Journal of neurosurgery. Pediatrics最新文献

{"title":"Prognostic scores in pediatric gunshot-induced traumatic brain injury: comparative analysis.","authors":"Jai C Trivedi, Makda G Mulugeta, Anna V Baer, Jacob Lepard, Joshua J Chern, Andrew Reisner, Laura S Blackwell","doi":"10.3171/2026.2.PEDS25619","DOIUrl":"10.3171/2026.2.PEDS25619","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the prognostic performance of the Baylor, St. Louis, and Surviving Penetrating Injury to the Brain (SPIN) scoring systems for mortality and neurosurgical intervention in children with gunshot-induced traumatic brain injury (GTBI), clarifying how their differing variable compositions influence accuracy and clinical applicability in pediatric GTBI.</p><p><strong>Methods: </strong>This was a retrospective cohort study of pediatric patients with firearm-related intracranial injuries presenting to a tertiary pediatric trauma center from January 2014 to April 2023. Clinical, laboratory, and neuroimaging variables were abstracted to calculate Baylor, St. Louis, and SPIN scores. Primary outcomes were mortality and neurosurgical intervention (external ventricular drain [EVD] placement, intracranial pressure [ICP] monitor placement, craniotomy, decompressive hemicraniectomy [DHC]). Associations were assessed with univariate and multivariate logistic regressions (α = 0.05). Discrimination was evaluated with receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). Optimal score cut points were derived for clinical utility, and confusion matrix metrics summarized performance. Clinical utility was assessed quantitatively by statistical performance and qualitatively by considering input availability (e.g., CT dependence), motivating a pragmatic, two-step workflow.</p><p><strong>Results: </strong>Eighty-two children (mean age 8.59 ± 4.73 years) met inclusion criteria; mortality occurred in 25.6%, and 54.9% underwent a neurosurgical procedure. All 3 scores were associated with mortality in univariate analyses. In multivariate modeling with age and the scores, the St. Louis score remained the strongest mortality predictor (adjusted OR 1.33, p = 0.013) and showed the highest discrimination (AUC 0.85) with a clinical threshold of 6.5. The SPIN score showed good discrimination (AUC 0.81) with a threshold of 31 and outperformed the Baylor score despite lacking imaging inputs; the Baylor score had lower overall discrimination. For neurosurgical intervention, only EVD placement showed significant univariate associations (St. Louis, SPIN, and age). In multivariate models, St. Louis and SPIN did not retain significance for EVD, but both demonstrated modest discrimination (SPIN AUC 0.671; St. Louis AUC 0.652) and high sensitivity/negative predictive value, supporting use as rule-out tools. No significant associations were observed for ICP monitor placement, craniotomy, or DHC.</p><p><strong>Conclusions: </strong>The authors' findings support a pragmatic, two-step workflow: use the SPIN scale at first contact, before neuroimaging, to inform triage, then apply the St. Louis scale after imaging to refine prognosis. Predefined cut points for mortality (SPIN score ≤ 31; St. Louis score ≥ 7) and EVD placement (SPIN score ≤ 41; St. Louis score ≥ 2) can standardize bedside decision-ma","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"361-369"},"PeriodicalIF":2.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338928","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. The timing dilemma in treating posthemorrhagic ventricular dilatation.","authors":"Kamila M Bond, Sanjana R Salwi, Gregory G Heuer","doi":"10.3171/2026.2.PEDS269","DOIUrl":"10.3171/2026.2.PEDS269","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"300-302"},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283943","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":"Incomplete tumor resection, central neuroradiological review, and second surgery in pediatric patients with intracranial ependymoma treated in the E-HIT2000 trial.","authors":"Kara L Krajewski, Gertrud Kammler, Denise Obrecht-Sturm, Martin Mynarek, Nicolas U Gerber, Björn-Ole Juhnke, Martin Benesch, Carsten Friedrich, André O von Bueren, Robert Kwiecien, Ulrich Thomale, Rolf-Dieter Kortmann, Jürgen Krauss, Torsten Pietsch, Brigitte Bison, Monika Warmuth-Metz, Katja von Hoff, Stefan Rutkowski","doi":"10.3171/2026.2.PEDS25277","DOIUrl":"10.3171/2026.2.PEDS25277","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to review the assessment of residual tumor, analyze surgical factors associated with incomplete resection, determine the risk of neurological sequelae for reoperation, and assess the impact of second surgeries on survival.</p><p><strong>Methods: </strong>Patients 0-21 years old with nonmetastatic intracranial ependymoma treated within the prospective multicenter E-HIT2000 trial were included. Prospective central neuroradiological review of pre- and postoperative imaging was performed.</p><p><strong>Results: </strong>The 291 patients included in the E-HIT2000 trial underwent surgery at 71 centers in Germany, Austria, and Switzerland. Timely central review of postoperative imaging of sufficient quality was performed in 206 patients, and extent of resection was classified as gross-total resection (GTR) in 137 (67%) patients and incomplete with residual disease (RD) in 69 (33%) patients. Surgeons erroneously reported GTR in 11/40 patients with RD and available surgical reports; adhesions in the rhomboid fossa and/or brainstem were the most common reasons for intentional RD. Twenty-three of the 69 patients with RD underwent a second surgery as part of their primary treatment, 11 before and 12 after the start of adjuvant therapy; in 11/23 patients, GTR was achieved after a maximum of 3 procedures. The frequency of postoperative neurological deficits in the patients with second surgery did not differ from that in patients with primary GTR. Ten-year overall survival with GTR was 69.8% ± 4.4% versus 51.2% ± 7.1% with RD (p = 0.002). A second surgery significantly improved progression-free survival (42.4% ± 11.5% vs 22.2% ± 6.5% without second surgery, p = 0.004).</p><p><strong>Conclusions: </strong>Second surgery was not associated with an increased frequency of neurological sequelae and conferred an advantage in survival overall. The authors strongly recommend early central neuroradiological review to evaluate postoperative residual tumor and discuss reoperation. Further studies are needed to outline a tailored risk assessment for each patient based on molecular and clinical aspects.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"401-410"},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283978","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":"Late cerebrospinal fluid shunt infections: a Hydrocephalus Clinical Research Network study.","authors":"David S Hersh, Hailey Jensen, Ron W Reeder, Nichol Nunn, Todd C Hankinson, Susan Staulcup, Jason S Hauptman, Albert M Isaacs, Eric M Jackson, Sydney White, Abhaya V Kulkarni, Thiemo F Dinger, Jonathan A Pindrik, Ian F Pollack, Destiney Davis, Jessica Becerra, Vijay M Ravindra, Jay Riva-Cambrin, Ruksana Rashid, Brandon G Rocque, Andrew T Hale, Tamara D Simon, Jennifer M Strahle, Farrell Landwehr, Mandeep S Tamber, Annika Weir, John C Wellons, Breanne Reisen, William E Whitehead, John R W Kestle","doi":"10.3171/2026.1.PEDS25552","DOIUrl":"10.3171/2026.1.PEDS25552","url":null,"abstract":"<p><strong>Objective: </strong>Infection is a significant complication of CSF shunt surgery, with most infections occurring early in the postoperative course. While standardized perioperative protocols have successfully reduced early infections, the epidemiology, risk factors, and clinical patterns of late shunt infections are poorly characterized. This study aimed to determine the incidence, risk factors, clinical features, and outcomes of late shunt infections in a large, multicenter pediatric cohort.</p><p><strong>Methods: </strong>The Hydrocephalus Clinical Research Network (HCRN) Core Data Project was queried for all CSF shunt procedures performed between November 2016 and June 2023 in patients younger than 18 years. Each shunt surgery was treated as an index surgery, defined as the starting point for subsequent infection surveillance. Shunt surgeries were assigned to one of the following categories: no infection, early infection (≤ 6 months after the surgery), or late infection (> 6 months after the surgery). Demographic, operative, and clinical features of early versus late infections were compared, and Cox proportional hazards models were developed to assess shunt survival following early versus late infections.</p><p><strong>Results: </strong>Of 6698 shunt procedures, 285 (4.3%) were followed by early infections and 58 (0.9%) by late infections. Late infections accounted for 16.9% of all shunt infections. Late infections were significantly more likely than early infections to be associated with abdominal pseudocysts (24.1% vs 3.5%, p < 0.001) and less likely to be diagnosed via CSF culture (53.4% vs 78.6%, p < 0.001). Clinical events that took place between the shunt surgery and the late infection included abdominal surgeries (21.4%), shunt taps (23.2%), bacteremia (9.1%), and nonoperative abdominal processes requiring hospitalization (19.6%). Vancomycin was administered less frequently in the late infection group (62.1% vs 85.3%, p < 0.001), and shunts were less likely to be initially treated with complete shunt removal (65.5% vs 88.4%, p < 0.001) and more likely to be initially managed with externalization of the distal catheter alone (34.5% vs 11.6%, p < 0.001). Shunt survival after infection did not differ significantly between early and late infections.</p><p><strong>Conclusions: </strong>Late CSF shunt infections are uncommon but clinically distinct from early infections and are often associated with heterogeneous secondary exposures not addressed by perioperative protocols. These findings highlight the need for long-term surveillance in patients with shunts, tailored diagnostic strategies, and expanded infection tracking efforts.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"315-325"},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283962","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":"Surgical complications in early versus late intervention centers for progressive posthemorrhagic ventricular dilatation in preterm infants: a multicenter analysis.","authors":"Grace Y Lai, Niek E van der Aa, Peter A Woerdeman, Burak Deliloglu, Mehmet N Cizmeci, Diane Wilson, Abhaya V Kulkarni, Sylke J Steggerda, Radboud W Koot, Sandi Lam, Maria L V Dizon, Nalin Gupta, Dawn Gano, David D Limbrick, Linda S de Vries","doi":"10.3171/2026.1.PEDS25486","DOIUrl":"10.3171/2026.1.PEDS25486","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to evaluate the clinical features and surgical complication rates of preterm infants with posthemorrhagic ventricular dilatation (PHVD) who underwent CSF diversion, comparing early intervention (EI) and late intervention (LI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective international multicenter study of infants born at ≤ 34 weeks' gestational age (GA) and treated between 2018 and 2022 for grade III or IV germinal matrix hemorrhage and intraventricular hemorrhage, who required intervention for PHVD. The primary outcome of interest was the rate of postoperative surgical complications. Secondary outcomes were rate of temporizing neurosurgical procedures (TNPs) after initial lumbar puncture (LP) if performed, rate of conversion from TNP to a ventriculoperitoneal shunt (VPS), and overall rate of VPS insertion. Summary statistics and univariable and multivariable logistic regression were performed to determine variables predictive of complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred seventy infants from 6 centers in the United States, Canada, and the Netherlands were included. Infants at LI centers were more premature (GA 26.7 ± 2.8 vs 29.3 ± 2.4 weeks, p &lt; 0.001) with lower birth weights (BWs; 1004 ± 448 vs 1438 ± 462 g, p &lt; 0.001) compared to those at EI centers. The first neurosurgical intervention occurred at a median day of life after birth (DOL) of 31.5 (IQR 24-45) days at LI centers versus 18 (IQR 13-21) days at EI centers (p &lt; 0.001). Ventricular index (&gt; 97th percentile) at the first neurosurgical intervention (TNP and/or VPS placement) was lower at EI centers (5.05 ± 2.32 vs 12.88 ± 5.70 mm, p &lt; 0.001). Infant weight at the first neurosurgical intervention did not differ between site types (p = 0.466). EI centers had a larger proportion of patients who underwent LP (97% vs 58%, p &lt; 0.001) and smaller proportion who required a VPS after TNP (42% vs 70%, p = 0.002). The overall VPS insertion rate was higher at LI centers (62% vs 30%, p &lt; 0.001). There was no statistical difference in the complication rate between EI and LI centers (11% vs 24%, respectively, OR 0.42, 95% CI 0.12-1.24, p = 0.115). On univariable analysis, lower GA (p = 0.002), lower BW (p = 0.003), later DOL at first neurosurgical intervention (p = 0.035), diagnosis of meningitis before neurosurgical intervention (p = 0.047), and of necrotizing enterocolitis (p = 0.017) during the neonatal intensive care unit admission were predictive of complications. However, only lower GA (p = 0.029) and BW (p = 0.031) remained significant on multivariable analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The neurosurgical complication rate did not differ between EI and LI centers. On multivariable analysis, neurosurgical complications were associated with younger GA and lower BW but not with variables regarding the timing of intervention. These observations support cautious early CSF diversion in more preterm infants ","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"303-312"},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283949","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. Sooner rather than later? The subtle nature of late-presenting shunt infections.","authors":"Michael D Partington","doi":"10.3171/2026.2.PEDS2613","DOIUrl":"10.3171/2026.2.PEDS2613","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"313-314"},"PeriodicalIF":2.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283940","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":"Postconcussion physical activity frequency and plasma biomarker associations among adolescents.","authors":"Ross R Moseley, Mathew J Wingerson, Kelsie L Richardson, Katelyn D Hurlburt, Kaitlyn Warren, Julie C Wilson, William P Meehan, Rebekah Mannix, David R Howell","doi":"10.3171/2026.2.PEDS25624","DOIUrl":"10.3171/2026.2.PEDS25624","url":null,"abstract":"<p><strong>Objective: </strong>Existing studies have reported the utility of plasma biomarkers for concussion diagnosis and outcome prognostication. In parallel, physical activity (PA) after concussion is associated with better outcomes. Therefore, this study sought to investigate the association between PA frequency and plasma biomarker concentration levels following concussion.</p><p><strong>Methods: </strong>The authors performed a cross-sectional analysis of adolescents diagnosed and evaluated within 21 days of a concussion. Participants self-reported engagement in PA as well as PA frequency since injury and underwent venipuncture. To account for variability in evaluation time, PA frequency was calculated as the percentage of days between concussion and initial evaluation in which PA was reported. Plasma analysis assays included glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), total tau, and neurofilament light chain (NF-L).</p><p><strong>Results: </strong>A total of 57 adolescents participated, including 32 who reported participating in PA (mean age 15.9 [SD 1.7] years, 44% female, mean 13.0 [SD 3.8] days postinjury) and 25 who did not (mean age 15.5 [SD 1.4] years, 68% female, mean 10.6 [SD 3.6] days postinjury). Postconcussion PA frequency across the cohort was 29.3% (SD 23%, mean 3.6 [SD 3.0] days of PA since injury). A higher percentage of PA days postconcussion was associated with significantly lower levels of plasma GFAP (β = -0.52, 95% confidence interval [CI] -0.96 to -0.07; p = 0.02) and NF-L (β = -0.81, 95% CI -1.59 to -0.03; p = 0.04) after adjusting for age, sex, and symptom severity. Log-transformed coefficients indicated that for every 10% increase in the percentage of PA days since concussion, GFAP levels decreased by approximately 5.1% and NF-L levels decreased by approximately 7.9%.</p><p><strong>Conclusions: </strong>These results indicate that more frequent PA in the days after concussion was associated with decreased levels of two biomarkers, GFAP and NF-L. Given the relevance of plasma biomarkers as indicators of neurobiological cell damage and ongoing repair processes after concussion, these findings suggest that postconcussion PA is associated with improved biological as well as clinical recovery outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"370-377"},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity of catheter insertion rates: an initial benchtop assessment of shunt catheter insertion for hydrocephalus.","authors":"Adam Menkara, Jeffrey Horbatiuk, James M Johnston, Anastasia Arynchyna-Smith, Taylor Brinkley, Andrew T Hale, Michael Joseph Feldman, Ricardo A Najera, Martina Gonzalez Gomez, Jeffrey P Blount, Carolyn A Harris","doi":"10.3171/2026.2.PEDS25395","DOIUrl":"10.3171/2026.2.PEDS25395","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate hydrocephalus shunt insertion dynamics and variability across a group of clinicians using a polyvinyl alcohol (PVA)-Phytagel-based brain-mimicking model for ventricular catheter placement.</p><p><strong>Methods: </strong>The rate of catheter insertion through a simplified PVA-Phytagel-based brain mimic was assessed in a group of clinicians at an academic pediatric neurosurgery division. Lateral and longitudinal catheter position and motion throughout insertion depth were assessed and analyzed. Additionally, survey data were collected to better understand the intentionality and thought process underlying each surgeon's insertion approach.</p><p><strong>Results: </strong>A total of 57 insertions were collected across 19 participants, of whom 16 were neurosurgeons and included in the final analysis. Based on survey results, the authors found that there was a positive correlation between the surgeons' attempt to speed up at earlier anatomical landmarks (ependyma) and slow down at deeper anatomical landmarks (deeper ventricular levels) throughout the depth of insertion. However, in practice, there was no correlation between the intended insertion rate and the actual insertion rate of the surgeons. Additionally, the authors found a high degree of variability in both the longitudinal and lateral directions for both position and velocity, independent of trial number, individual surgeon, or insertion depth.</p><p><strong>Conclusions: </strong>In the brain mimic of compliant uniform hydrogel, the surgeon's insertion rate throughout insertion and across samples was found to not be uniform, with catheter insertion rates being highly heterogeneous and nonrepeatable. Analogous fields within the neural implant space have regulated output for both insertion rates and dynamics in order to optimize implant outcome and minimize neuroinflammatory response. The authors believe this study sets a precedent to begin exploration of hydrocephalic tissue response in vivo to differential longitudinal and lateral catheter velocities.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"341-351"},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13418182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure outcomes after laser interstitial thermal therapy for pediatric extratemporal lobe epilepsy.","authors":"Bryce S Owen, Amber L Gaulden, Torin Karsonovich, Hansel M Greiner, Ravindra Arya, James L Leach, Paul S Horn, Jesse Skoch, Francesco T Mangano","doi":"10.3171/2025.12.PEDS2553","DOIUrl":"10.3171/2025.12.PEDS2553","url":null,"abstract":"<p><strong>Objective: </strong>Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in localization and treatment because these patients often have diffuse and complex epileptogenic networks. Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative for localizable DRE, yet data for its use in the pediatric ETLE population remain limited. This study aimed to evaluate the safety and efficacy of LITT in pediatric ETLE and identify predictive factors for favorable seizure outcomes.</p><p><strong>Methods: </strong>This retrospective study reviewed pediatric patients who underwent LITT for ETLE at a single National Association of Epilepsy Centers level 4 epilepsy center from 2015 to 2023. Patients with prior LITT for temporal lobe epilepsy, hypothalamic hamartomas, or corpus callosotomies were excluded. Preoperative evaluations included noninvasive testing (e.g., video-EEG, MRI, PET, magnetoencephalography) and invasive monitoring with stereo-EEG. The primary study endpoints were 1) International League Against Epilepsy (ILAE) classification at 12 months after the index LITT or additional surgical intervention for the treatment of seizures, and 2) procedure-related complications. Secondary analyses examined imaging concordance with the final ablation location, total ablation volume, and perioperative metrics.</p><p><strong>Results: </strong>Twenty-nine patients underwent an index LITT procedure for ETLE. At 12 months, 14 patients (48.3%) achieved a good outcome (ILAE class 1-3), and 12 (41.4%) were seizure free (ILAE class 1). There were 6 patients (20.7%) who required additional surgery within 12 months. Concordant PET with the final LITT ablation volume independently predicted seizure outcome (p = 0.04). The total ablation volume ranged from 0.66 to 8.45 cm3, and was not statistically different between groups. In the perioperative period, 3 patients developed transient steroid-responsive LITT-related edema, while no permanent neurological deficits, hematomas, surgical site infections, or deaths occurred.</p><p><strong>Conclusions: </strong>This study demonstrated that LITT is a safe and effective treatment option for pediatric ETLE and may achieve acceptable rates of seizure freedom with a minimally invasive approach. Concordance between noninvasive imaging (particularly PET) with LITT targets was associated with favorable outcomes, underscoring the importance of thorough preoperative evaluations to determine appropriate ablation candidates. Future multicenter prospective studies are warranted to further refine patient selection criteria and optimize treatment paradigms.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"414-423"},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239505","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":"Comparative sensitivity and specificity of change in third ventricular diameter or global ventricular change for detecting pediatric ventriculoperitoneal shunt malfunction: a 10-year retrospective cohort study.","authors":"Charlie Cho, Liam G Coulthard, Annabelle M Harbison, Norman Ma, Robert A J Campbell, Amelia J Jardim, Elena How, Michael J Stuart","doi":"10.3171/2026.2.PEDS25625","DOIUrl":"10.3171/2026.2.PEDS25625","url":null,"abstract":"<p><strong>Objective: </strong>Clinical features of shunt malfunction are often nonspecific and neuroimaging is a well-established aid in diagnosis. In practice, qualitative assessment of overall ventricular change guides management; however, change in third ventricular diameter (TVD) alone has been proposed as a low-complexity quantitative index of overall ventricular change. This study aimed to evaluate the diagnostic utility of change in TVD compared with global assessment of ventricular caliber change by a neurosurgeon in detecting shunt malfunction.</p><p><strong>Methods: </strong>A retrospective review of all pediatric ventricular shunt revisions performed at a single center (November 2014-September 2024) was conducted. TVDs were measured when the patient was last known well and on preoperative imaging. Quantitative change was compared to the overall impression of change in ventricular caliber by neurosurgeons for detecting shunt malfunction. Shunt malfunction was defined as the need to replace one or more shunt components at the time of surgery (diagnostic gold standard). Diagnostic performance was assessed using comparison of areas under the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>A total of 422 shunt revisions were performed during the study period, of which 315 (75%) were found to have shunt malfunction. ROC analysis utilizing a cutoff of ≥ 2-mm TVD increase detected shunt malfunction with 63% sensitivity and 58% specificity (area under the curve [AUC] 0.62, 95% CI 0.55-0.69; p < 0.001). Pragmatic refinement by restricting the cohort to the subset of 136 patients known to have a change in ventricular caliber at the time of previous shunt failure and selecting a ≥ 1-mm cutoff increased the discriminative power of change in TVD to 92% sensitivity and 21% specificity. In this restricted cohort, the overall assessment of ventricular change by neurosurgeons yielded 81% sensitivity and 62% specificity (AUC 0.72, 95% CI 0.59-0.84) and the AUC difference between the two techniques was not statistically significant (AUC difference 0.08, 95% CI -0.03 to 0.20; p = 0.16).</p><p><strong>Conclusions: </strong>In a pragmatically selected cohort, an increase ≥ 1 mm from baseline TVD alone provides sensitivity comparable to that of overall assessment of ventricular change by a neurosurgeon identifying shunt malfunction in a cohort undergoing shunt revision. This simple linear measurement could be integrated as a screening test in clinical, imaging, and/or AI algorithms to facilitate rapid recognition of pediatric shunt failure.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"326-334"},"PeriodicalIF":2.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239524","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}