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

{"title":"Sequential intraoperative protocol to improve bulbocavernosus reflex monitorability during pediatric spinal surgery.","authors":"Vizmary J Montes-Peña, Pedro Álvarez-Díaz, Wael A AlShaya, Samir O AlSayegh, Sami AlEissa, Fayez AlEnazy, Atheer Alamri, Faisal R Jahangiri","doi":"10.1007/s00381-026-07437-z","DOIUrl":"10.1007/s00381-026-07437-z","url":null,"abstract":"<p><strong>Purpose: </strong>Bulbocavernosus reflex (BCR) monitoring assesses sacral S2 to S4 pathway integrity during pediatric spinal surgery; however, its intraoperative utility is limited when responses are absent or unilateral. We prospectively evaluated a sequential intraoperative protocol designed to improve the interpretation of these patterns and reduce uncertainty during sacral monitoring.</p><p><strong>Methods: </strong>We prospectively studied 242 consecutive pediatric patients aged 0.4-12 years who underwent spinal surgery between 2023 and 2025. Bilateral external anal sphincter (EAS) recordings were obtained using subdermal-needle electrodes. Intramuscular placement was verified using tetanic stimulation. BCR responses were elicited using single-train stimulation (STS), followed by double-train stimulation (DTS). A persistent absence with failed EAS verification was classified as a pattern consistent with efferent nonacquisition, whereas a persistent absence despite preserved verification was classified as a pattern consistent with afferent nonacquisition.</p><p><strong>Results: </strong>Final BCR acquisition was achieved in 225 of 242 patients (93.0%; 95% CI, 89.3-95.7). STS produced bilateral responses in 61.2% of patients, whereas DTS increased bilateral acquisition to 87.2%, rescued 57.5% of initially absent responses, and converted 81.5% of unilateral responses to bilateral responses. Persistent absence was observed in 17 patients (7.0%), including nine patterns consistent with efferent nonacquisition and eight with afferent nonacquisition. Younger age was independently associated with persistent absence.</p><p><strong>Conclusion: </strong>A sequential protocol that combines EAS verification with DTS improves the intraoperative interpretation of BCR findings during pediatric spinal surgery. It provides a practical framework for interpreting absent or unilateral responses and reducing uncertainty when nonacquisition persists.</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":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805043","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":"Reverse brain herniation after CSF diversion: beyond recognition to anticipation.","authors":"Sreekanth Velpula, Pulkit Mittal, Rahul Singh, Nishant Goyal","doi":"10.1007/s00381-026-07435-1","DOIUrl":"10.1007/s00381-026-07435-1","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":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763763","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":"Bedside external ventricular drainage in the NICU: procedural efficiency and infection trends in a 15-year single-center cohort.","authors":"Taehoon Kim, Seung-Ki Kim, Joo Whan Kim, Seh Hyun Kim, Ju Sun Heo, Baek Sup Shin, Seung Han Shin, Ee-Kyung Kim, Han-Suk Kim, Ji Hoon Phi","doi":"10.1007/s00381-026-07374-x","DOIUrl":"10.1007/s00381-026-07374-x","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the procedural efficiency of bedside versus operating-room external ventricular drainage (EVD) insertion in a neonatal intensive care unit (NICU) and to describe culture-positive EVD-associated infections.</p><p><strong>Methods: </strong>We performed a retrospective single-center cohort study of NICU infants who underwent EVD insertion between 2011 and 2025. Operative time and insertion characteristics were analyzed at the insertion level. Culture-positive EVD-associated infections acquired at the study hospital were described, and annual infection incidence was explored in relation to unit methicillin-resistant Staphylococcus aureus (MRSA) acquisition rates.</p><p><strong>Results: </strong>Sixty-six infants underwent 161 EVD insertions (115 bedside, 28 operating room, 18 outside hospital). Among 140 study-hospital insertions with documented operative time, bedside insertion was faster than operating-room insertion (24.5 (11.4) vs 57.4 (35.2) min; adjusted difference, 32.5 min; 95% CI, 16.7-48.4; p < 0.001). Seven study-hospital-acquired culture-positive EVD-associated infections occurred (2.37 per 1000 catheter-days at risk), all during bedside catheter episodes. Median time from catheter insertion to first positive culture was 2 days. In an exploratory annual ecological analysis, infection incidence correlated with NICU MRSA acquisition rates (Pearson r = 0.74; p = 0.009).</p><p><strong>Conclusion: </strong>Bedside NICU EVD insertion was substantially faster than operating-room insertion after adjustment for case-mix differences. Culture-positive infections occurred only during bedside catheter episodes; therefore, infection findings should be interpreted descriptively rather than as evidence of comparative infection safety.</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":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763809","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":"Complication profile of two surgical techniques, neurosurgical experience, and operative setting for pediatric external ventricular drainage implantation.","authors":"Tommaso Araceli, Sarah Klarner, Florian Zeman, Amer Haj, Sebastian Siller, Martin Proescholdt, Nils Ole Schmidt, Christian Ott","doi":"10.1007/s00381-026-07413-7","DOIUrl":"10.1007/s00381-026-07413-7","url":null,"abstract":"<p><strong>Purpose: </strong>External ventricular drain (EVD) insertion, a standard procedure for treating acute hydrocephalus, is also associated with significant risks. This retrospective study compares two surgical techniques routinely employed at our clinic and analyzes the influence of surgeon experience and the operative setting on complication rates in a pediatric population.</p><p><strong>Methods: </strong>The study population was divided into two cohorts based on the surgical procedures used to access the ventricular system: the BoltKit system (BS) or drain tunnelling (DT). Statistical analysis balanced age, sex, site and side of the drainage, neurosurgical experience, i.e. junior surgeons (JS) or senior surgeons (SS), and operating settings, i.e. intensive care unit (ICU) or operating room (OP), with complications such as cerebrospinal fluid infection, multiple insertion attempts (MIA), malpositioning, revision, and bleeding.</p><p><strong>Results: </strong>This retrospective study included 101 patients (62 males, 39 females, mean age 7.1 years): 79 were treated with DT, and 22 with BS. Overall, 81 EVDs were placed frontal, 18 occipital, 68 at the right and 25 at the left side; 22 revisions (22%), 13 infections (13%), 11 MIA (11%), 10 malpositionings (10%), and 4 bleedings (4%) occurred. MIA, malpositionings, and revisions were significantly more frequent after BS than DT (p = 0.012, p = 0.038, p = 0.020). Revisions were also more common in ICU than OP insertions (p = 0.002) and in JS vs. SS (p = 0.018). Infections were significantly associated with frontal catheter placement (p = 0.018) but not with technique. In multivariable models, both DT and SS reduced the risk of MIA independently, while an ICU setting predicted the need for revision independently.</p><p><strong>Conclusion: </strong>In children, DT is associated with fewer complications than BS. Both surgical experience and the operative setting significantly influence outcome, highlighting the importance of careful technique selection and supervision in pediatric EVD placement.</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":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13468987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725775","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 Gamma Knife radiosurgery in pediatric arteriovenous malformations: the role of age and lesion characteristics.","authors":"Jong Seok Lee, Jung Won Choi, Hye Won Choi, Kyung Won Chang, Hyung Jin Shin, Jung Il Lee","doi":"10.1007/s00381-026-07394-7","DOIUrl":"10.1007/s00381-026-07394-7","url":null,"abstract":"<p><strong>Purpose: </strong>The influence of age on radiosurgical outcomes in pediatric arteriovenous malformations (AVMs) remains unclear. This study evaluated the efficacy and safety of Gamma Knife radiosurgery (GKRS) across pediatric age subgroups.</p><p><strong>Methods: </strong>We retrospectively analyzed pediatric patients (≤ 18 years) who underwent GKRS for intracranial AVMs between 2000 and 2025. Patients were stratified into preadolescent (≤ 12 years) and older pediatric (> 12 years) groups. Clinical, radiological, and treatment-related parameters were compared. Time-to-event analyses were performed to evaluate nidus obliteration and post-GKRS hemorrhage.</p><p><strong>Results: </strong>The study included 136 patients who underwent 194 GKRS sessions. Fifty-seven patients (41.9%) were aged ≤ 12 years at the time of first GKRS. Baseline characteristics and treatment parameters were comparable between the age groups. During follow-up, complete nidus obliteration was achieved in 52 patients (38.2%), and post-GKRS hemorrhage occurred in 5 patients (3.7%). The estimated cumulative obliteration rates were 35.0% at 3 years and 41.8% at 5 years after GKRS. Age was not associated with nidus obliteration or post-GKRS hemorrhage in univariable or multivariable analyses. Higher prescription dose demonstrated a marginal independent association with nidus obliteration, whereas higher Spetzler-Martin grade showed a trend toward increased hemorrhage risk. Adverse radiation effects were rare and asymptomatic (2.9%). Repeat GKRS was performed in 31.6% of patients, primarily for persistent or residual AVMs identified during follow-up after the initial treatment.</p><p><strong>Conclusion: </strong>Within the pediatric population, younger age was not associated with inferior radiosurgical outcomes. AVM complexity and treatment-related factors were the primary determinants of treatment outcome. GKRS can be applied safely and effectively across most pediatric age groups, and repeat radiosurgery represents a reasonable treatment strategy for selected complex 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":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702712","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":"Methodological determinants and prevalence of elevated intracranial pressure in isolated single-suture craniosynostosis: a systematic review and meta-analysis.","authors":"Beste Gülsuna, Parth Patel, Abdurrahman F Kharbat, Sixia Chen, Michael Machiorlatti, Andrew Jea, Nicholas Sader","doi":"10.1007/s00381-026-07418-2","DOIUrl":"10.1007/s00381-026-07418-2","url":null,"abstract":"<p><strong>Objective: </strong>Elevated intracranial pressure (ICP) in isolated single-suture craniosynostosis (SSC) may contribute to neurodevelopmental impairment, yet reported prevalence varies widely. This systematic review and meta-analysis estimate the pooled prevalence of elevated ICP in isolated SSC and evaluate potential modifiers including suture subtype, measurement timing, and assessment modality.</p><p><strong>Methods: </strong>PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched (inception to February 2026). Eligible studies reported ICP outcomes in children with isolated SSC using invasive monitoring or optical coherence tomography (OCT). Pooled prevalence was estimated using random-effects meta-analysis with Freeman-Tukey transformation, stratified by measurement modality (invasive vs. OCT). Subgroup analyses evaluated suture type and measurement timing. Heterogeneity was explored through meta-regression and sensitivity analyses.</p><p><strong>Results: </strong>Seventeen studies (720 patients; 1982-2025) met inclusion criteria. All invasive studies applied a uniform ≥ 15 mmHg threshold; OCT studies used four distinct retinal nerve fiber layer algorithms approximating this threshold. Pooled prevalence was 38% (95% CI, 26-51%; I² = 77.0%) by invasive monitoring (13 studies; n = 448) and 43% (95% CI, 28-61%; I² = 83.8%) by OCT (4 studies; n = 272). The combined estimate was 39% (95% CI, 30-50%). By suture type, prevalence ranged from 33% (metopic) to 43% (sagittal) without significant differences (p = 0.89). Intraoperative studies yielded higher prevalence than preoperative (52% vs. 34%; p = 0.13). Meta-regression explained only 11.7% of between-study variance.</p><p><strong>Conclusions: </strong>Elevated ICP is reported in a substantial proportion of children with isolated SSC, although prevalence estimates vary considerably based on diagnostic methodology and timing of assessment. Across included studies, pooled estimates ranged between 30-50%. Noninvasive screening, such as OCT, may aid adequate detection in at-risk patients. Standardized ICP thresholds and longitudinal neurocognitive studies are needed to guide management and optimize 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":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698569","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":"Programmable shunt valve stability after MRI: a 2-year institutional experience across valve types and field strengths.","authors":"Brannan E O'Neill, Adelaide Pfeuffer, Dallas J Soyland, Sonora Robles, Saige Teti, Kerri B Thorn, Carl J Bailey, Robert Crowder, Amiya Rattley, Abdullah Feroze, Daniel A Donoho, Chima O Oluigbo, John S Myseros, Hasan R Syed, Robert F Keating","doi":"10.1007/s00381-026-07409-3","DOIUrl":"10.1007/s00381-026-07409-3","url":null,"abstract":"<p><strong>Objective: </strong>Programmable cerebrospinal fluid (CSF) shunt valves permit noninvasive adjustment of opening pressure but remain vulnerable to inadvertent setting changes when exposed to magnetic fields. This study evaluated the incidence, direction, and clinical significance of MRI-associated setting changes across six contemporary programmable valve models at both 1.5-T and 3-T field strengths.</p><p><strong>Methods: </strong>All brain MRI scans performed between October 2023 and October 2025 in patients with cranially implanted programmable valves at a single tertiary pediatric center were prospectively documented using a standardized pre- and post-MRI valve-check protocol. Valve type, magnet strength, and setting changes were recorded, and statistical analyses incorporated Fisher's exact testing and mixed-effects logistic regression to account for repeated scans.</p><p><strong>Results: </strong>A total of 240 MRI examinations were performed in 87 patients. Overall, 64/240 scans (26.7%) resulted in valve setting changes, with the highest rates occurring in Medtronic Strata valves (28/38, 73.7%), followed by Sophysa Polaris (21/68, 30.9%), Certas Plus (14/115, 12.2%), and proGAV (1/10, 10.0%). No setting changes occurred in Strata MR (0/3) or proGAV 2.0 (0/6) valves. Two valves were non-programmable during assessment. After adjustment for valve type and clustering by patient, magnet strength was not independently associated with valve change. No adverse neurological outcomes occurred.</p><p><strong>Conclusions: </strong>MRI-related setting changes remain common in certain programmable valves despite newer designs. Brand is the dominant factor, whereas MRI strength alone does not predict risk. Routine pre- and post-MRI valve checks are recommended for all programmable valves.</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":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687616","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":"Second primary malignancies among childhood medulloblastoma survivors: a population-based competing risk analysis.","authors":"Lue Li, Jin Zhang, Wanshui Wu","doi":"10.1007/s00381-026-07427-1","DOIUrl":"10.1007/s00381-026-07427-1","url":null,"abstract":"<p><strong>Purpose: </strong>Childhood medulloblastoma (MB) survivors face elevated second primary malignancy (SPM) risk because of multimodal treatment. Prior studies were limited by small samples, older data, and methods that ignored competing risks. We aimed to quantify SPM risk using contemporary SEER data and competing risk methodology.</p><p><strong>Methods: </strong>Using the SEER 17 registries database (2000-2023), we identified 1806 patients diagnosed with MB at ages 0-19 years. Standardized incidence ratios (SIRs) were calculated using the MP-SIR module. Cumulative incidence functions (CIFs) were estimated within a competing risk framework, with non-SPM death as the competing event. Fine-Gray regression was fitted to identify independent predictors of SPM, yielding subdistribution hazard ratios (sHRs).</p><p><strong>Results: </strong>Of 1806 MB patients, 104 (5.8%) developed SPMs over a mean follow-up of 111 months. The overall SIR was 21.87 (males) and 20.78 (females). The most frequent SPM types were brain/central nervous system tumors (n = 26; SIR = 63.64), thyroid cancer (n = 23; SIR = 75.17 in males), and leukemia (n = 19; SIR = 25.60), with acute myeloid leukemia exhibiting SIRs of 99.41-100.95. On Fine-Gray regression, more recent diagnosis era was the only factor statistically associated with SPM occurrence; compared with 2000-2005, sHRs were 1.72 (95% CI 1.05-2.83; P = 0.031) for 2012-2017 and 2.28 (95% CI 1.04-5.01; P = 0.039) for 2018-2023. This era association should be interpreted cautiously, as it is likely driven by longer follow-up, more intensive surveillance, and declining competing mortality in recently diagnosed cohorts rather than a true increase in the underlying biologic risk of SPM; similarly, the null associations for radiation therapy and chemotherapy do not exclude a true effect, given the limited treatment detail available in SEER. Among 5-year survivors, cumulative SPM incidence surpassed non-SPM death beyond 15 years. Mortality after SPM diagnosis was 51.9%.</p><p><strong>Conclusion: </strong>Childhood MB survivors face a substantially elevated SPM risk persisting beyond two decades. Brain tumors, thyroid cancer, and therapy-related leukemia predominate. These findings support lifelong surveillance incorporating thyroid screening, neuroimaging, and hematologic monitoring for MB survivors.</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":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687626","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":"Distraction in anterior plagiocephaly: technique, risks, and long-term results.","authors":"Santiago Lopez-Becerra, David Perrault, Kirin Naidu, Maura R Guyler, Samir Shakir, Jordan W Swanson, Jesse A Taylor","doi":"10.1007/s00381-026-07338-1","DOIUrl":"10.1007/s00381-026-07338-1","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to define the perioperative outcomes and long-term aesthetic outcomes of patients with unicoronal craniosynostosis (UCS) treated with fronto-orbital distraction osteogenesis (FODO) and compare them to a contemporaneous cohort treated with conventional fronto-orbital advancement and remodeling (FOAR).</p><p><strong>Methods: </strong>A retrospective review was performed for all patients treated at the Children's Hospital of Philadelphia for non-syndromic UCS from 2009-2025. Demographic and perioperative data were collected. Preoperative and 5-year or greater postoperative frontal 2D photographs were used to assess for facial, and specifically periorbital, symmetry. Symmetry ratios were calculated to assess periorbital facial morphometry.</p><p><strong>Results: </strong>Sixty-two patients were included in the study, 34 FODO, and 28 FOAR. FODO demonstrated significantly shorter anesthesia and surgical times, lower estimated blood loss, and shorter length of stay (all p < 0.001). The overall complication rate was similar (p = 0.175), but postoperative infection was more commonly reported in the FODO group (24 vs 1%, p = 0.033). Thirty-two patients had a 5-year or greater postoperative photographs, 16 FODO, and 16 FOAR. Patients in the FODO group were found to have greater improvements in palpebral width symmetry (0.32 vs -3.4, p = 0.039) and canthal tilt symmetry (1.51 vs -1.20 degrees, p = 0.035). One patient in the FOAR group required reoperation due to signs of elevated ICP.</p><p><strong>Conclusion: </strong>FODO results in improved perioperative and long-term aesthetic outcomes compared to FOAR, resulting in improved canthal tilt and palpebral width symmetry. Future studies should focus on severity-matched analyses.</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":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671842","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":"Postoperative meningitis in pediatric posterior fossa tumors: risk stratification and the role of early CSF cytology.","authors":"Srishti Dixit, Ashutosh Kumar, Aanchal Datta, Deepti Tripathi, Soumen Kanjilal, Pawan Kumar Verma, Ved Prakash Maurya, Kuntal Kanti Das, Anant Mehrotra, Arun Kumar Srivastava, Awadhesh Kumar Jaiswal","doi":"10.1007/s00381-026-07423-5","DOIUrl":"10.1007/s00381-026-07423-5","url":null,"abstract":"<p><strong>Background: </strong>Postoperative meningitis remains an important complication following pediatric posterior fossa tumor (PPFT) surgery and is associated with increased morbidity, prolonged hospitalization, and delays in adjuvant therapy. However, data regarding its incidence and perioperative risk factors in children remain limited.</p><p><strong>Objectives: </strong>To determine the incidence, risk factors, microbiological profile, and cerebrospinal fluid (CSF) characteristics of postoperative meningitis in PPFTs.</p><p><strong>Methodology: </strong>A retrospective analysis of 116 PPFT cases was performed. Patients with postoperative meningitis were compared with those without meningitis to identify potential risk factors. Meningitis cases were further classified into culture-positive and culture-negative groups, and CSF biochemical and cytological parameters were analyzed. Statistical analysis was performed with significance set at p < 0.05.</p><p><strong>Results: </strong>Among 116 patients (age = 9 ± 4 years; male:female::2.2:1), postoperative meningitis occurred in 19 (16.4%). Emergency surgery was significantly associated with meningitis (11/19, 57.9% vs 27/97, 27.8%; p = 0.011). Wound complications were more frequent in meningitis patients (52.6% vs 29.9%, p = 0.055). Age, tumor location, raised intracranial pressure, preoperative external ventricular drainage, shunt placement, postoperative CSF leak, intraventricular hemorrhage (IVH), and leukocyte count were not significantly associated. Among meningitis cases, 6 were culture-positive and 13 culture-negative. Bacterial meningitis showed higher median CSF cell counts (415 vs 12.5 cells/mm³, p = 0.082) and protein levels (139.3 vs 71.05 mg/dL, p = 0.190). IVH was more frequent in bacterial meningitis (33.3% vs 0%, p = 0.028). The most common isolates were Klebsiella species and methicillin-resistant Staphylococcus aureus (MRSA).</p><p><strong>Conclusion: </strong>Postoperative meningitis occurred in one-sixth of pediatric PFT cases. Emergency surgery independently increased risk, while culture-positive cases showed intraventricular hemorrhage and higher CSF inflammatory indices. The microbial profile highlights the increasing prevalence of multidrug-resistant organisms.</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":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671856","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}