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

{"title":"Vein of Galen aneurysmal malformations: retrospective evaluation of endovascular treatment outcomes.","authors":"Sanubar Nazarli, Cafer Ikbal Gulsever, Duran Sahin, Mehmet Barburoglu, Serra Sencer, Altay Sencer, Aydin Aydoseli","doi":"10.1007/s00381-025-06901-6","DOIUrl":"https://doi.org/10.1007/s00381-025-06901-6","url":null,"abstract":"","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"238"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669262","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":"Paediatric idiopathic syringomyelia - a follow-up of radiological and clinical outcomes into adulthood.","authors":"Rosa Sun, Pritsana Punyawai, Navin Furtado, Fardad T Afshari, Pasquale Gallo","doi":"10.1007/s00381-025-06885-3","DOIUrl":"https://doi.org/10.1007/s00381-025-06885-3","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic syringomyelia (IS) is defined by the presence of a spinal syrinx without identifiable primary pathology. The natural history, clinical implications, and radiological management of IS in the paediatric patient remain poorly understood, with existing literature providing limited long-term data. This study aims to evaluate the long-term clinical and radiological outcomes of paediatric patients with IS, focusing on understanding predictive factors of clinical or radiological progression, and the correlation between clinical and radiological evolution.</p><p><strong>Methods: </strong>This retrospective study included 28 paediatric patients diagnosed with IS, all with a minimum of three years of radiological follow-up. Cases of secondary syrinx caused by upstream pathology were excluded. Clinical and imaging data were analysed to assess the radiological change of the syrinx and change in symptoms. Correlations between radiological and clinical features were explored.</p><p><strong>Results: </strong>The median radiological and clinical follow-up durations were 6.84 years and 7.66 years, respectively. A reduction in syrinx size (≥ 1 mm in width or anterior-posterior diameter) was observed in 53.6% of patients, with no significant association with gender, age at diagnosis, initial syrinx size, or scoliosis. Back pain occurred in 25% of patients; other modes of presentation include urological disturbance and neurological deficits. All patients remained clinically asymptomatic, stable or improved during follow-up. Radiological changes did not correlate with clinical outcomes. No predictors were found for radiological or clinical outcomes.</p><p><strong>Conclusions: </strong>IS in paediatric patients follow a predominantly benign course, with radiological changes showing little clinical relevance. Repeated interval imaging appears unnecessary in stable cases, and management should prioritise clinical symptoms. This study provides the largest long-term dataset to date, supporting a conservative approach to IS management.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"236"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652027","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":"Surgical outcomes of third ventriculostomy using neuronavigation-guided new modified endoscopic approach: a series of 11 patients.","authors":"Erdinç Özek, Anas Abdallah, Serkan Kitis, Mustafa Aziz Hatiboglu","doi":"10.1007/s00381-025-06895-1","DOIUrl":"https://doi.org/10.1007/s00381-025-06895-1","url":null,"abstract":"<p><strong>Objective: </strong>Neuroendoscopy is widely used and has become the gold standard for the most intraventricular approaches. Integration of a neuronavigation system to the neuroendoscopy system is a minimally invasive technique that brings many advantages to neurosurgeons, especially for patients with distorted anatomical landmarks. We present the surgical outcomes of 11 consecutive patients using a new, unique modified endoscopic trocar that integrates the Medtronic Stealth Station S7 Axiem shunt kit system to the Karl Storz Lotta rigid ventriculoscope system.</p><p><strong>Material and methods: </strong>Medical records of hydrocephalus patients who underwent endoscopic third ventriculostomy surgery in our hospital during a 2-year period from 2017 to 2018 were retrospectively reviewed. All patients who underwent endoscopic third ventriculostomy using this modified technique and followed up for at least 12 months were selected as the core sample used for this study.</p><p><strong>Results: </strong>Eleven patients were operated via this surgical approach; four patients were male and seven patients were female. Nine patients were operated to perform third ventriculostomy for obstructive hydrocephalus. One patient had a large temporal arachnoid cyst and was treated via endoscopic fenestration. One adult patient underwent endoscopic biopsy for lateral ventricular mass. The histopathological diagnosis was confirmed to be a CNS lymphoma.</p><p><strong>Conclusion: </strong>This new modified obturator has advantages to tracker attached trocar system, such as it does not require rigid head fixation especially in babies, manipulation of the trocar is easier due to tracker's weight and shape, and less fixation difficulties of trocar. We suggest this method may be a less expensive and safe alternative to standard tracker attached systems of ventricular access.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"232"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629299","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":"Long-term neurocognitive and behavioral outcomes in patients with non-syndromic craniosynostosis.","authors":"Jacqueline Ihnat, Kevin Gao Hu, Jeremy Goss, Omar Allam, Neil Parikh, Melanie Vassallo, Linda Mayes, John Persing, Michael Alperovich","doi":"10.1007/s00381-025-06888-0","DOIUrl":"https://doi.org/10.1007/s00381-025-06888-0","url":null,"abstract":"<p><strong>Purpose: </strong>In this study, we explore the long-term cognitive capabilities and behaviors of patients in late adolescence and early adulthood who underwent corrective surgery for craniosynostosis as infants.</p><p><strong>Methods: </strong>Patients 16 years of age or older who had undergone surgery as infants for any type of non-syndromic craniosynostosis were identified from the operating records of three craniofacial plastic surgeons from a single institution. Participants underwent standardized neurocognitive testing using the BEERY and WASI. A subset of patients additionally underwent behavioral testing using the CAARS-2, ASR, SRS-2, and BRIEF standardized tests.</p><p><strong>Results: </strong>Thirty-two participants underwent neurocognitive testing and 22 participants underwent behavioral testing. The mean scores for the WASI FSIQ-4, PRI, and VCI were not significantly different than the general population. The mean score for BEERY VMI was 95, BEERY VP was 97, and BEERY MC was 92, all of which were significantly lower than the population average. Twenty-three percent of participants scored high or very high on the CAARS-2 ADHD index, and of the 44 total patients contacted, 13.6% either confirmed having a diagnosis of autism or tested moderate-severe on the SRS-2 autism screener.</p><p><strong>Conclusions: </strong>Patients have comparable neurocognition relative to the general population, with deficits in visual and motor integration. However, there is a significantly higher prevalence of ADHD and autism-related behaviors in this cohort. These findings are useful in counseling parents with infants who have been diagnosed with craniosynostosis, as well as in directing early screening and intervention for these patients to provide the resources and therapies families need.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"233"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639565","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":"MRI-based, three-dimensionally assessed tumor burden and growth velocity to predict visual acuity deterioration in optic pathway glioma - results of a retrospective longitudinal analysis.","authors":"David Gorodezki, Felix Tonagel, Julian Zipfel, Markus Mezger, Karin Haas-Lude, Ursula Holzer, Thomas Nägele, Martin Ulrich Schuhmann, Martin Ebinger","doi":"10.1007/s00381-025-06890-6","DOIUrl":"10.1007/s00381-025-06890-6","url":null,"abstract":"<p><strong>Purpose: </strong>Optic pathway gliomas (OPGs) bear a high risk of visual acuity (VA) impairment, while balancing disease-related morbidity and potential therapy-related sequelae remains challenging. We assess the predictive value of MRI-based, three-dimensionally assessed tumor burden and growth velocity for VA outcomes in NF1-associated and sporadic OPGs.</p><p><strong>Methods: </strong>Thirty-three OPG patients were longitudinally observed over a median follow-up period of 10.3 years, while sequential tumor volumetry was performed to assess tumor burden and tumor growth velocity. VA was assessed as minimal angle of resolution (logMAR) with age-appropriate measures during regular ophthalmology visits.</p><p><strong>Results: </strong>During observation, therapeutic intervention was initiated in 64% of individuals due to VA deterioration or radiological progress. Impaired VA occurred in 55 vs 80% of NF1-associated vs sporadic OPG patients, respectively, while blindness of at least one eye occurred in 36% of individuals. Tumor burden showed significant correlation with VA impairment at diagnosis and individual logMAR change during follow-up (R² = .22, p = .011), while individual tumor growth velocity during follow-up showed correlation with VA deterioration in non-NF1 OPG (R² = .35, p = .04). ROC analyses identified a threshold tumor burden (> 11.1 cm³, AU ROC 0.76) and growth velocity (> 0.1 cm³/month, AU ROC 0.81) to predict loss of VA with modest sensitivity and specificity.</p><p><strong>Conclusion: </strong>These data indicate a predictive value of three-dimensionally assessed tumor burden and growth velocity for VA outcomes in OPG. Prospective evaluation within future trials may facilitate further implementation for advanced stratification, potentially identifying patients who may benefit from early therapeutic intervention.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"230"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610933","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":"Glucocorticoid use in paediatric posterior fossa tumour surgery and the occurrence of postoperative speech impairment.","authors":"Rebekka Sarup, Aske F Laustsen, Martin K Sørensen, Conor Mallucci, Barry Pizer, Kristian Aquilina, Emanuela Molinari, Magnus Aasved Hjort, Radek Frič, Per Nyman, Magnus Sabel, Pelle Nilsson, Algimantas Matukevičius, Peter Hauser, Katalin Mudra, Andrea Carai, Julian Zipfel, Eelco Hoving, Kirsten van Baarsen, Vladimír Beneš IIIrd, Andreas Peyrl, Karsten Nysom, Astrid Marie Sehested, Kjeld Schmiegelow, Marianne Juhler, Jonathan K Grønbæk, René Mathiesen","doi":"10.1007/s00381-025-06850-0","DOIUrl":"10.1007/s00381-025-06850-0","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative speech impairment (POSI) is a core symptom of cerebellar mutism syndrome (CMS) and is a common complication after the resection of paediatric posterior fossa (PF) tumours. Preoperative glucocorticoids (pGC) are considered standard treatment to reduce tumour oedema; in addition, glucocorticoids are often administered intraoperatively (iGC) to reduce both postoperative nausea and vomiting. The study aims to investigate whether the occurrence of POSI may be associated with pGC and iGC.</p><p><strong>Methods: </strong>In a prospective observational multicentre study, we included children with a PF tumour requiring either resection or open biopsy. The use of pGC and iGC, including drug type and dose, was registered. Postoperative speech status was classified as mutism, reduced speech, or habitual speech, where mutism and reduced speech were considered POSI of higher and lower severity, respectively. Proportional odds logistic regression with adjustment for tumour type, tumour location, and age was used to analyse the occurrence of POSI associated with glucocorticoids (GC).</p><p><strong>Results: </strong>From August 2014 to November 2024, we recruited 810 children, of whom 605 were included in the primary analysis. We found no association between the use of GC (pGC nor iGC) and the occurrence of POSI. The result did not change when adjusting for tumour type, tumour location, and age. The analysis included both a comparison between using and not using pGC (OR 1.06 [95% CI 0.46 -2.49], reference level: use of pGC) and/or iGC (1.28 [0.58-2.82], reference level: use of iGC), and a dose-response analysis of the occurrence of POSI in relation to doubling the dose of GC (pGC OR 1.28 [0.84-1.98]; iGC OR 1.07 [0.62-1.82]).</p><p><strong>Conclusion: </strong>Our study did not find evidence of a significant change in the occurrence of POSI with the use of pGC or iGC, but our results alone cannot rule out that the administration of pGC or iGC may have some effect. Therefore, our data do not call for a change in recommendations for the use of GC as protection against the development of POSI.</p><p><strong>Trial registration number: </strong> Clinicaltrials.gov (NCT02300766).  Date of registration: November 25, 2014.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"231"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610932","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":"Outpatient Follow-up After Pediatric Traumatic Brain Injury at an Urban Safety Net Hospital: A Retrospective Cohort Study.","authors":"Eric A Grin, Aarti Kishore Jain, Hannah Weiss, Asmita Mittal, Gaddah Abouzein, Paul Huang, Sandra Tomita, Eveline Teresa Hidalgo","doi":"10.1007/s00381-025-06893-3","DOIUrl":"https://doi.org/10.1007/s00381-025-06893-3","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is the leading cause of pediatric disability. Most pediatric TBIs are mild but can result in long-term cognitive and functional impairments. Outpatient follow-up is essential to detect post-concussive symptoms and aid recovery.</p><p><strong>Methods: </strong>All patients 3-18 years of age with positive TBI findings on CT or MRI from 2018-2024 were retrospectively reviewed. Follow-up was defined as an appointment with neurology, neuropsychology, neurosurgery, or physical medicine and rehabilitation within three months of discharge. Analyses were performed with appropriate Chi-squared, Fisher's exact, Mann-Whitney U, or t-tests.</p><p><strong>Results: </strong>Fifty-seven patients (41 male, mean age 11.4 years) were identified, with mild TBIs (GCS 13-15) comprising 41/57 (71.9%). Four patients (7.0%) died from their injury. Of 53 surviving patients, 20 (37.7%) had follow-up appointments scheduled for them at discharge, seven (13.2%) were given a specific date and contact number, 17 (32.1%) received service referrals without a specific date, and eight (15.1%) received nonspecific directions or were directed only to follow-up with non-neuroscience services. Within three months, 32 (60.4%) patients followed up, though only 22/53 (41.5%) patients saw a non-surgical neuroscience discipline. Patients who followed up were more likely to have undergone neurosurgery (p = 0.007) or any surgical procedure at all (p = 0.007). They were also more likely to have a shorter hospital length of stay (p = 0.021). Discharge instruction type was significantly associated with follow-up (p = 0.0013); 62.5% of patients who followed up had an appointment scheduled for them or were given a specific date versus 33.4% of patients who did not follow-up. Conversely, 38.1% of patients without follow-up received nonspecific instructions or were told to follow-up with non-neuroscience specialties. This finding remained significant when excluding patients with severe TBI. Follow-up had no significant associations with demographics, injury severity, or insurance type.</p><p><strong>Conclusion: </strong>Patient-centered discharge instructions with detailed service referrals increase access to critical follow-up care. Children with TBIs should have follow-up care arranged regardless of injury severity. Larger multicenter studies are needed to validate these findings.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"228"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602739","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":"Neurologic outcomes in patients with skeletal dysplasias undergoing cervical fusion and occipitocervical fusion.","authors":"John P Avendano, Tej D Azad, William ElNemer, Paul D Sponseller, Mari L Groves","doi":"10.1007/s00381-025-06860-y","DOIUrl":"https://doi.org/10.1007/s00381-025-06860-y","url":null,"abstract":"<p><strong>Purpose: </strong>To assess neurologic function after cervical or occipitocervical spinal decompression and fusion in patients with skeletal dysplasias, and to compare the incidence of reoperation between cervical vs. occipitocervical fusion and between postoperative bracing vs. no postoperative bracing.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 15 patients (mean age, 27 ± 22 years) with skeletal dysplasias (achondroplasia, chondrodysplasia punctata, osteogenesis imperfecta, Morquio syndrome, Hurler syndrome) who underwent cervical (n = 12) or occipitocervical (n = 3) decompression and fusion from 1997 to 2021 and had minimum 2-year follow-up (mean, 5.4 years). We assessed radiographic evidence of fusion, reoperation, and neurologic function (measured by the Barthel Index for Activities of Daily Living, which ranges from 0 [completely dependent] to 100 [fully independent]). Chi-squared tests compared outcomes between cervical vs. occipitocervical fusion and postoperative bracing vs. no bracing.</p><p><strong>Results: </strong>Among the 9 patients with Barthel Index values, mean values were 49 ± 29 preoperatively, 51 ± 29 postoperatively, and 53 ± 27 at medium-term follow-up, reflecting a lack of worsening in neurologic function. Five of 15 patients underwent reoperation. We found no difference in the incidence of reoperation between cervical and occipitocervical fusion (p = .49) or between braced and non-braced patients (p = .85).</p><p><strong>Conclusion: </strong>For patients with skeletal dysplasia, cervical and occipitocervical decompression and fusion can prevent worsening of neurological function. Fusion to the occiput and postoperative bracing were not associated with differences in the incidence of reoperation. Cervical spine abnormalities in patients with skeletal dysplasias, and the stenosis and instability they can cause, can be addressed with rigid internal fixation.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"229"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610934","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":"Pediatric meningioma and seizures: A scoping review.","authors":"Emma Ye, Ashwin Gupta, Alexander T Lyons, Shilpa B Reddy, Devang J Pastakia, Michael C Dewan","doi":"10.1007/s00381-025-06889-z","DOIUrl":"10.1007/s00381-025-06889-z","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric meningiomas (PM) are rare tumors with unique clinical characteristics, including their association with seizures. This review aims to explore the available evidence regarding the nature of this association, the types of evidence available, and the gaps in our understanding.</p><p><strong>Methods: </strong>We synthesized evidence from systemic literature search. We identified key clinical concepts including the frequency of seizures as a presenting feature, seizure outcomes following surgical treatment, the relationship between extent of resection and seizure freedom, the impact of histologic features or grade on seizure freedom, and the role of post-operative anti-seizure medications (ASMs). Two proportion z-tests were performed with a p < 0.05 significance threshold.</p><p><strong>Results: </strong>In our search, we found 824 pediatric meningioma cases, with 293 (35.6%) presenting with seizure(s) at the time of meningioma diagnosis. Varying information regarding tumor grade, recurrence, seizure outcomes, and use of ASM was available in all 293 patients. One hundred-thirteen cases had a listed meningioma grade, with 80 (70.8%) classified as grade I, 19 (16.8%) as grade II, and 14 (12.4%) as grade III. 12 of the 113 patients with graded tumors (10.6%) received post-operative ASMs. Post-operative seizure status was reported in 76 of these patients and 50 (65.8%) achieved seizure freedom. Twenty-one underwent subtotal resection and only 2 of 7 (28.6%) were known to have had seizure freedom.</p><p><strong>Conclusions: </strong>Seizures are a recognized clinical feature in pediatric meningioma, occurring in approximately 36% of patients. They may present at diagnosis or emerge as a postoperative complication, with implications for long-term neurological outcomes. Surgical resection remains the standard of care for pediatric meningioma, and a greater extent of resection improves seizure outcomes. The role of post-resection ASMs and the relationship between seizures and molecular characteristics of pediatric meningioma warrants further investigation.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"227"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602740","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":"Clinical impact of fetal sac size on closed neural tube defects.","authors":"Sierra D Land, Taryn Gallagher, Sanjana R Salwi, Tom A Reynolds, Leny Mathew, Edward R Oliver, Dana A Weiss, Tracy M Flanders, Juliana S Gebb, N Scott Adzick, Gregory G Heuer","doi":"10.1007/s00381-025-06866-6","DOIUrl":"10.1007/s00381-025-06866-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between lesion volume and postnatal outcomes in patients with closed spina bifida (SB).</p><p><strong>Methods: </strong>Single-center retrospective review of all patients diagnosed with a closed SB evaluated between 2013 and 2023. Prenatal lesion volume < 3 mL was categorized as \"no sac,\" and volume ≥ 3 mL was categorized as \"sac.\"</p><p><strong>Results: </strong>Of eligible patients, 22 had a sac, and 33 did not. Myelocystocele patients more commonly had an associated saccular lesion than lipomyelomeningoceles (80% vs. 28%, p = 0.02). Lipomyelomeningocele patients demonstrated less prenatal lesion growth compared to myelocystocele patients (6.26 vs. 58.0 mL) over a median of 12.7 and 10.5 weeks, respectively. Patients with a sac had a higher proportion of talipes (40.9% vs. 9.1%; p = 0.007) compared to those without. At 5 years old, a higher proportion of patients with no sac was able to ambulate independently and required less CIC than patients with a sac (80% vs. 42%; 0% vs. 41.7%). VUDS showed a greater frequency of detrusor overactivity (60.0% vs. 45.0%) and abnormal bladder compliance (60.0% vs. 5.0%) in those with a sac compared to those without. Repeat tethered cord release was also more common (30.0% vs. 3.4%) among patients with a sac-associated defect.</p><p><strong>Conclusions: </strong>Patients with a sac had an increased risk of prenatal talipes, decreased ability to ambulate independently, increased use of CIC, and increased need for repeat tethered cord release compared to patients without a sac. Given numerous associated morbidities reported in this study, longitudinal multidisciplinary follow-up is critical in the care of these patients.</p>","PeriodicalId":520587,"journal":{"name":"Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery","volume":"41 1","pages":"226"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602738","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}