on late presentation to this tertiary care center.</p><p><strong>Results: </strong>One hundred eighteen infants (53% male, n = 62) were enrolled, with 22% (n = 25) born prematurely. Seventy-one percent (n = 84) had a delayed presentation to the tertiary hospital. The median age at first neurosurgical evaluation was 8.0 (IQR 3.0-22.0) days. The median maternal age was 25.0 (IQR 20.0-30.0) years, with a median parity of 2 (IQR 1-4). Most mothers (67%, n = 79) had either no formal education or completed primary school only, and of those who answered the question, the majority were married (72%, 47/65). The self-reported median monthly household income was 16.56 (IQR 4.42-26.50) US dollars. The median distance from the primary referring center to the tertiary hospital was 414.9 (IQR 206.5-577.0) km. Preterm infants (OR 3.997, p = 0.027) and those who traveled ≥ 500 km to receive care (OR 5.085, p = 0.001) were more likely to present late, while those who received ≥ 1 antenatal ultrasound after 20 weeks' gestation tended to have earlier presentation (OR 0.363, p = 0.032). No statistically significant association was found between late presentation and any of the following: maternal age at delivery, education level, marital status, parity, multiplicative increases in monthly household income, infant sex, and presence of any congenital anomalies or comorbidities (p > 0.05).</p><p><strong>Conclusions: </strong>Longer distances to care and preterm birth were associated with delayed patient presentation, while receipt of antenatal ultrasound was associated with earlier presentation. Further investigations aimed at enhancing antenatal and postnatal care, as well as improving transportation access to neurosurgical tertiary care services, are warranted.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"561-569"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689334","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":"Letter to the Editor. Urodynamic outcomes and IONM signal integrity in secondary tethered cord syndrome after MMC repair.","authors":"Tongtong Li, Ke Yang, Zhirui Liu","doi":"10.3171/2026.4.PEDS26185","DOIUrl":"10.3171/2026.4.PEDS26185","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"621-623"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689325","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. Beyond the age threshold: DBS for dystonia in children younger than 7 years.","authors":"Anton Fomenko, Patrick J McDonald","doi":"10.3171/2026.3.PEDS2674","DOIUrl":"10.3171/2026.3.PEDS2674","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"426-429"},"PeriodicalIF":2.2,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689319","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 magnet-actuated craniofacial (MAC) distraction system: preclinical surgical feasibility in a cadaveric model.","authors":"Mohammed A Fouda, Alexander I Evins, Chibuikem A Ikwuegbuenyi, Noah Willett, David Dostal, Caitlin E Hoffman","doi":"10.3171/2026.4.PEDS2687","DOIUrl":"10.3171/2026.4.PEDS2687","url":null,"abstract":"<p><strong>Objective: </strong>Craniofacial distraction osteogenesis (DO) is an established technique for the management of complex craniosynostosis but remains limited by the morbidity associated with external activation ports, including infection, wound breakdown, CSF leakage, and mechanical failure. The magnet-actuated craniofacial (MAC) distraction system was developed to eliminate externalized activation components by enabling fully internalized, contactless, noninvasive actuation. The authors of this study aim to evaluate the surgical feasibility, mechanical reliability, and positional stability of the MAC system in a cadaveric human cranial model.</p><p><strong>Methods: </strong>The MAC system was subjected to comprehensive preclinical biomedical and mechanical engineering validation, including finite element analysis, benchtop force-torque testing, magnetic coupling characterization, and assessment of back-drivability resistance and torque-limiting safety features. Following validation, the system was implanted in preserved cadaveric human heads. Devices were placed in a parasagittal coronal configuration. After a latency period, distraction was performed at a rate of 1 mm/day for 10 days, followed by a simulated 60-day consolidation period. CT imaging was performed at predefined intervals to assess device position, distraction distance, and positional stability.</p><p><strong>Results: </strong>Preclinical testing demonstrated that the MAC system maintained structural integrity under loads exceeding those expected during craniofacial distraction, with a minimum factor of safety of 3 and no evidence of material yielding or mechanical instability. In the cadaveric model, device implantation was surgically feasible without anatomical conflict. An average distraction of 6-9 mm was achieved with controlled, incremental advancement. No device migration, hardware loosening, or unintended back-drivability was observed during active distraction or consolidation. The device maintained the achieved distraction distance at the end of the consolidation period.</p><p><strong>Conclusions: </strong>This cadaveric feasibility study demonstrates that a fully internalized MAC distraction system can achieve controlled, stable cranial vault distraction without the need for external activation ports. The MAC system exhibited reliable mechanical performance, positional stability, and resistance to back-drivability under anatomically relevant conditions. These findings support further in vivo investigation of biological responses, long-term durability, and clinical safety prior to translation to pediatric craniofacial surgery.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"537-547"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648691","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":"Neuroendoscopic lavage in neonatal posthemorrhagic hydrocephalus: a systematic review and single-arm meta-analysis.","authors":"Walter Fagundes, Lucca T A Carretta, Martín Kotochinsky, Rafael R D Oliveira, Iago N S Petry, Yasmin P Silva, Paweł Łajczak, Ricardo F O Suruagy-Motta, Luiz G S Almeida, Rafael T F Santos","doi":"10.3171/2026.3.PEDS25406","DOIUrl":"10.3171/2026.3.PEDS25406","url":null,"abstract":"<p><strong>Objective: </strong>Posthemorrhagic hydrocephalus (PHH) is a significant complication of intraventricular hemorrhage (IVH) in preterm neonates. Neuroendoscopic lavage (NEL) is a treatment option. The authors aimed to evaluate the effectiveness and safety of NEL alone for early treatment of PHH in neonates.</p><p><strong>Methods: </strong>This systematic review and meta-analysis were conducted according to Cochrane Collaboration guidelines and the PRISMA statement. A comprehensive search of databases (PubMed, Embase, Google Scholar, and Web of Science) was conducted to identify studies evaluating NEL in the treatment of PHH in neonates. The analysis used random-effects models. The primary outcome was dependency on a ventriculoperitoneal (VP) shunt. Secondary outcomes included infection rates, multiloculated hydrocephalus, and mortality.</p><p><strong>Results: </strong>The authors evaluated 312 neonates from 9 studies. The pooled analysis revealed a shunt dependency rate of 58.3% (95% CI 52.5-64.2%, I2 = 10%). The infection rate was 5.6% (95% CI 1.7-9.6%, I2 = 48.4%), while the incidence of multiloculated hydrocephalus was 6.5% (95% CI 1.56-11.4%, I2 = 32.6%). Mortality was low at 2.4% (95% CI 0%-4.9%, I2 = 25.2%).</p><p><strong>Conclusions: </strong>This meta-analysis of NEL for neonatal PHH showed moderate rates of shunt dependence, along with low rates of infection and mortality. These findings suggest that NEL is a safe procedure associated with relatively low VP shunt dependence; however, well-designed randomized controlled trials are required to confirm these results and to compare NEL with traditional management strategies. Systematic review registration no.: CRD42024556947 (https://www.crd.york.ac.uk/prospero/).</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"512-520"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648695","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 and radiographic outcomes in children with or without prescribed bracing for stable thoracolumbar compression fractures.","authors":"Ross Moseley, Reid Boyce, Amanda Moon Owens, Julia Pazniokas, Todd C Hankinson, Mark A Erickson, Sumeet Garg, Klane K White, Mohammed Alshareef","doi":"10.3171/2026.3.PEDS25664","DOIUrl":"10.3171/2026.3.PEDS25664","url":null,"abstract":"<p><strong>Objective: </strong>The role of bracing in stable pediatric thoracolumbar compression fractures remains uncertain, with limited pediatric-specific evidence to guide practice. Therefore, the aim of this study was to determine the impact of prescribed bracing on symptom recovery, return to activity (RTA), radiographic remodeling, and reinjury in children and adolescents with this common injury.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort analysis with AO Spine type A1 stable vertebral compression fractures treated at a single academic children's hospital in 2016-2025. Inclusion criteria comprised an age ≤ 18 years, radiographically confirmed type A1 thoracic or lumbar compression fracture, and adequate follow-up with radiographic documentation. Outcomes included symptoms at follow-up, RTA clearance, and vertebral height restoration. Cohort comparisons were performed, as were region-stratified analyses. Both univariate and multivariable analyses along with interaction models were performed, and random forest classifiers were trained.</p><p><strong>Results: </strong>Two hundred three pediatric patients with a median age of 12 years (range 2-18 years) were included in this study. The braced group was slightly older (median age 13 vs 11 years, p = 0.004). Forty-eight percent of the entire cohort was female (52% vs 43%, p = 0.132). Bracing was prescribed in 56% of cases. Injury severity was similar between groups (median height loss: 19.7% braced vs 20.4% unbraced, p = 0.261). At the first follow-up (FU1) 4-6 weeks postinjury, 42% of braced patients remained symptomatic versus 31% of unbraced patients, with braced patients with thoracic fractures showing more than 3 times higher odds of persistent symptoms (OR 3.2, 95% CI 1.48-6.67, p = 0.003). This effect persisted at the second follow-up (FU2) 3-6 months postinjury (p = 0.026). Bracing was also associated with a delayed RTA at FU1 (p = 0.001), although this effect diminished by FU2. Radiographically, braced patients demonstrated vertebral height restoration significantly sooner (brace × time interaction, p = 0.002), but this did not correspond to improved symptoms or function. Reinjury within 1 year was also more common in braced patients (11.5% vs 3.3%, OR 3.77, 95% CI 1.04-13.67, p = 0.04).</p><p><strong>Conclusions: </strong>In a pediatric cohort with stable thoracolumbar compression fractures, prescribed bracing was not associated with symptomatic or functional improvement and was correlated with delayed recovery and increased reinjury risk, despite accelerated radiographic remodeling. These findings add to the growing literature questioning a default brace prescription in thoracolumbar compression fractures. Future prospective studies will be necessary to validate these findings.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"483-493"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648749","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":"Evidence that prior endoscopic third ventriculostomy with choroid plexus cauterization protects against subsequent shunt failure among infants treated for hydrocephalus.","authors":"Benjamin C Warf, Emma N Puglisi, Dylan S Keusch, Alfred P See, Katherine G Holste, Scellig S D Stone","doi":"10.3171/2026.3.PEDS25681","DOIUrl":"10.3171/2026.3.PEDS25681","url":null,"abstract":"<p><strong>Objective: </strong>It is unclear whether shunt survival differs for infants in whom prior endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) failed compared with those treated initially by shunt placement. Results among four previous studies spanning a range of age groups have suggested either no effect or a protective effect of prior endoscopic treatment on shunt survival. The aim of this study was to determine whether prior ETV/CPC positively impacts shunt survival among infants with hydrocephalus regardless of etiology.</p><p><strong>Methods: </strong>The authors conducted a historical cohort review of all patients under 12 months corrected age who underwent ventriculoperitoneal shunt (VPS) placement either with or without prior ETV/CPC at their institution between December 2008 and December 2023. Statistical analyses included Cox regression modeling, Kaplan-Meier survival curves, and log-rank testing to evaluate the time to shunt failure.</p><p><strong>Results: </strong>The study included 122 infants with and 46 infants without prior ETV/CPC who underwent VPS placement. There were no statistically significant differences between groups regarding sex, race, gestational age at birth, or corrected age at initial treatment for hydrocephalus. The distribution of etiologies and initial frontal-occipital horn ratios (FOHRs) were similar. The median pre-shunt FOHR was greater in the ETV/CPC group. The patients in the primary shunt placement group were all candidates for ETV/CPC based on retrospective review. Seventy-one infants (58%) with prior ETV/CPC remained free of shunt revision compared with 17 infants (37%) with primary shunt placement (OR 2.4, 95% CI 1.1-5.1; p = 0.01). The estimated 2-year shunt survival probability was 75% with and 50% without prior ETV/CPC (log-rank p = 0.001). The estimated 5-year survival was 60% with and 45% without prior ETV/CPC (p = 0.045).</p><p><strong>Conclusions: </strong>Infants who underwent ETV/CPC prior to VPS placement had better shunt survival than those who did not. ETV/CPC might reduce the risk of subsequent shunt failure, indicating the potential benefit of the procedure even when it fails.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"494-499"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648737","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}