Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery最新文献

{"title":"Comment on \"MRgLITT in pediatric neurosurgery: does technological progress justify a first-line designation\".","authors":"Aisha Waheed, Ujala Khan, Sehar Dua","doi":"10.1007/s00381-026-07488-2","DOIUrl":"10.1007/s00381-026-07488-2","url":null,"abstract":"","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and causes of 30-day failure after shunt placement in pediatric hydrocephalus: a systematic review and meta-analysis.","authors":"Leonardo Di Cosmo, Christopher Peter Imbrogno, Jad El Choueiri, Arthur Nantes, Joshua Vishal Sahgal, Francesca Totis, Ismail Zaed, Noor Ul Owase Jeelani","doi":"10.1007/s00381-026-07487-3","DOIUrl":"10.1007/s00381-026-07487-3","url":null,"abstract":"<p><strong>Background: </strong>Ventriculoperitoneal (VP) shunting is the most common long-term treatment for pediatric hydrocephalus; however, early shunt failure remains a significant cause of morbidity and economic burden. Although individual studies have investigated risk factors for early failure, findings are fragmented and inconsistent. This meta-analysis evaluates the prevalence, predictors, and causes of 30-day VP shunt failure in pediatric patients.</p><p><strong>Methods: </strong>Following PRISMA guidelines, databases were searched through November 2025 for studies reporting 30-day VP shunt failure in pediatric cohorts. Randomized controlled trials, prospective, and retrospective studies were included. Random-effects models were used, with risk ratios (RR) calculated for dichotomous outcomes and pooled prevalence estimated using generalized linear mixed models.</p><p><strong>Results: </strong>Our analysis included 11,596 pediatric patients, with one randomized trial and 8 observational studies. The pooled prevalence of 30-day shunt failure was 13.8% (95% CI 11.2-16.8), with significantly lower rates following primary compared with secondary shunt insertion (12.6% vs 18.0%). A separate comparative analysis confirmed this reduced risk of early failure after primary insertion (RR 0.58, 95% CI 0.49-0.69; p < 0.001). When pooled female sex was associated with decreased risk of early failure, while no hydrocephalus etiology demonstrated a significant effect. Poor ventricular catheter placement was the only modifiable predictor associated with increased risk of early failure from the pooled analyses (RR 1.64, 95% CI 1.08-2.50; p = 0.02); however, this association was based on only two studies and lost significance in leave-one-out analyses. Cause-specific failure mechanisms were poorly reported across studies. Among studies reporting these outcomes, proximal catheter obstruction and malposition were the most frequently reported mechanisms of early shunt failure, followed by shunt infection. Several additional predictors were significant in individual studies and were qualitatively reported, but could not be pooled due to heterogeneous reporting.</p><p><strong>Conclusion: </strong>VP shunt failure affects approximately one in eight pediatric patients in the first 30 days following placement, and occurs significantly more frequently following secondary shunt insertion. Among the pooled predictors, ventricular catheter placement quality represents the most significant modifiable factor associated with early shunt survival, although this finding was based on limited data. Several predictors showed estimates suggestive of increased risk; however, prospective studies with standardized reporting are necessary to define the size of these associations.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420261305777.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic third ventriculostomy for diencephalosynapsis-related hydrocephalus in MPDZ gene syndrome: a case report and review of the literature.","authors":"Sergio Cavalheiro, Marcos Devanir Silva da Costa, Fernando Seiji Suzuki, Patrícia Alessandra Dastoli, Diego Pereira de Melo Oliveira, Rocio Ester Gómez Verges, Gabriela Cavalieri de Oliveira, Mariana Rodrigues Martino","doi":"10.1007/s00381-026-07483-7","DOIUrl":"10.1007/s00381-026-07483-7","url":null,"abstract":"<p><strong>Purpose: </strong>MPDZ syndrome is a rare autosomal recessive disorder caused by biallelic pathogenic variants in MPDZ (9p23) and typically managed with ventriculoperitoneal shunting (VPS). Recent characterization of MPDZ-related hydrocephalus as an obstructive process-driven by diencephalosynapsis and third ventricle atresia-provides theoretical grounds for endoscopic third ventriculostomy (ETV), yet no primary ETV treatment has previously been reported in a genetically confirmed, liveborn patient.</p><p><strong>Methods: </strong>We report a female infant with prenatally diagnosed obstructive ventriculomegaly, subsequently confirmed as MPDZ syndrome by whole-exome sequencing, who was treated with ETV as the primary surgical intervention, and we review the literature on the neurosurgical management of MPDZ-related hydrocephalus.</p><p><strong>Results: </strong>Fetal MRI demonstrated diencephalosynapsis and third ventricle atresia with secondary occlusion of the aqueduct of Sylvius. A ventriculo-amniotic shunt was placed at 29 weeks of gestation; the infant was born at 36 weeks and 1 day and underwent ETV on the fifth day of life without complications. At 2 years and 5 months of age, she developed intermittent symptoms of intracranial hypertension due to late stoma occlusion at the level of the Liliequist membrane, successfully managed with endoscopic stoma revision. At the most recent follow-up (4 years and 5 months), she remains free of ventriculoperitoneal shunting, with age-appropriate neurodevelopment. A systematic review of the literature identified no prior report of ETV used as primary treatment in a genetically confirmed, liveborn patient with MPDZ syndrome.</p><p><strong>Conclusions: </strong>This case provides proof of concept that ETV is both mechanistically justified and clinically effective in selected patients with MPDZ-related obstructive hydrocephalus, potentially avoiding lifelong shunt dependency. Patient selection should nonetheless remain individualized, based on ventricular anatomy, third ventricular floor thickness, and associated structural anomalies.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric spasticity in Brazil: insights from a neurosurgical referral center.","authors":"Renato Fedatto Beraldo, Gisele Souza da Silva, Luana Rahal Cardoso Cenatti, Mayara Helena Martins Dondalski, Lúcio Ricieri Perotti, Leonardo Almeida Frizon, Bianca Castellani Scarcelli Segura, Bruno Liebl","doi":"10.1007/s00381-026-07470-y","DOIUrl":"10.1007/s00381-026-07470-y","url":null,"abstract":"<p><strong>Aim: </strong>To characterize pediatric spasticity in a Brazilian tertiary center and identify functional demand for neurosurgical interventions.</p><p><strong>Method: </strong>Retrospective, cross-sectional study of 161 patients. Functional status was assessed using GMFCS and FMS scales.</p><p><strong>Results: </strong>Cerebral palsy (CP) predominated (75.3%), showing high functional severity (43.6% GMFCS V). Median age at referral was 8.5 years. Dystonia was present in 41.1% of the spasticity subgroup. Functional severity did not correlate with age groups (p = 0.266).</p><p><strong>Interpretation: </strong>Late referral (median age 8.5 years) contributes to progressive musculoskeletal complications despite stable neurological lesions. Systematic use of GMFCS and FMS provides a reproducible screening tool for surgical candidacy in resource-limited settings. The high prevalence of dystonia (41.1%), characterizing a late-stage mixed hypertonia profile due to delayed referrals, highlights the need for expanded neuromodulation access in public healthcare systems.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frameless VarioGuide biopsy for pediatric brainstem lesions in the molecular era: diagnostic performance and workflow characteristics in a comparative single-center series.","authors":"Sepide Kashefiolasl, Karsten Lachner, Christian J Braun, Katharina J Weber, Luciana Porto, Marcus Czabanka, Tobias Finger","doi":"10.1007/s00381-026-07484-6","DOIUrl":"10.1007/s00381-026-07484-6","url":null,"abstract":"<p><strong>Background: </strong>Molecular characterization has become essential for the diagnosis and treatment of pediatric brainstem lesions. While frame-based stereotactic and robotic-assisted biopsies are well established, comparative data on frameless VarioGuide biopsy for pediatric brainstem lesions remain scarce. This study evaluated the diagnostic performance, safety, and workflow characteristics of frameless VarioGuide biopsy compared with frame-based stereotactic and ROSA-assisted techniques.</p><p><strong>Methods: </strong>We retrospectively reviewed all pediatric patients (≤ 18 years) who underwent stereotactic biopsy of a brainstem lesion at a single tertiary neurosurgical center between 2016 and 2026. Patients were grouped according to biopsy technique (frameless VarioGuide, frame-based stereotaxy, or ROSA-assisted biopsy). Diagnostic yield, molecular diagnostic yield, complications, operative times, and workflow parameters were analyzed.</p><p><strong>Results: </strong>Twenty-two pediatric patients met inclusion criteria. Six underwent frameless VarioGuide biopsy, nine frame-based stereotactic biopsy, and seven ROSA-assisted biopsy. Overall diagnostic and molecular diagnostic yields were 95%. Diagnostic and molecular diagnostic yields were 100% with VarioGuide, 89% with frame-based stereotactic biopsy, and 100% with ROSA-assisted biopsy, without statistically significant differences between groups (p = 0.62). Median operative times were similar among groups (32, 36, and 25 min, respectively; p = 0.28). However, preoperative setup time differed significantly, with the shortest duration observed in the VarioGuide cohort (40.5 min) compared with ROSA-assisted biopsy (64 min) and frame-based stereotaxy (112 min; p = 0.002). Despite the absence of intraoperative neuropathological assessment, all VarioGuide procedures yielded diagnostically and molecular-pathologically informative tissue. No procedure-related hemorrhage, infection, permanent neurological deficit, or procedure-related mortality were observed.</p><p><strong>Conclusions: </strong>In this exploratory single-center cohort, frameless VarioGuide biopsy achieved high diagnostic and molecular diagnostic yields without permanent procedure-related morbidity and was associated with shorter preoperative setup time. These findings support further evaluation of frameless VarioGuide biopsy as a workflow-efficient approach for tissue acquisition in pediatric brainstem lesions.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated clival Langerhans cell histiocytosis in a pediatric patient: systematic review and illustrative case report.","authors":"Adam M Abdallah, Atef F Hulliel, Tala Y Dabash, Dana Saleh, Sarah Al Sharie, Maysa Al-Hussaini, Mouness Obeidat","doi":"10.1007/s00381-026-07467-7","DOIUrl":"10.1007/s00381-026-07467-7","url":null,"abstract":"<p><strong>Background: </strong>Langerhans cell histiocytosis is a rare clonal myeloid disorder with heterogeneous clinical manifestations, predominantly affecting children. Osseous involvement is common; however, isolated localization to the clivus is exceptionally rare and poses significant diagnostic and therapeutic challenges due to its proximity to critical neurovascular structures. We present an illustrative pediatric case alongside a systematic review of the literature to better characterize this uncommon entity.</p><p><strong>Method: </strong>This study presents a rare case of a 3.5-year-old boy diagnosed with isolated clival Langerhans cell histiocytosis confirmed by histopathological and immunohistochemical evaluation. In addition, we systematically reviewed 11 published studies encompassing 11 patients with histologically confirmed isolated clival LCH. The systematic review adhered to PRISMA guidelines, with a comprehensive literature search conducted in PubMed and Scopus using predefined keywords related to Langerhans cell histiocytosis and clival involvement.</p><p><strong>Results: </strong>Eleven published cases met inclusion criteria. Most patients were pediatric, with a slight female predominance. Abducens nerve palsy and diplopia were the most frequent presenting symptoms. Imaging typically demonstrated osteolytic clival lesions that mimicked chordoma and other skull base tumors. Histopathology consistently showed characteristic LCH morphology with CD1a and S100 positivity. Management strategies varied and included biopsy, surgical resection, chemotherapy, and radiotherapy. Outcomes were favorable in most cases, with significant neurological improvement and no reported recurrences during follow-up.</p><p><strong>Conclusion: </strong>Isolated clival LCH is an exceptionally rare presentation that can radiologically mimic aggressive skull base neoplasms. Histopathological confirmation is essential. Early recognition and appropriate multidisciplinary management are associated with favorable outcomes.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occipitocervical fusion and decompression in Morquio syndrome: a case report and literature review.","authors":"Kadir Oktay, Umut Pektas, Suleyman Selcuk Carkacı, Ammar Alnageeb, Kerem Mazhar Ozsoy, Nuri Eralp Cetinalp, Tahsin Erman","doi":"10.1007/s00381-026-07480-w","DOIUrl":"10.1007/s00381-026-07480-w","url":null,"abstract":"<p><p>Mucopolysaccharidosis IVA, also known as Morquio syndrome, is a rare autosomal recessive lysosomal storage disorder caused by a deficiency of N-acetylgalactosamine-6-sulfate sulfatase. Spinal involvement, particularly at the craniocervical junction, is a major contributor to morbidity and mortality due to atlantoaxial instability and cervical spinal stenosis. Early diagnosis and timely surgical intervention are essential to prevent irreversible neurological deterioration. In this report, we present the case of a 10-year-old girl with progressive quadriparesis due to severe cervical myelopathy associated with mucopolysaccharidosis IVA. She underwent successful occipitocervical decompression and fusion, resulting in significant neurological improvement and long-term spinal stability. This case highlights the importance of early recognition and surgical management of cervical spine pathology in Morquio syndrome. Additionally, a review of the literature on surgical strategies for craniocervical instability in mucopolysaccharidosis IVA is presented.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal spontaneous bilateral extradural hematoma with swirl sign in a child with sickle cell disease: lessons from delayed surgical access at a tertiary center.","authors":"Grace Ella Armande Djonde, Landry Drogba, Wilfried Meuga, Remy Ngarnayal, Ines Stephanie Assouan, Dramane Ouattara","doi":"10.1007/s00381-026-07481-9","DOIUrl":"10.1007/s00381-026-07481-9","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous extradural hematoma (EDH) is a rare neurosurgical complication of sickle cell disease (SCD), with bilateral pediatric presentations rarely reported. The \"swirl sign\" on non-contrast CT, a marker of active bleeding and independent predictor of poor prognosis in traumatic EDH and in spontaneous intracerebral hemorrhage, has never been described in spontaneous SCD-related EDH. In low-resource settings, equitable and timely access to emergency neurosurgery remains a critical and modifiable determinant of outcome.</p><p><strong>Case description: </strong>A 13-year-old girl with homozygous SCD (HbSS) presented with sudden altered consciousness (Glasgow coma scale 9) and left hemiparesis, without history of trauma. Hemoglobin was 8 g/dL with normal hemostasis. Non-contrast CT revealed bilateral acute EDHs, with a large compressive right-sided component exhibiting the swirl sign. Emergency surgical evacuation was indicated, but delayed by over 12 h due to upfront, out-of-pocket payment requirements. During this delay, GCS dropped from 9 to 7 with right-sided mydriasis. Right fronto-parietal craniotomy with hematoma evacuation was performed. Upon scalp and pericranial reflection, the external calvarial cortex displayed an abnormal grayish-blue mottled discoloration. The bone was strikingly friable on manipulation. The hematoma was completely evacuated. At the end of the procedure, during skin closure and still under general anesthesia, the patient developed acute desaturation and hemodynamic instability and died before extubation. Autopsy was not performed.</p><p><strong>Conclusions: </strong>This is, to our knowledge, the first description of the swirl sign in spontaneous SCD-related EDH, suggesting that this radiological marker may also indicate active bleeding in this rare clinical entity. The unusual macroscopic appearance and friability of the calvarial bone raise the possibility of a bone marrow-related perioperative complication, including fat embolism, although the cause of death could not be established. The documented neurological deterioration during the delay to surgery highlights the potential impact of delayed access to emergency neurosurgical care in resource-limited settings such as ours.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of nationwide variation in post-haemorrhagic ventricular dilatation management following national guideline implementation in the Netherlands.","authors":"J P F Bertens, P A Woerdeman, L S de Vries, G E van den Bosch, S J Steggerda, J K H Spoor, L S Smit, D R Buis, R W Koot, M W Aalbers, H R Jeltema, J van Aalst, N E van der Aa, M L Tataranno, L C Weeke, H J Ter Horst, T R de Haan, R J Vermeulen, K P Dijkman, S M Mulder-de Tollenaer, E Roze, O H J Eelkman Rooda","doi":"10.1007/s00381-026-07477-5","DOIUrl":"10.1007/s00381-026-07477-5","url":null,"abstract":"<p><strong>Purpose: </strong>Post-haemorrhagic ventricular dilatation (PHVD) is a severe complication of germinal matrix-intraventricular haemorrhage in preterm infants and is associated with significant morbidity and adverse neurodevelopmental outcomes. In 2023, national recommendations for PHVD management were revised, but implementation has not been evaluated. We aimed to assess diagnostic and therapeutic practices across Dutch neonatal intensive care units (NICUs), quantify inter-centre variation, and provide a basis for a national PHVD registry.</p><p><strong>Materials and methods: </strong>A nationwide, cross-sectional survey was disseminated among representatives from nine Dutch NICUs and seven affiliated paediatric neurosurgical departments. Per centre, one paediatrician and paediatric neurosurgeon reported institutional practices regarding monitoring, cerebrospinal fluid (CSF) drainage thresholds, temporising interventions, permanent CSF diversion criteria, follow-up, and research priorities. Practices were compared to the Dutch guideline.</p><p><strong>Results: </strong>All NICUs and neurosurgical centres responded. PHVD case volume varied (< 5 patients/year in 3/9 centres; > 20 in 1/9). Diagnostic thresholds were ventricular index > 97th percentile and anterior horn width > 6 mm in 7/9 centres, with higher or additional criteria in 2/9. Initial temporising management consisted of serial lumbar punctures and ventricular access device (VAD) placement. VAD tap duration before permanent diversion was typically 4-6 weeks (6/7). Ventriculoperitoneal shunting was the preferred permanent intervention in all centres, with weight thresholds of 2.0-2.5 kg.</p><p><strong>Conclusion: </strong>Following implementation of a national guideline, PHVD management in Dutch NICUs demonstrates high consistency in core diagnostics and treatment principles, showing that national standardisation of PHVD care is feasible. Residual variation is concentrated in areas where evidence remains limited, identifying priorities for future collaborative research.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of delayed CSF diversion protocol in Infants with lumbosacral myelomeningocele: impact of timing of presentation on hydrocephalus development and postoperative complications.","authors":"Hayder Sahib Almayali, Karrar Najeh Shareef","doi":"10.1007/s00381-026-07476-6","DOIUrl":"10.1007/s00381-026-07476-6","url":null,"abstract":"<p><strong>Background: </strong>Myelomeningocele (MMC) remains one of the most common congenital central nervous system anomalies, with Iraq reporting notably higher prevalence rates (31.9 per 10,000 births) compared to global standards. The timing of presentation and cleanliness of the defect site may significantly impact outcomes in these vulnerable infants.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of a delayed cerebrospinal fluid (CSF) diversion protocol following primary back repair in infants with lumbosacral myelomeningocele and to assess the impact of timing of hospital presentation on clinical outcomes and complication rates.</p><p><strong>Methods: </strong>This prospective single-arm interventional cohort study enrolled 186 consecutive newborns with lumbosacral MMC between February 2021 and April 2024 at two neurosurgical centers in Iraq. Patients were categorized into two groups based on timing of presentation: clean lesion group (n = 117, presented within 24 h of birth at hospitals) and contaminated lesion group (n = 69, presented 2-7 days after birth). All underwent primary back repair with deliberately delayed CSF diversion. Patients were followed for 12 months for the development of hydrocephalus and for postshunting possible complications.</p><p><strong>Results: </strong>Overall, 143 of 186 patients (76.8%) required VP shunt placement, which is lower than the globally reported rate of 82-90%. The shunt-free rate was significantly higher in the clean lesion group (26.4%, 31/117) compared to the contaminated lesion group (17.4%, 12/69). Postoperative complications were more frequent in the contaminated lesion group, including higher rates of wound infections (26.3% vs. 15.1%), shunt infections (19.3% vs. 8.1%), and shunt malfunctions (24.6% vs. 16.3%). The clean lesion group underwent VP shunt placement earlier (median 11-16 days postrepair) compared to variable timing in the contaminated lesion group (5-29 days).</p><p><strong>Conclusion: </strong>Delayed CSF diversion following MMC repair appears feasible and may reduce overall shunt dependency rates. Early hospital presentation within 24 h of birth is associated with cleaner defects, lower infection rates, and fewer postoperative complications. These findings support the importance of optimizing referral systems and community health education to ensure timely presentation of newborns with MMC.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"42 1","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}