Journal of neurosurgery. Pediatrics最新文献

{"title":"Thalamic neuromodulation for pediatric drug-resistant epilepsy: a case series evaluating deep brain stimulation and responsive neurostimulation.","authors":"Dominic Nistal, Benjamin Edmonds, Adriel Barrios-Anderson, Scott Boop, Shiyu Elena Wang, Matthew J Recker, Jeffrey G Ojemann, Edward Novotny, Robert T Buckley, Jason S Hauptman, Hannah E Goldstein","doi":"10.3171/2026.3.PEDS25489","DOIUrl":"10.3171/2026.3.PEDS25489","url":null,"abstract":"<p><strong>Objective: </strong>Children with generalized or multifocal drug-resistant epilepsy (DRE) without a clearly localizable and safely resectable seizure focus present a significant clinical challenge, as traditional resective interventions are often not viable. Emerging evidence supports the use of neuromodulation-particularly deep brain stimulation (DBS) and responsive neurostimulation (RNS)-for generalized and multifocal epilepsy in adults. However, safety and efficacy data for thalamic neuromodulation in pediatric populations remain limited. This single-institution case series describes, to our knowledge, the largest pediatric cohort treated with thalamic DBS or RNS for generalized or multifocal DRE, providing descriptive data on safety and seizure burden.</p><p><strong>Methods: </strong>The authors performed a retrospective chart review of pediatric patients with DRE who underwent thalamic neuromodulation using RNS or DBS at Seattle Children's Hospital between January 2020 and July 2025 with at least 6 months of follow-up. Clinical, surgical, and seizure outcome data were collected, including seizure frequency and complications. Seizure outcomes were stratified into categorical frequency bins, and a trend analysis was performed to evaluate postoperative shifts in seizure burden.</p><p><strong>Results: </strong>Twenty-six patients (mean age 14.5, range 6-20 years) underwent thalamic neuromodulation with DBS (n = 12) or RNS (n = 14). The centromedian nucleus was the target in 24 cases; 1 patient each underwent targeting of the anterior nucleus and pulvinar nucleus. At the last follow-up (median 30.2 months), 65.4% of patients met the responder criteria (≥ 50% seizure reduction), with a higher response in the DBS group (83.3%) compared with the RNS group (50.0%). The median seizure reduction was 75.7% for DBS and 37.5% for RNS. A significant downward shift in seizure frequency was observed postoperatively across the entire cohort (p = 0.031), including among patients with the highest baseline seizure burden. No intraoperative complications occurred. Two patients (7.7%) required device explantation, 1 due to infection and 1 due to behavioral side effects, and 1 patient discontinued therapy without explantation. No instances of sudden unexpected death in epilepsy or hardware malfunction were observed.</p><p><strong>Conclusions: </strong>Thalamic neuromodulation using DBS and RNS was safe and well tolerated in pediatric patients with DRE, including multifocal and generalized seizure onsets. Meaningful seizure reduction was observed across a range of epilepsy phenotypes, with a trend toward greater benefit in the DBS group. These findings support thalamic neuromodulation as a promising treatment option in children with nonlesional DRE and highlight the need for prospective multicenter studies with extended follow-up.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"456-464"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648702","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 \"mustache sign\": a radiographic biomarker of angiogenic potential in advanced moyamoya disease.","authors":"Rohan Vij, Coleman P Riordan, Liam Shanahan, Emma N Puglisi, Edward R Smith","doi":"10.3171/2026.3.PEDS25629","DOIUrl":"10.3171/2026.3.PEDS25629","url":null,"abstract":"<p><strong>Objective: </strong>Moyamoya disease (MMD) is a progressive arteriopathy of intracranial internal carotid arteries. The authors identified a characteristic angiographic finding associated with arterio-arterial collaterals in which ischemic brain recruits blood supply from the posterior circulation with robust splenial-to-anterior pericallosal artery anastomoses, manifesting as a characteristic \"mustache\" appearance on an anterior-posterior angiogram projection. In this paper, a cohort of pediatric patients with MMD is presented to assess the utility of this finding as a potential marker of disease severity and angiogenic potential and its predictive value for surgical intervention.</p><p><strong>Methods: </strong>A retrospective single-center review of pediatric patients with MMD who underwent bilateral surgical revascularization from 2014 to 2020 was performed. The presence of a mustache sign was determined and its presence or absence was correlated with Suzuki and Matsushima grades and clinical outcome.</p><p><strong>Results: </strong>A total of 100 pediatric patients (200 total hemispheres) with MMD were identified (mean age 11 [SD 7] years). Of the total hemispheres, 12% exhibited a low Suzuki grade (I or II) with the remainder exhibiting a high Suzuki grade (III-VI), and 59% demonstrated a mustache sign. If a mustache sign was present, this demonstrated a 94% positive predictive value for the presence of a high Suzuki grade and 77% positive predictive value for a Matsushima grade A/B outcome postoperatively.</p><p><strong>Conclusions: </strong>As MMD severity correlated with the development of different forms of collateralization, a unique angiographic finding of a mustache sign is highlighted, which is seen in advanced MMD and indicates robust arterio-arterial collateralization with anticipated benefit from surgical revascularization.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"531-536"},"PeriodicalIF":2.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648730","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":"Natural history of filum terminale lipoma and low-set conus medullaris.","authors":"Kenichiro Nagai, Hideki Ogiwara","doi":"10.3171/2026.3.PEDS25539","DOIUrl":"10.3171/2026.3.PEDS25539","url":null,"abstract":"<p><strong>Objective: </strong>Filum terminale lipoma and low-set conus medullaris may cause tethered cord syndrome; however, the natural course of these lesions has not yet been fully elucidated. In this study, the authors investigated the natural history of filum terminale lipoma and low-set conus medullaris.</p><p><strong>Methods: </strong>The authors retrospectively analyzed the data of patients who were diagnosed with filum terminale lipoma or low-set conus medullaris and followed without untethering surgery. Cases with a follow-up period of < 12 months were excluded.</p><p><strong>Results: </strong>From 2010 to 2021, 1070 cases were diagnosed with filum terminale lipoma and/or low-set conus medullaris on initial lumbar MRI at our hospital. Of these, 960 cases underwent untethering surgery after initial diagnosis. One hundred ten cases were followed without untethering surgery. Of these cases, 92 were evaluated, excluding those with a follow-up period of < 12 months. Among those, 12 cases had abnormal findings on initial cystography or abdominal ultrasound and were considered symptomatic, while 80 cases were asymptomatic. Of the 12 symptomatic cases, 3 (25%) developed worsening or new symptoms. These 3 cases underwent untethering surgery, with 2 (67%) showing improvement in symptoms and 1 remaining unchanged. During follow-up, 21 of 80 asymptomatic cases (26%) developed symptoms. Among these, 14 cases had filum terminale lipoma and 8 cases had low-set conus medullaris (1 case had both). Of these, 19 cases underwent untethering surgery; 10 cases (53%) improved, 2 cases remain unchanged, and the results of 7 cases are unknown.</p><p><strong>Conclusions: </strong>In this study, 26% of asymptomatic patients with filum terminale lipoma or low-set conus medullaris eventually developed symptoms, and 25% of symptomatic patients had worsening or new symptoms. These incidence rates should be considered when discussing preventive surgery for these lesions.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"555-560"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583953","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 Pediatric Section Research Group: a framework for collaborative multicenter research through the AANS/CNS Section on Pediatric Neurological Surgery.","authors":"David S Hersh, Todd C Hankinson, Allyson L Alexander, Ruth E Bristol, Mari L Groves, George M Ibrahim, Rajiv R Iyer, Paul Klimo, Amy Lee, David D Limbrick, Samuel G McClugage, Vijay M Ravindra, Brandon G Rocque, Jonathan P Scoville, Alfred P See, Matthew D Smyth, Eric A Sribnick, Jennifer M Strahle, Mandeep S Tamber, Alexander M Tucker, Richard C E Anderson","doi":"10.3171/2026.3.PEDS2647","DOIUrl":"https://doi.org/10.3171/2026.3.PEDS2647","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":"38 4","pages":"610-616"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110527","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":"Age at referral for sagittal suture synostosis: a decreasing trend in 20 years.","authors":"Idilay Kaymaz, Victor L van Roey, Irene M J Mathijssen, Elin L Weissbach, Jacoba Kats, Marie-Lise C Van Veelen, Martijn J Cornelissen","doi":"10.3171/2026.3.PEDS25569","DOIUrl":"10.3171/2026.3.PEDS25569","url":null,"abstract":"<p><strong>Objective: </strong>Early referral of patients with suspected sagittal suture synostosis is important as it enables minimally invasive surgery. To encourage early referrals, the authors' craniofacial center has increased its efforts to educate referring healthcare providers. This study evaluated the developments of timely referral and age at referral of patients with sagittal suture synostosis.</p><p><strong>Methods: </strong>Nonsyndromic patients born between 2000 and 2020 were included in this cohort study. The type of surgery was mainly based on age at referral: frontobiparietal remodeling was done if the patient was older than 6 months of age, and a minimally invasive procedure was done if the patient was younger. Logistic regression was performed to assess the relationship between the year of birth and the probability of a timely first visit (i.e., before 5.5 months).</p><p><strong>Results: </strong>A total of 698 patients were included, with a median age at first visit of 3.6 months. Of the patients born in 2000, 60% had their first visit before the age of 5.5 months, compared to 77% of those born in 2020. Since 2010, there has been a statistically significant positive association between the year of birth and the probability of having the first visit on time (OR 1.10, 95% CI 1.03-1.18). Overall, pediatricians were the most frequent referrers.</p><p><strong>Conclusions: </strong>The proportion of timely referred patients with nonsyndromic sagittal suture synostosis has increased over the past 20 years, and since 2010, there has been a statistically significant increase in the probability of timely referral, allowing for more patients to be treated with minimally invasive spring-assisted correction. Further efforts are needed to increase timely referrals and raise awareness among parents and healthcare providers.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"548-554"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584538","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 of environmental exposures and area-level socioeconomic status with pediatric hydrocephalus outcomes.","authors":"Yifei Sun, Heather H Johnson, Anastasia Arynchyna-Smith, Michael J Feldman, Curtis J Rozzelle, James M Johnston, Jeffrey P Blount, Brandon G Rocque","doi":"10.3171/2026.3.PEDS2615","DOIUrl":"10.3171/2026.3.PEDS2615","url":null,"abstract":"<p><strong>Objective: </strong>Previous research has identified an association of socioeconomic status with poor health outcomes related to the treatment of pediatric hydrocephalus. However, the impact of environmental exposures and neighborhood disadvantage remains unexplored. The authors sought to determine how these factors affect hydrocephalus outcomes.</p><p><strong>Methods: </strong>This study is an analysis of prospectively collected registry data of pediatric hydrocephalus patients from 2008 to 2023 at a single institution. Geospatial analysis was conducted using the patient's address at the time of the initial procedure for treatment of hydrocephalus. Socioeconomic status was quantified using the Area Deprivation Index (ADI), and environmental exposure data were obtained from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and satellite-derived ground-level fine particulate matter, linked to patients' addresses using hospital administrative data. Multivariable Cox regressions with robust standard errors to adjust for clustering of area-level measures were utilized to assess the independent association of neighborhood and environmental factors with shunt revisions and complications.</p><p><strong>Results: </strong>In total, 881 patients who underwent primary shunt insertion for nontraumatic etiologies were included. The median (IQR) ADI percentile was 78 (61-90). The most common hydrocephalus etiology was intraventricular hemorrhage of prematurity (33%), followed by myelomeningocele (12%). At the latest follow-up, 48% of patients had experienced at least one shunt failure. The median (IQR) follow-up duration was 5.6 (1-11) years. In a multivariable Cox proportional hazards model, high ozone exposure areas (HR 1.38, 95% CI 1.05-1.82) and high ADI (HR 1.46, 95% CI 1.15-1.86) were independently associated with an increased risk of failure. High coal exposure was associated with an increased risk of shunt infection (HR 1.92, 95% CI 1.28-2.88). High PM2.5 (particulate matter with a diameter ≤ 2.5 μm) was also significantly associated with increased all-cause mortality (HR 3.16, 95% CI 1.11-8.99).</p><p><strong>Conclusions: </strong>Exposure to environmental toxins and elevated neighborhood disadvantage are associated with worse outcomes in children with hydrocephalus. Environmental exposure may increase inflammatory pathways in children and reflect poor socioeconomic status. These results highlight social and environmental risk factors that warrant further investigation through biochemical or qualitative means.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"500-511"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583968","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":"Neurocognitive profile of pediatric moyamoya disease with posterior cerebral artery involvement.","authors":"Kanade Tanaka, Yusuke Kusano, Takeshi Funaki, Noyuri Nishida, Ami Tabata, Tsukasa Ueno, Hideo Chihara, Yohei Mineharu, Keita Ueda, Sachi Okuchi, Katsuhiko Mitsumoto, Ryosuke Ikeguchi, Yoshiki Arakawa","doi":"10.3171/2026.3.PEDS2641","DOIUrl":"10.3171/2026.3.PEDS2641","url":null,"abstract":"<p><strong>Objective: </strong>While posterior cerebral artery (PCA) involvement in moyamoya disease (MMD) is associated with poor educational and social outcomes, its specific impact on neurocognitive function remains unclear. The aim of this study was to clarify the neurocognitive profile of pediatric patients with MMD with PCA involvement.</p><p><strong>Methods: </strong>This cross-sectional study included pediatric patients with MMD who underwent baseline neuropsychological assessment at a single institution between June 2016 and December 2023. Neurocognitive function was evaluated using the Das Naglieri Cognitive Assessment (CAS) system and the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). Profiles were compared between patients with and without PCA involvement using multivariate ANOVA (MANOVA), followed by multiple linear regression analyses. Regional cerebral blood flow was assessed using 3D stereotactic surface projection analysis and the stereotactic extraction estimation method.</p><p><strong>Results: </strong>Fifty-two patients, including 11 with PCA involvement and 41 without, were analyzed. MANOVA revealed significant overall between-group differences across the 4 CAS domains and the 4 WISC-IV index scores. Post hoc comparisons showed that patients with PCA involvement had significantly lower scores in the CAS planning domain (p < 0.001) and WISC-IV processing speed index (p = 0.002), both of which involve timed tasks requiring visual scanning, number matching, connecting ordered sequences, and symbol coding. PCA involvement remained significantly associated with these deficits after adjustment for confounders. Patients with PCA involvement exhibited more severe hypoperfusion in the temporo-parieto-occipital regions than those without PCA involvement.</p><p><strong>Conclusions: </strong>Patients with MMD with PCA involvement exhibited a distinct neurocognitive profile characterized by weakness in visual processing speed and visual search, accompanied by hypoperfusion in the temporo-parieto-occipital regions. Early identification of these deficits could facilitate targeted educational and rehabilitative support, and long-term postoperative evaluation is required.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"521-530"},"PeriodicalIF":2.2,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583951","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":"Patient risk factors for 30-day unplanned readmission after pediatric neurosurgery: are we improving?","authors":"Sina Sadeghzadeh, Shaila D Ghanekar, Paul Serrato, Ethan D L Brown, Apratim Maity, Michael DiLuna, Aladine A Elsamadicy","doi":"10.3171/2026.2.PEDS25600","DOIUrl":"10.3171/2026.2.PEDS25600","url":null,"abstract":"<p><strong>Objective: </strong>Thirty-day unplanned readmission is a key quality metric in pediatric neurosurgery, yet contemporary drivers of readmission in pediatric neurosurgery and whether outcomes are improving remain unknown. Thus, the authors assessed temporal readmission trends and evaluated patient- and hospital-level predictors of 30-day unplanned readmissions across major pediatric neurosurgical procedures.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program Pediatric data (2012-2023). Children who underwent CSF shunt placement or revision, craniosynostosis repair, tumor surgery, Chiari decompression, spine procedures, or myelomeningocele closure were included. The primary outcome was 30-day unplanned readmission; secondary endpoints were unplanned reoperation, length of hospital stay (LOS), and mortality. Multivariable logistic regression was used to identify independent predictors, including era of treatment (2012-2017 vs 2018-2023).</p><p><strong>Results: </strong>Among 95,104 procedures, readmissions decreased from 10.8% in 2012-2017 to 9.1% in 2018-2023 (p < 0.001), and the later era independently lowered the readmission risk (adjusted OR [aOR] 0.80, 95% CI 0.76-0.84). Unplanned reoperations decreased (from 10.4% to 9.6%, respectively, p < 0.001), LOSs shortened (from 6.89 to 5.92 days, respectively, p < 0.001), and mortality was unchanged (0.5%). Relative to those for shunt placement, readmission odds were higher after shunt revision or removal (aOR 1.28, 95% CI 1.19-1.37) and lower after craniosynostosis repair (aOR 0.26, 95% CI 0.22-0.30), Chiari decompression (aOR 0.62, 95% CI 0.56-0.69), and spine procedures (aOR 0.51, 95% CI 0.46-0.56). The readmission risk increased with a higher American Association of Anesthesiologists class (1 vs 3: aOR 1.77, 95% CI 1.48-2.12; 1 vs ≥ 4: aOR 1.76, 95% CI 1.44-2.15), nonelective case status (emergency: aOR 1.36, 95% CI 1.27-1.45), and longer anesthesia time (aOR 1.08, 95% CI 1.06-1.09). Early postoperative complications were the strongest correlates for readmission risk: organ/space surgical site infection (SSI; aOR 19.01, 95% CI 16.77-21.55) and superficial SSI (aOR 8.68, 95% CI 7.69-9.80).</p><p><strong>Conclusions: </strong>Pediatric neurosurgical readmissions have improved over the past decade, but risk remains concentrated after shunt revision or removal and among nonelective, high complexity cases, highlighting targets for quality improvement and perioperative efficiency.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"590-598"},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470981","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":"Intrathecal baclofen pump infection management: immediate versus delayed reimplantation. A single-center, 24-year experience.","authors":"Joseph H McAbee, Patrick F O'Brien, Saige Teti, Suresh N Magge, Chima O Oluigbo, Robert F Keating","doi":"10.3171/2026.2.PEDS25438","DOIUrl":"10.3171/2026.2.PEDS25438","url":null,"abstract":"<p><strong>Objective: </strong>Intrathecal baclofen (ITB) pumps (ITBPs) are commonly used to provide symptomatic relief and facilitate patient care for children with spasticity. Unfortunately, patients are at long-term risk for device-related infections. Removal of infected pumps can require complicated, prolonged hospital stays for systematic reduction of preexisting high doses of ITB. The management strategy for ITBP infections has not been clearly defined. In this study, the authors sought to determine whether immediate reimplantation after wound washout is a viable strategy when managing ITBP infections rather than the more standard-of-care approach of removal and delayed reimplantation.</p><p><strong>Methods: </strong>A retrospective review was performed for patients who underwent ITBP placement at Children's National Hospital from 1999 to 2023 (24 years) with subsequent infection requiring removal and reimplantation. Demographics, timing of reimplantation, and outcomes were collected. Statistical analysis was performed with unpaired t-tests.</p><p><strong>Results: </strong>Over 24 years, 356 baclofen pump implantation surgeries were performed with an overall infection rate of 9.8%. Seven patients underwent ITBP removal and delayed reimplantation, and 16 underwent washout with immediate reimplantation followed by extended intravenous antibiotic therapy. There was a statistically significant decrease/wean in ITB dose prior to surgery in the delayed group compared with the immediate reimplantation group (dose decreased by a mean of 209.1 vs 15.6 μg/day, p = 0.01) with a resultant increase in preoperative length of stay for baclofen weaning (2.57 vs 1.19 days), overall hospital stay (mean 13.14 vs 7.63 days), and postoperative baclofen withdrawal (42.9% vs 6.3%, p = 0.03). There was a significantly increased risk of reinfection in the immediate reimplantation cohort (63% vs 14%, p = 0.03). However, 33% of the patients with successful immediate reimplantation were able to maintain their current baclofen dose and did not require a prolonged ICU stay. Eighty percent of patients who experienced reinfection after immediate reimplantation chose final removal, while 86% of patients who underwent delayed reimplantation still have an existing ITBP.</p><p><strong>Conclusions: </strong>There is a lower risk of reinfection with removal and delayed reimplantation of ITBPs, and more patients in this cohort ultimately maintained their device. However, for patients on high ITB doses, immediate reimplantation in select cases may help to shorten hospital stays and prevent dangerous baclofen withdrawals and is successful for long-term pump utilization (without infection) one-third of the time.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"442-448"},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471202","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. Industrial hydraulic accumulators as a blueprint for next-generation hydrocephalus treatment.","authors":"Muhammad Saqib Hussain, Muhammad Aqib Hussain","doi":"10.3171/2026.3.PEDS26141","DOIUrl":"10.3171/2026.3.PEDS26141","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"617-619"},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470964","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}