Journal of neurosurgery. Pediatrics最新文献

{"title":"Minimum serum cholinesterase levels as a prognostic marker for 6-month outcomes in pediatric traumatic brain injury: a retrospective cohort study.","authors":"Lijuan Zhang, Ming Zhang, Hua Zhang, Weifeng Lu","doi":"10.3171/2026.2.PEDS25464","DOIUrl":"10.3171/2026.2.PEDS25464","url":null,"abstract":"<p><strong>Objective: </strong>Although cholinesterase levels have been linked to disease severity in critically ill patients, their prognostic significance in pediatric traumatic brain injury (TBI) remains uncertain. In this study, the authors investigate the association between minimum cholinesterase levels during hospitalization and 6-month outcomes in children with TBI, as well as the potential dose-response relationship between these factors.</p><p><strong>Methods: </strong>This retrospective cohort study included children with TBI who were admitted to Jiangsu Children's Medical Center between June 2017 and June 2024. Inverse probability of treatment weighting was used to adjust for confounding, fitting weighted outcome regression models and using restricted cubic spline (RCS) regression to evaluate both the association and the dose-response relationship between minimum cholinesterase levels and 6-month Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds) scores. Robustness was assessed through a bootstrap sensitivity analysis with 1000 resamples, and extreme weights were truncated at the 5th and 95th percentiles to minimize the influence of outliers. Stratified analysis by Glasgow Coma Scale (GCS) score (≤ 8 vs > 8) was conducted to assess effect modification.</p><p><strong>Results: </strong>The primary analysis included 370 pediatric patients. Adequate balance was achieved across baseline covariates. Lower minimum cholinesterase levels were significantly associated with higher odds of an unfavorable 6-month GOS-E Peds outcome, even after adjusting for all potential confounders (OR per 1000-unit increase 0.61, 95% CI 0.402-0.912, p = 0.002). RCS analysis showed no evidence of nonlinearity. The association remained robust in the sensitivity analysis. In a stratified analysis by baseline GCS score, the association was stronger in patients with severe TBI (GCS score ≤ 8: OR 0.33, 95% CI 0.18-0.58, p < 0.001) than in those with moderate TBI (GCS > 8: OR 0.68, 95% CI 0.52-0.89, p = 0.004).</p><p><strong>Conclusions: </strong>Lower minimum cholinesterase levels were significantly associated with worse 6-month outcomes in pediatric TBI. Routine monitoring of cholinesterase levels may help identify high-risk pediatric patients with TBI, but further studies are needed to validate its prognostic value.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"475-482"},"PeriodicalIF":2.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470950","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":"Beyond total scores: symptom composition as a predictor of recovery according to concussion history.","authors":"Nick De Oliveira, Clayton R Baker, Jai Horsey, Kristen L Williams, Scott L Zuckerman, Douglas P Terry","doi":"10.3171/2026.2.PEDS25657","DOIUrl":"10.3171/2026.2.PEDS25657","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to determine whether early symptom cluster composition at presentation predicts recovery after sport-related concussion, and whether these associations differ by concussion history.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors conducted a retrospective cohort study of athletes aged 12-22 years who were evaluated at their regional concussion center between November 2017 and April 2022. Cluster ratios for cognitive, somatic, and emotional symptoms were calculated as domain sums divided by the initial Post-Concussion Symptom Scale (PCSS) score. Primary outcomes were the number of days to return to learn (RTL), symptom resolution (SR), and return to play (RTP). Multivariable linear regression models were fit separately for athletes with no prior concussion and for those with ≥ 1 prior concussion, entering all three cluster ratios and adjusting for age, sex, time to presentation, and a history of attention-deficit/hyperactivity disorder, migraine, and psychiatric conditions. Effect modification was assessed using a hierarchical full-cohort model that included a cognitive ratio × number of prior concussions interaction term. Kaplan-Meier curves were used to assess recovery across strata defined by prior concussion (yes/no) and high versus low cognitive burden (median split), with groups compared using log-rank tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 2086 screened patients, 476 met the inclusion criteria (58.4% with no prior concussion and 41.6% with ≥ 1 prior concussion). Athletes with prior concussion were older (mean age 16.43 ± 1.92 vs 15.67 ± 1.55 years, p &lt; 0.001), more often White (87.8% vs 76.3%, p = 0.011), presented later (mean 3.59 ± 3.34 days vs 2.86 ± 3.13 days, p = 0.016), and had similar initial PCSS scores (mean 29.39 ± 22.07 vs 28.32 ± 22.82, p = 0.607), but longer RTP (mean 33.40 ± 24.46 days vs 27.50 ± 22.34 days, p = 0.017). In multivariable models, symptom cluster ratios were not associated with RTL, SR, or RTP in the no prior concussion group. In the prior concussion group, a higher cognitive cluster ratio was associated with longer RTL (p = 0.020) and independently predicted longer SR (p = 0.003). In whole-cohort models, the interaction between cognitive ratio and prior concussion was significant for SR (p = 0.005), indicating that the adverse impact of cognitive-dominant profiles on recovery increased with the number of prior concussions. Kaplan-Meier analyses showed stepwise delays in RTL, SR, and RTP across cognitive burden-prior concussion strata (SR: log-rank χ2(3) = 10.62, p = 0.014; RTP: χ2(3) = 10.48, p = 0.015; RTL: χ2(3) = 8.10, p = 0.044), with the slowest recovery demonstrated in the group with prior concussion and high cognitive burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Symptom composition at presentation is prognostic primarily in athletes with prior concussion. Cognitive-dominant profiles predicted slower SR and RTL in this subgroup, and the adverse effect ","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"465-474"},"PeriodicalIF":2.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421760","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 and affective dysfunction in Chiari malformation type I.","authors":"William Davalan, Neel H Mehta, Andrew T Hale, Qiang Li, Baojian Fan, William Munoz, Adam J Kundishora, Phan Q Duy, William E Butler, Kristopher T Kahle","doi":"10.3171/2026.2.PEDS25432","DOIUrl":"10.3171/2026.2.PEDS25432","url":null,"abstract":"<p><strong>Objective: </strong>Chiari malformation type I (CM-I) is traditionally conceptualized as a structural disorder of the posterior cranial fossa characterized by cerebellar tonsillar herniation. However, increasing clinical and experimental evidence suggests that CM-I may be associated with distributed neurocognitive and affective sequelae consistent with cerebellar network dysfunction.</p><p><strong>Methods: </strong>The authors conducted a PRISMA-compliant systematic review of the MEDLINE and Embase databases from database inception through November 2025 to identify studies reporting standardized neuropsychological outcomes in pediatric and adult patients with CM-I. Given substantial heterogeneity in study design, cognitive instruments, and outcome reporting, findings were synthesized using a structured narrative approach. Methodological quality was assessed using an adapted Newcastle-Ottawa Scale and mapped to Agency for Healthcare Research and Quality criteria.</p><p><strong>Results: </strong>Thirty-four studies comprising 2113 individuals with CM-I met inclusion criteria. Across pediatric and adult cohorts, selective cognitive vulnerabilities were most consistently observed in complex attention, executive function, visuospatial processing, learning and memory, language, and higher-order social cognition. These profiles closely resembled features of cerebellar cognitive affective syndrome. Cognitive deficits varied by developmental stage and were modulated by chronic pain, psychiatric comorbidity, and neurodevelopmental factors. Advanced neuroimaging studies demonstrated widespread disruption of cerebello-thalamo-cortical and cortico-ponto-cerebellar networks. Reported effects of posterior fossa decompression on neurocognitive outcomes were heterogeneous and inconsistent across domains and study designs.</p><p><strong>Conclusions: </strong>The available evidence supports reconceptualizing CM-I as a heterogeneous, large-scale brain network disorder with clinically meaningful cognitive and affective consequences in a subset of patients. Integration of domain-specific neuropsychological assessment into routine clinical evaluation may improve prognostication and guide future mechanism-based interventions.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"570-581"},"PeriodicalIF":2.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421758","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":"Development of the superficial temporal artery in pediatric patients: considerations for surgical revascularization.","authors":"Allison S Liang, Samuel A Tenhoeve, Michael T Bounajem, Craig J Kilburg, Karol P Budohoski, Ramesh Grandhi, Michael L Levy, Vijay M Ravindra, William T Couldwell, Robert C Rennert","doi":"10.3171/2026.2.PEDS25616","DOIUrl":"10.3171/2026.2.PEDS25616","url":null,"abstract":"<p><strong>Objective: </strong>The size of the superficial temporal artery (STA) is a key consideration for pediatric patients with moyamoya disease or arteriopathies requiring intracranial perfusion augmentation. For selected patients, STA-to-middle cerebral artery bypass is considered. Because STA lumen diameter is critical to the success of this procedure, the authors aimed to characterize STA growth from infancy to adulthood.</p><p><strong>Methods: </strong>This single-institution retrospective analysis included patients in 6 age groups (0-3 years old, 4-7 years old, 8-11 years old, 12-15 years old, 16-18 years old, and > 18 years old) without disease or trauma that could affect STA morphology who underwent computed tomography angiography of the head. The diameters of the left and right STAs were measured at the main branch at the level of the zygoma and at the frontal and parietal branches at the level of the orbit. Differences were assessed via 1-way analysis of variance and post hoc analyses. In a subanalysis, the STA lumen diameters of the 0- to 3-year-old patients were modeled via a logistic growth model.</p><p><strong>Results: </strong>A total of 10 patients were included in each age category, resulting in 120 STAs from 60 patients. The mean ± SD main branch STA diameters by age were 2.0 ± 0.47, 2.6 ± 0.44, 2.4 ± 0.37, 2.5 ± 0.30, 2.4 ± 0.28, and 2.6 ± 0.33 mm. The mean frontal branch diameters were 1.6 ± 0.55, 2.2 ± 0.51, 2.3 ± 0.39, 2.2 ± 0.20, 2.4 ± 0.28, and 2.3 ± 0.39 mm, and the mean parietal branch diameters were 1.5 ± 0.54, 2.2 ± 0.45, 2.1 ± 0.45, 2.3 ± 0.46, 2.1 ± 0.43, and 2.1 ± 0.30 mm by age group. Children aged 0-3 years had significantly smaller diameters compared with all other age groups (p < 0.001). During peak STA growth (0-3 years), the main, frontal, and parietal STA growth rates were 33.6%, 21.9%, and 31.0% per year, respectively.</p><p><strong>Conclusions: </strong>STA maturation mostly occurs in the first 3 years of life. STA growth patterns can assist with operative planning for pediatric patients with vascular pathologies requiring direct bypass.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"395-400"},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382218","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":"Impact of handheld and wearable electronics on programmable shunt valves.","authors":"Minjun Park, Maaria Chaudhry, Nabiha Quadri, Joanna Kemp","doi":"10.3171/2026.2.PEDS25125","DOIUrl":"10.3171/2026.2.PEDS25125","url":null,"abstract":"<p><strong>Objective: </strong>CSF diversion through ventricular shunt placement is a mainstay of hydrocephalus treatment, and the advent of programmable shunt valves in the last 40 years has continued to improve treatment options. Programmable shunt valves allow noninvasive setting adjustment with magnetic programming devices. However, since there are objects in everyday life that emit magnetic fields, the shunt valve setting may be unintentionally changed. The authors aimed to summarize the current literature on handheld, wearable, and earpiece devices and their impact on programmable shunts, as well as explore the effect of the magnetic field of handheld and wearable electronics when actively in use in common positions on programmable shunt valve settings.</p><p><strong>Methods: </strong>The following reprogrammable shunt valves were tested: Medtronic Strata II, Codman Hakim, and Codman Certas. The electronic devices used were Apple AirPods Pro 2, Bose QC 45, Oculus Meta Quest 3, Apple iPad 6, and Apple iPhone 15. A shunt valve with a predetermined setting was attached to the skull model in the right parieto-occipital and right frontal locations. The devices in their active mode were placed on or around the ear for a minimum of 5 minutes. The shunt valve setting was then rechecked. As rotary motion may impact magnetic fields, secondary testing with various motions was performed and the shunt setting was rechecked.</p><p><strong>Results: </strong>The programmable shunt valves were set as follows: Medtronic Strata II at 1.5, Codman Hakim at 70 mm H2O, and Codman Certas at 4. After a minimum of 5 minutes of realistic interaction with the aforementioned electronics, the shunt setting was rechecked. The shunt setting remained the same in each case tested.</p><p><strong>Conclusions: </strong>It is safe for children and adults with hydrocephalus and programmable shunt valves to use common handheld and wearable electronics without concern for their shunt valve setting being affected unknowingly.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"335-340"},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382249","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":"Who are we training and where do they go? Trends in demographics in the pediatric neurosurgery workforce.","authors":"Danielle Wishart, Bianca Luna-Lupercio, Logan Muzyka, Michael J Feldman, Susan R Durham, Natalie Limoges","doi":"10.3171/2025.12.PEDS25211","DOIUrl":"10.3171/2025.12.PEDS25211","url":null,"abstract":"<p><strong>Objective: </strong>There has been a steady increase in the number of pediatric neurosurgery fellowship applicants and positions. As more trainees graduate pediatric fellowships, it is important to identify demographic trends, and how and where graduates ultimately practice. The purpose of this study was to investigate trends over time in the demographics and practice settings of fellowship-trained pediatric neurosurgeons.</p><p><strong>Methods: </strong>A database of all Accreditation Council for Pediatric Neurosurgery Fellowships (ACPNF) graduates since 1992 was compiled using data from the San Francisco Match and publicly available sources. ACPNF graduates were sent a survey to self-report demographic data (gender, race, and ethnicity). Trends in demographic data were evaluated, and subgroup analyses were performed by comparing practice setting, gender, and graduates by decade of graduation.</p><p><strong>Results: </strong>As of June 2024, 525 individuals have completed a pediatric neurosurgery fellowship, with an additional 25 matched to graduate in 2025. Female representation increased from 0% in the first fellowship graduating class of 1993 compared with 46.4% in 2023. Among the 152 individuals who self-reported race, 71.7% identified as non-Hispanic White. The highest proportion of graduates practicing in free-standing academic pediatric hospitals are those who completed fellowship between 2011 and 2020 (58.1%), followed by graduates from 2021 onward (56.2%). International medical graduates were significantly less likely to practice in a free-standing hospital (OR 0.37 [95% CI 0.24-0.57], p < 0.0001).</p><p><strong>Conclusions: </strong>As the number of fellowship graduates continues to increase, a substantial proportion continue to not secure positions in free-standing pediatric hospitals. Additionally, the number of women pursuing pediatric neurosurgery continues to increase, while data on race and ethnicity remain limited. Continued ongoing data collection is crucial for monitoring these demographic trends over time.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"603-609"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339029","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":"Correlation of noninvasive near-infrared spectroscopy with outcomes in pediatric traumatic brain injury.","authors":"Ellie D Gabriel, Nankee K Kumar, Kumaran Senthil, Claudia Hejazi-Garcia, Clara Wang, Ayush Lacoul, Vanessa Mazandi, Mix Wannasarnmetha, Aashim Bhatia, Alexander M Tucker, Phillip B Storm, Tracy M Flanders, Gregory G Heuer, Benjamin C Kennedy, Matthew Kirschen, Alexis Topjian, Conall Francoeur, Ian Yuan, Chong Tae Kim, Todd J Kilbaugh, Jimmy W Huh, Shih-Shan Lang","doi":"10.3171/2026.2.PEDS25567","DOIUrl":"10.3171/2026.2.PEDS25567","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric traumatic brain injury (TBI) is a major cause of morbidity and mortality. Preventing cerebral hypoxia and hypoperfusion is crucial. Near-infrared spectroscopy (NIRS), which measures regional cerebral oxygen saturation (rSO2), may provide a noninvasive method of identifying impaired cerebral oxygenation. Whether NIRS correlates with physiological variables or clinical changes following pediatric TBI is unknown, and its relationship with invasive intracranial pressure (ICP), cerebral perfusion pressure (CPP), and brain tissue oxygenation (PbtO2) is poorly defined.</p><p><strong>Methods: </strong>This retrospective exploratory study used electronic health records from 2016 to 2022 at a quaternary children's hospital. Patients ≤ 18 years of age with moderate or severe TBI (admission Glasgow Coma Scale [GCS] score ≤ 12) who underwent bilateral frontal NIRS monitoring and intubation for ≥ 48 hours were included. The repeated-measures correlation test, Mann-Whitney U-test, and Kruskal-Wallis test assessed associations and differences between NIRS rSO2 and 1) physiological values (respiratory, hemodynamic, systemic temperature), 2) ICP, CPP, and PbtO2 at clinically relevant thresholds, 3) EEG-confirmed seizures, 4) intracranial hemorrhage, and 5) outcomes (admission GCS score, 6-month Glasgow Outcome Scale-Extended [GOS-E] score, and length of stay [LOS] in the pediatric intensive care unit [PICU] and hospital). Significance was defined as p < 0.05 and correlation coefficient |r| > 0.10.</p><p><strong>Results: </strong>Seventy-two patients were included. NIRS rSO2 positively correlated with systolic blood pressure (right, r = 0.12, p < 0.001) and PbtO2 ≥ 20 mm Hg (left, r = 0.30; right, r = 0.25; p < 0.001), and NIRS rSO2 correlated negatively with systemic temperature (left, r = -0.14, p < 0.001) but not with ICP ≥ 20 mm Hg, mean arterial pressure, or suboptimal/ischemic PbtO2 levels. While not statistically significant, NIRS rSO2 trended higher following seizure and lower with hemorrhage. Bilateral NIRS rSO2 positively correlated with initial GCS score (left, r = 0.393, p = 0.001; right, r = 0.30, p = 0.018) and GOS-E score at 6 months (left, r = 0.315, p = 0.0161; right, r = 0.429, p = 0.0011) but not with PICU or hospital LOS.</p><p><strong>Conclusions: </strong>NIRS rSO2 demonstrated significant correlations with select physiological parameters, including invasive optimal PbtO2 levels and acute outcomes (GCS and GOS-E scores), but not with respiratory measures, invasive neuromonitoring during ICP crisis or brain tissue ischemia, seizures, or intracranial hemorrhage. These findings suggest that noninvasive NIRS in its current state cannot reliably predict many physiological or clinical changes important for moderate to severe pediatric TBI or substitute invasive neuromonitoring.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"352-360"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338973","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 Supreme Court of New Jersey has done a disservice to victims of abusive head trauma.","authors":"Gregory W Albert","doi":"10.3171/2026.4.PEDS2699","DOIUrl":"10.3171/2026.4.PEDS2699","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"424-425"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338976","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. Training pediatric neurosurgeons: but where in the world do they go?","authors":"Edward S Ahn","doi":"10.3171/2026.1.PEDS25646","DOIUrl":"10.3171/2026.1.PEDS25646","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"599-602"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338934","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":"Comparison of outcomes after occipitocervical fusion in adult versus pediatric patients: the University of Oklahoma experience.","authors":"Parth Patel, Matthew Jea, Andrew Jea","doi":"10.3171/2026.2.PEDS25579","DOIUrl":"10.3171/2026.2.PEDS25579","url":null,"abstract":"<p><strong>Objective: </strong>Occipitocervical fusion (OCF) is a well-established technique for stabilizing the craniovertebral junction in cases of trauma, congenital malformation, degenerative changes, infection, or neoplasm. Although numerous studies have evaluated outcomes in isolated adult or pediatric cohorts, no direct comparisons between these populations have been published. The authors hypothesized that OCF is better tolerated in pediatric patients, with lower complication rates and superior functional recovery.</p><p><strong>Methods: </strong>A retrospective analysis of patients who underwent OCF between March 2021 and August 2023 at a single institution was conducted. Patients with ≥ 6 months' follow-up or those who died within 6 months of surgery were included in the analysis. The patients' clinical symptoms, radiographic fusions, complication rates, and responses to the 3-item Occipitocervical Fusion Outcomes Survey (OFOS-3) were assessed. The OFOS-3 is a novel, 3-question, patient- or parent-reported outcomes tool for evaluating pain, function, and head and neck mobility.</p><p><strong>Results: </strong>Twenty-four patients, 11 adult and 13 pediatric, were included in this study. The mean follow-up for the patients who survived at least 6 months after surgery was 30 months (range 7-51 months). Fusion levels most commonly ranged from the occiput to C4 in adult patients and the occiput to C2 in pediatric patients, with screw lengths ranging from 6 to 24 mm and screw diameters ranging from 3.0 to 4.5 mm. Adult patients demonstrated a higher complication rate (27.3%) than pediatric patients (0%); however, complication rates were not significantly different between the two. In comparing adult and pediatric patients, the OFOS-3 overall scores were statistically different (p = 0.037), but the OFOS-3 component scores were not. CT-proven fusion was achieved in all patients who had ≥ 6 months' follow-up. There were no significant differences in non-age-related demographics (sex, indication for surgery, American Society of Anesthesiologists status), procedure-related factors (operative time, estimated blood loss, size of spinal instrumentation), and outcomes (length of stay, intensive care unit placement, OFOS-3 scores).</p><p><strong>Conclusions: </strong>OCF appears to be safe and effective in both adult and pediatric populations, with similar surgical and functional outcomes observed. The OFOS-3 may be more sensitive at revealing clinical differences than the individual measures of pain, function, and head and neck mobility. Further prospective studies are warranted to validate the comparative findings between adult and pediatric patients, as well as the OFOS-3 instrument.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"290-299"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338904","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}