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

{"title":"Multiple congenital dermal sinus tracts: a case-based review involving a unique triple-tract configuration that challenges current embryological concepts.","authors":"Michihiro Kurimoto, Tomoki Nawashiro, Mihoko Kato","doi":"10.1007/s00381-026-07448-w","DOIUrl":"10.1007/s00381-026-07448-w","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital dermal sinus tract (DST), a rare spinal dysraphism, typically presents as a solitary midline lesion. Lateral and multiple DSTs are extremely rare, and their embryological basis remains unclear. Here, we report a case of triple DSTs and review the literature on lateral and multiple DSTs to better characterize their clinical and anatomical features.</p><p><strong>Methods: </strong>A unique case of a 1-month-old infant with triple DSTs (left and right laterals and a midline) at the sacrococcygeal level with intradural convergence, complicated by meningitis and an associated dermoid cyst, is reported. A literature review of lateral and multiple DST case reports was performed in PubMed.</p><p><strong>Results: </strong>Three independent DSTs converged into the dural sac, all requiring surgical excision. Complete resection was achieved without neurological complications. At the latest follow-up, neurological function was preserved, with no signs of recurrent infection or lesion recurrence. The literature review revealed that lateral DSTs are rare and multiple DSTs are exceptionally uncommon. Very few reports described bilateral or intradural convergence patterns; none reported this specific triple-tract configuration.</p><p><strong>Conclusion: </strong>DSTs may present as multiple and non-midline lesions. Bilateral and midline DST coexistence with intradural continuity cannot be fully explained by the conventional focal nondisjunction theory. It is necessary to consider not only \"simple localized failure of separation during the primary neural tube formation stage\"-the conventional model-but also caudal developmental process abnormalities, including the secondary neural tube formation stage. Awareness of non-midline and multiple DSTs is essential for early diagnosis, comprehensive imaging, and complete surgical treatment.</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":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852329","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 cranial hydatid disease: lessons learned from three successive surgical interventions in a single patient with long-term follow-up.","authors":"Mehdi Borni, Saadia Makni, Amal Ayedi, Hela Ben Jemaa, Balkis Essid, Firas Gahbiche, Sirine Saadoun, Mohamed Zaher Boudawara","doi":"10.1007/s00381-026-07445-z","DOIUrl":"10.1007/s00381-026-07445-z","url":null,"abstract":"<p><p>Brain involvement in hydatid disease accounts for 1-2% of all Echinococcus granulosus infections. Extradural localization remains exceptional, particularly when associated with intra-axial dissemination or infection. Here, we report the complete clinical course over 4 years of a pediatric patient who presented sequentially with a primary osteolytic extradural complicated hydatid cyst, likely via microscopic dural disruption or hematogenous seeding, and subsequently underwent customized low-cost acrylic cranioplasty using a 3D-printed mold. At final follow-up (4 years post-initial presentation, 3 years post-final surgery), the patient remains disease free with favorable cosmetic outcome. Neurological examination is normal, and cognitive assessment demonstrates age-appropriate development. He shows normal academic performance and social integration. The cost-effective cranioplasty technique (< 2000 Tunisian dinars ≈ €600) provided perfect cranial contour restoration with no implant-related complications. To our knowledge, this is the first reported pediatric case of sequential extradural, disseminated intra-axial, and multiply recurrent cranial hydatidosis which demonstrates that a multidimensional strategy combining radical surgery, antiparasitic therapy, and delayed custom cranioplasty can achieve favorable long-term functional and cosmetic outcomes even in resource-limited settings. The favorable long-term recovery in neurological function, cognitive abilities, and quality of life underscores the importance of aggressive recurrence management and multidisciplinary follow-up in pediatric neuroparasitology.</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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842644","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":"Clinical characteristics, neurosurgical management, and outcomes of pediatric abusive head trauma: a 30-year single-center study.","authors":"Fauve Poncelet, Katrien Jansen, Gunnar Buyse, Liesbeth De Waele, Lieven Lagae, Sofie Dietvorst, Frank Van Calenbergh, Philippe De Vloo","doi":"10.1007/s00381-026-07433-3","DOIUrl":"10.1007/s00381-026-07433-3","url":null,"abstract":"<p><strong>Purpose: </strong>Abusive head trauma (AHT) is a leading cause of severe brain injury, mortality and long-term neurological disability in infants. Data on clinical indicators for neurosurgical intervention and long-term neurological outcome remain limited. This study aimed to describe clinical characteristics, indicators for neurosurgical management, and long-term outcomes of pediatric AHT.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study including all children younger than two years with suspected or confirmed AHT between 1993 and 2024. Clinical, radiological, treatment, and outcome data were extracted from medical records. Neurological outcome was assessed using the Pediatric Cerebral Performance Category (PCPC) score at discharge and last follow-up.</p><p><strong>Results: </strong>A total of 101 children presenting at University Hospitals of Leuven were included. Neurosurgical intervention was required in 72% of patients, and overall mortality was 11%. At last follow-up, neurological outcome was good in 67 patients (68%), intermediate in 12 patients (12%), and poor (including death) in 19 patients (19%). Among the 72 surgically treated patients, 64 (89%) underwent subdural external drainage. The median duration of drainage was 9 days (range 1-41), requiring a re-evacuation in 21%. Of all symptoms, only bulging fontanelle was independently associated with neurosurgical intervention (OR 3.19, 95% CI 1.25-8.13, p = 0.015). Cerebral edema or ischemia was the strongest independent determinant of poor neurological outcome (OR 38.69, 95% CI 6.92-216.35, p < 0.001).</p><p><strong>Conclusion: </strong>Abusive head trauma in early childhood is associated with substantial mortality and long-term neurological morbidity. A prospective multicenter study is needed to further refine surgical decision-making.</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":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842662","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":"A clinical activation protocol improves response time to urgent/emergent neurosurgical care in children with brain tumors and intracranial hemorrhage.","authors":"Rishi Jain, Hinda Najem, Shreya Mukherjee, Megan Votoupal, Kaethe Leonard, Julia Martorana, Yiannis Katsogridakis, Michael DeCuypere","doi":"10.1007/s00381-026-07436-0","DOIUrl":"10.1007/s00381-026-07436-0","url":null,"abstract":"<p><strong>Introduction: </strong>While there are well-established protocols for trauma and ischemic stroke care, there are few dedicated to brain tumors or non-traumatic intracranial hemorrhage (ICH), especially within pediatric neurosurgery. At Ann & Robert H. Lurie Children's Hospital of Chicago, a neurosurgical emergency activation protocol for non-traumatic intracranial emergencies, Code Intracranial Emergency (CIE), was developed and applied in 2021. This is a multidisciplinary protocol with synchronized workflows, predetermined roles, scripted communication, and streamlined patient assessment. Here we examine the effectiveness of this protocol in time management and access to care at a large tertiary referral center.</p><p><strong>Methods: </strong>Sixty-four patients with either a brain tumor or a non-traumatic ICH were retrospectively reviewed. We utilized a case-control study design for comparison purposes (January 2016-August 2022 [no code deployed, control cases, n = 36]; September 2021-January 2023 [CIE deployed, n = 28]). Both cohorts were matched for age and diagnosis/pathology. Group comparisons were conducted across time intervals (time from the emergency department (ED) to initial imaging, time to initial neurosurgery consultation, time to operating room (OR) arrival, and total length of hospital stay).</p><p><strong>Results: </strong>Across all tumor patients, the protocol significantly reduced the time from consultation to OR arrival (p = 0.03). For urgent/emergent tumor-related cases, significant improvements were observed in consultation to OR arrival time (p < 0.01). In addition, protocol utilization led to a significant reduction in consultation to OR time (p = 0.024) and lowered average ED to initial imaging time (56 min vs. 1.19 h) for urgent ICH cases.</p><p><strong>Conclusions: </strong>Implementation of CIE effectively reduced response time to OR arrival for patients suffering from intracranial tumor and ICH emergencies. While this cohort is underpowered, this analysis highlights the importance of a multidisciplinary protocol for optimal workflow during neurosurgical emergencies, where timely and streamlined communication is crucial for effective access to care.</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":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835913","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 and MR neuroimaging features of lumbosacral spinal malformations: a tertiary care institutional experience in south India.","authors":"Daniel P S Nesamani, Padigepati Madhuri, Krishnan Nagarajan, Andi Sadayandi Ramesh, Mani Manoranjitha Kumari, Krishnaraj Ariharan","doi":"10.1007/s00381-026-07429-z","DOIUrl":"10.1007/s00381-026-07429-z","url":null,"abstract":"<p><strong>Background and aims: </strong>Spinal dysraphisms are a group of malformations of the spinal cord or neural elements and the meninges with or without bony and soft tissue involvement due to defects in different stages of neural tube development. We aimed to study the clinico-radiological profile of spinal lumbosacral malformations in a tertiary care institution in south India.</p><p><strong>Material and methods: </strong>Clinical and MR neuroimaging features of 120 patients with congenital lumbosacral spinal malformation (113 children and 7 adults) were analyzed including skeletal abnormalities, cutaneous stigmata, and level of malformations. The malformations were divided into simple single-level defects and complex multi-level defects.</p><p><strong>Results: </strong>There were 101 cases of single-level defect malformations and 19 cases of complex malformations involving multiple levels or defects. Meningoceles (11), myelomeningocele (16), lipomyelocele (29), lipomyelomeningocele (20), split cord malformation types I (17) and II (23), intradural lipoma with dural defect (7), and caudal regression syndrome (9) are the major anomalies noted. Low-lying cord and tethering were noted in both groups (> 80 and 75%). Thickened filum (40), filar lipoma (22), central canal prominence (29), and syrinx (22) are other findings. Brain MRI findings include Chiari malformation in 9 cases of myelomeningocele and corpus callosal hypoplasia in 2 cases of lipo-myelomningocele.</p><p><strong>Conclusions: </strong>Our study is an attempt to give a structured descriptive profile and classification of spinal lumbosacral malformations based on MR neuroimaging from a tertiary care institution in south India.</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":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805102","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":"Clinical characteristics and treatment strategies of brainstem lesion in children with neurofibromatosis type 1.","authors":"Han Yong, Wang Yongqiang, Wang Hangzhou, Chen Min","doi":"10.1007/s00381-026-07441-3","DOIUrl":"10.1007/s00381-026-07441-3","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinical characteristics, treatment strategies, and prognosis of Brainstem Lesion (BSL) in children with neurofibromatosis type 1 (NF1).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 269 children with NF1 admitted to Children's Hospital of Soochow University from July 2016 to March 2025. All children underwent cranial magnetic resonance imaging (MRI), and BSL was diagnosed based on imaging findings. The incidence, clinical characteristics, disease progression, and prognosis of NF1-associated BSL were analyzed. Family trio whole exome sequencing was performed in 7 of 11 children with NF1-associated BSL to explore the correlation between NF1 genotype and clinical phenotype.</p><p><strong>Results: </strong>Among 269 children with NF1, 11 (4.1%) had concurrent BSL. Lesion distribution: 1 case involved the medulla and cervical spinal cord, 1 case involved the medulla, 2 cases involved the pons, 2 cases involved the tectum of the midbrain, and 5 cases involved the medulla and pons. One child with tectal lesion underwent endoscopic third ventriculostomy for obstructive hydrocephalus; at the last follow-up, the lesion size remained stable and symptoms related to hydrocephalus improved. The remaining 10 cases were managed with clinical follow-up and observation; during follow-up, all clinical symptoms remained stable, with 2 cases showing radiological lesion regression and 8 cases showing stable lesion size. Family trio whole exome sequencing results of 7 children revealed NF1 gene mutations located in: exon 54, exon 16, exon 18, exon 22, exon 4, and splicing site mutations in intron 29 and intron 32 in 2 cases, respectively.</p><p><strong>Conclusion: </strong>The incidence of BSL in children with NF1 is comparable to international reports, with the medulla and pons being the most commonly affected sites. NF1-associated BSL mostly demonstrates biological indolence; the vast majority do not require active intervention and have a favorable prognosis. The correlation between NF1 genotype and the clinical phenotype of BSL warrants further investigation.</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":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805089","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":"Reirradiation for diffuse intrinsic pontine glioma in an upper middle-income country: does full dose improve outcomes?","authors":"Natália Dassi, Maria Luisa Sucharski Figueiredo, Francine Tesser Gamba, Marcos Devanir Silva da Costa, Ana Carolina Dos Santos Torquato, Jessica Benigno Rodrigues, Ronaldo Modesto de Souza Filho, Sergio Cavalheiro, Patricia Alessandra Dastoli, Frederico Adolfo Silva, Carlota Vitoria Blassioli Moraes, Silvia Regina Caminada de Toledo, Nasjla Saba Da Silva, Michael Jenwei Chen, Andrea Maria Cappellano","doi":"10.1007/s00381-026-07390-x","DOIUrl":"10.1007/s00381-026-07390-x","url":null,"abstract":"<p><strong>Purpose: </strong>Reirradiation (reRT) during diffuse intrinsic pontine glioma (DIPG) progression has emerged as a potential treatment strategy for prolonging survival.</p><p><strong>Methods: </strong>This retrospective, single-center observational study was conducted on children diagnosed with DIPG between 2010 and 2025, and data from 58 were collected. Doses for reRT were as follows: 50-54 Gy (1.8-2.0 Gy daily/fractions) or 39 Gy (3 Gy daily/fractions). Overall survival (OS) was defined as the time from diagnosis to the date of death and reRT OS, reirradiation starting to death. The Kaplan-Meier method and log-rank test were used for survival analysis.</p><p><strong>Results: </strong>The median age was 7.1 years (range 2.9-16.2 years). Twenty-six patients underwent a biopsy. The H3K27M mutation was the most prevalent in our study, followed by TP53 altered gene. Twenty-two patients underwent reRT at progression. The median time from initial treatment to reRT was 9.9 months (range 6.7 to 20.5 months). Seven of the 22 patients received reRT at a dose of 39 Gy while 14 at doses of 50-54 Gy. The median OS from reRT to death was 5.8 months (range, 0.9-18.3 months). Patients who received reRT had a longer OS compared to those who did not (median OS of 17.9 versus 9.8 months; p = 0.005). Longer time for progression (> 9 months) and dose of reRT > 50 Gy were statistically significantly correlated with better OS. Reirradiation was generally well-tolerated by all patients.</p><p><strong>Conclusions: </strong>This study offers molecular insights into this tumor type and presents a therapeutic option with higher nominal doses reRT within a palliative context to prolong survival of these patients.</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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805098","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, molecular, and surgical predictors of outcome in non-DIPG pediatric diffuse midline gliomas: A collaborative retrospective analysis.","authors":"Sara Iglesias, Victoria Becerra, Pablo Miranda, Trinidad Márquez, Lara Galbarriatu, Pablo M Munarriz, Jorge Gimenez, Javier Saceda, Francisca Rius, José Hinojosa","doi":"10.1007/s00381-026-07432-4","DOIUrl":"10.1007/s00381-026-07432-4","url":null,"abstract":"<p><strong>Purpose: </strong>To review a multicentric series of non-pontine diffuse midline glioma (DMG), describing clinical and histomolecular variability, surgical planning and complications, treatment strategies and factors related to outcome.</p><p><strong>Methods: </strong>A retrospective multicentre study promoted by the Spanish Society of Paediatric Neurosurgery (SENEP) was conducted including paediatric patients with non-pontine DMG who underwent surgery and were diagnosed between 2016 and 2025, with a minimum follow-up of 1 month. Associations between clinical variables and survival were explored using Kaplan-Meier curves and Cox regression analyses.</p><p><strong>Results: </strong>Thirty-five paediatric patients (aged 2-17) were included. Tumour location was unilateral thalamic in 48.6%, bithalamic in 25.7%, and less frequently involved the hypothalamus, pineal region, or showed dissemination. Biopsy was the first surgery in 80% of patients, yielding high diagnostic accuracy with minimal complications. Hydrocephalus developed in 77.1% of patients, and 17.1% experienced non-surgical brain swelling and/or intratumoural haemorrhage. Median overall survival was 16.0 months (95% CI 7.75-24.25), and median progression-free survival was 5.0 months (95% CI 2.76-7.24). Location and molecular subtype were linked to better OS in exploratory multivariate analyses, although these results should be interpreted with caution given the limited sample size and number of survival events.</p><p><strong>Conclusions: </strong>Literature on paediatric DMGs arising outside the pons remains limited. Biopsy appears to be a safe and effective diagnostic strategy, although resection may be beneficial in selected unilateral thalamic tumours. Observed differences in survival according to tumour location and molecular subtype should be regarded as hypothesis-generating and require validation in larger cohorts.</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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805104","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":"Building a pediatric spasticity surgery program in a low-awareness setting: capacity creation, multidisciplinary integration, and early outcomes.","authors":"Mohit Agrawal, Mahesh Gadhvi, Prabodh Kantiwal, Lokesh Saini, Mayank Garg","doi":"10.1007/s00381-026-07440-4","DOIUrl":"10.1007/s00381-026-07440-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Selective dorsal rhizotomy (SDR) and other spasticity-relieving procedures remain markedly underutilized in many regions of the world, not because of technical infeasibility but because of low awareness among referring specialties, the absence of structured referral pathways, and limited multidisciplinary integration. We describe the stepwise establishment of a pediatric spasticity surgery program in such a setting, with emphasis on capacity creation, stakeholder engagement, individualized treatment selection, and early clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This program was developed at a tertiary care government-aided academic hospital in Western India, beginning in April 2024 under a fellowship-trained functional neurosurgeon. In the absence of a preexisting referral ecosystem, initial cases were identified through surgeon-led screening of existing neurosurgical follow-up patients, with all identified candidates reviewed through structured multidisciplinary assessment before surgical candidacy was confirmed. In parallel, a physiologist was trained in intraoperative neurophysiological monitoring (IONM) using published protocols to build local monitoring capability. An initial cohort of four adult patients with severe post-traumatic spasticity (three with post-spinal cord injury paraparesis/quadriparesis, one with post-traumatic brain injury paraparesis) underwent SDR, confirming technical feasibility and perioperative safety of the locally developed protocol. Between April 2025 and March 2026, nine pediatric patients (age 5-18 years) underwent spasticity surgery (SDR, n = 8; selective tibial neurectomy, n = 1). The approach comprised (1) surgeon-led case identification with structured multidisciplinary review, (2) in-house neurophysiology capacity building, and (3) progressive integration with pediatric neurology, orthopedics, and rehabilitation services with an explicit individualized treatment selection framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Most pediatric patients presented late, with severe spasticity (Modified Ashworth Scale [MAS] grade 3/4), often accompanied by secondary fixed musculoskeletal contractures. A significant reduction in tone was achieved in all patients (MAS 3 → 1 in four patients, MAS 4 → 1 in four patients; MAS 4 → 2 in one patient). No perioperative neurosurgical complications occurred. All patients also demonstrated improvement in ambulatory status after surgery. Three patients with fixed deformities subsequently underwent planned, staged orthopedic contracture release once tone had been reduced. Over the course of the program, progressive multidisciplinary engagement led to improved awareness, increased referrals, and more coordinated care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The principal barrier to pediatric spasticity surgery in settings such as ours is low awareness and the absence of structured referral pathways, rather than technical limitations. Capacity building and a","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805063","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":"Protocol fragility and molecular blindspots in pediatric central nervous system embryonal tumor regimens.","authors":"Olukorede Olabanji Adekunle, Abdullahi Adinoyi Suleiman, Oluwaseun Oluwafemi Ayorinde","doi":"10.1007/s00381-026-07442-2","DOIUrl":"10.1007/s00381-026-07442-2","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":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805110","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}