Pediatric Neurosurgery最新文献

{"title":"State-of-the-Art Management of Children with Intractable Epilepsy and Brain Tumors.","authors":"Nir Shimony, Sarah Weatherspoon, Emily Hanzlik, Raja B Khan, Giles William Robinson, Ulrich-Wilhelm Thomale, Asim Choudhri, Soniya N Pinto, Jason Chiang, Paul Klimo, James W Wheless, George Jallo","doi":"10.1159/000551567","DOIUrl":"10.1159/000551567","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a common and frequently debilitating manifestation of pediatric brain tumors, especially low-grade epilepsy-associated tumors (LEATs) such as gangliogliomas, DNETs, and PXAs. In many children, seizures are the presenting symptom and may evolve into intractable epilepsy, affecting neurocognitive development and quality of life. Understanding the relationship between tumor biology, epileptogenic networks, and clinical presentation is essential for guiding timely and effective management.</p><p><strong>Summary: </strong>This review synthesizes current evidence and expert consensus on the integrated management of tumor-related epilepsy in children. We describe the anatomical, histopathological, and molecular correlates of epileptogenicity in pediatric brain tumors, with particular attention to the distinct clinical behavior of LEATs. Diagnostic strategies, including advanced imaging, neurophysiology, and invasive monitoring, are reviewed in the context of localizing the seizure onset zone while preserving function. The review outlines the indications and strategies for early surgical intervention, emphasizing that seizure control should be viewed as a primary therapeutic goal rather than a secondary outcome of tumor resection. Surgical approaches are discussed in relation to epilepsy duration, tumor location, and electroclinical concordance. For early, well-localized cases, lesionectomy may be sufficient, while longstanding epilepsy or tumors near eloquent cortex often require epilepsy-directed resections guided by intracranial monitoring. The role of preoperative ancillary tests (such as MEG, TMS, and neuropsychology) and intraoperative techniques (including ECoG and IONM) is highlighted for improving safety and precision.</p><p><strong>Key messages: </strong>(i) Epilepsy is a significant contributor to morbidity in children with brain tumors, particularly LEATs. (ii) Multidisciplinary care is essential for seizure localization and for optimizing outcomes in children with tumor-related epilepsy. (iii) Early surgical intervention is associated with better seizure and cognitive outcomes. (iv) Delayed treatment increases the risk of secondary epileptogenesis and long-term developmental effects. (v) Individualized surgical planning should balance oncologic and epilepsy goals from the first clinical encounter. (vi) Ancillary diagnostic and intraoperative tools enhance safety and help achieve maximal functional preservation.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-19"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial Injuries Due to Misuse of Infant Carriers.","authors":"Mathias Kant, Timothy Helmuth, Mark S Dias","doi":"10.1159/000551485","DOIUrl":"https://doi.org/10.1159/000551485","url":null,"abstract":"<p><p>Infant carriers (car seats, bouncy chairs) can cause injuries when used for other than their intended purpose. We studied children aged 0-24 months with carrier related injuries reported to the Pennsylvania Trauma Outcome Study (PTOS) dataset (2001-2022 inclusive). There were 562 injured children, averaging 23 injuries per year. Mean age was 3.3 months; 54.3% were male. Most (82.7%) fell from an elevated surface; 88.7% fell an estimated 2-5 feet. Head injuries (intracranial injury/hemorrhage and/or skull fracture) were present in 85.6%. Admission Glasgow Coma Scores were most commonly 15 (79.1%); 7 had GCS < 12. Average Injury Severity Scores were 9.3. Average length of stay was 1.4 days; 30% spent > 1 day in the intensive care unit. Two children underwent cranial operations. There were no deaths, and 82.9% were discharged home. We conclude that falls in, or from, infant carriers are a significant public health concern. Education, advocacy, and changes in carrier design may help to reduce the frequency of these injuries.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-16"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foramen Magnum Stenosis in Achondroplasia: Imaging-Based Surgical Indications, Synchondrosis Fusion, and the Role of Ventriculomegaly.","authors":"Ryo Ando, Osamu Numata","doi":"10.1159/000551092","DOIUrl":"10.1159/000551092","url":null,"abstract":"<p><strong>Introduction: </strong>Foramen magnum stenosis (FMS) and ventriculomegaly are frequent in achondroplasia due to cranial base hypoplasia. While FMS can cause spinal cord compression, the optimal treatment strategy remains debated. We reviewed our single-center experience and explored factors influencing surgical decisions.</p><p><strong>Methods: </strong>We retrospectively analyzed 18 children with achondroplasia evaluated between 2008 and 2024. MRI was used to assess FMS by anterior-posterior diameter and cerebrospinal fluid (CSF) area at the foramen magnum level. Ventriculomegaly was defined as an Evans Index ≥0.30. CT was used to evaluate foramen magnum morphology and synchondrosis fusion. Surgical indications were based on imaging findings of compression and intramedullary changes.</p><p><strong>Results: </strong>The median age at initial imaging was 9.5 months. Thirteen patients underwent foramen magnum decompression (FMD) and 5 were managed conservatively. The surgical group showed significantly smaller craniocervical junction CSF spaces compared with nonsurgical cases (p < 0.05). Synchondrosis fusion occurred earlier in achondroplasia than in controls. Ventriculomegaly was present in 66%, but its severity did not correlate with FMD. All surgical cases achieved decompression without major complications. Of the 13 surgical patients, 9 were followed for more than 1 year (median follow-up: 122 months). Within this subgroup, 4 developed radiological bone regrowth with re-stenosis, but all remained asymptomatic and none required reoperation.</p><p><strong>Conclusions: </strong>FMS in achondroplasia poses major risks, yet its natural history and management remain unclear. Our findings support early imaging-based screening and timely intervention in cases with cord compression. While FMD effectively relieves compression, it does not address underlying ossification abnormalities, requiring continued surveillance. Premature synchondrosis fusion may play a key role, and future studies should consider combined surgical and medical approaches to improve outcomes.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":1.3,"publicationDate":"2026-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Primary Fourth Ventricle Outlet Obstruction in Childhood - New Clinical Insights and Long-Term Outcome.","authors":"Marcos Devanir Silva da Costa, Wagner Lazaretto Padua, Thais Cristina de Souza Melo, Paloam Cardoso Nôvo, Fernando Seiji Suzuki, Patricia Dastoli, Sergio Cavalheiro","doi":"10.1159/000550833","DOIUrl":"10.1159/000550833","url":null,"abstract":"<p><strong>Introduction: </strong>Primary fourth ventricle outlet obstruction (PFVOO) is a rare cause of obstructive hydrocephalus in children. Diagnosis often requires high clinical suspicion and advanced magnetic resonance imaging (MRI) sequences, and the optimal management remains a matter of debate.</p><p><strong>Case presentation: </strong>We report a 3-year-old girl with unexplained tetraventricular hydrocephalus who presented with progressive macrocephaly, intermittent headaches, and atypical stereotyped head movements. She had previously undergone ventriculoperitoneal shunting in infancy, which failed after 18 months. High-resolution 3D-CISS MRI confirmed a patent aqueduct and a membranous obstruction at the foramen of Magendie, establishing the diagnosis of idiopathic PFVOO. An endoscopic third ventriculostomy (ETV) was performed uneventfully, and postoperative MRI confirmed ventricular size reduction. The patient remains clinically stable 2 years later, representing one of the longest pediatric follow-ups reported after ETV for PFVOO.</p><p><strong>Conclusion: </strong>PFVOO should be included in the differential diagnosis of unexplained tetraventricular hydrocephalus in children when conventional imaging is inconclusive. Advanced MRI sequences such as 3D-CISS are valuable for identifying subtle outlet obstructions. This case, extending the pediatric follow-up to 2 years, reinforces ETV as a safe and durable first-line treatment option in selected patients with PFVOO.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Virtual Reality for Postoperative Recovery in an Adolescent Idiopathic Scoliosis Population: A Prospective Pilot Study.","authors":"Prabhath Mannam, Michael Vazquez, Daniel Mittelman, Ethan Knapp, Weston Carpenter, William Lambert, Kim Koenig, Robert Astur, William Zempsky, Mark Lee, David S Hersh","doi":"10.1159/000550834","DOIUrl":"10.1159/000550834","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative recovery following adolescent idiopathic scoliosis (AIS) surgery includes multimodal pain management and physical therapy (PT). Though virtual reality (VR) has been explored as a non-pharmacologic strategy for reducing pain and anxiety during bedside procedures, its impact on postoperative pain and opioid use following AIS correction has not been well characterized.</p><p><strong>Methods: </strong>Adolescent patients undergoing spinal fusion for AIS between March 2024 and June 2025 were eligible for recruitment. Patients completed a 20-min immersive underwater VR scenario prior to each postoperative inpatient PT session. Pain scores (measured on a 10-point Likert scale) before and after PT, opioid usage, number of completed PT sessions, and length of hospitalization were recorded for study subjects and were compared to controls.</p><p><strong>Results: </strong>Ten patients in the VR cohort were compared to 10 controls. There were no differences in sex (p = 0.58), race (p = 0.07), ethnicity (p > 0.99), or average age at surgery (15.1 vs. 15.8 years, p = 0.30). Patients in the VR cohort had a greater average reduction in pain scores associated with postoperative PT compared to controls (-0.72 vs. +0.61, p = 0.02). Patients in the VR and control groups did not differ significantly with regard to total opioid usage in morphine equivalents (55.7 vs. 49.9 mg, p = 0.71), completed PT sessions (3.2 vs. 3.2 sessions, p > 0.99), or length of hospitalization (2.6 vs. 2.4 days, p = 0.53). Side effects of the VR intervention included fatigue (n = 3), nausea (n = 3), headache (n = 2), eye strain (n = 1), and dizziness (n = 1).</p><p><strong>Conclusion: </strong>Our pilot study demonstrated that an immersive VR session prior to each postoperative PT session significantly reduced the change in PT-associated pain scores among patients undergoing spinal fusion for AIS. Future investigations utilizing a randomized controlled design will continue to elucidate the impact of VR on postoperative recovery for patients undergoing AIS correction.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12991808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Soul of Pediatric Neurosurgery: Wellness as a Path to Purpose.","authors":"Anthony M Avellino, Lori Ann McBride, Jeffrey S Raskin","doi":"10.1159/000550661","DOIUrl":"10.1159/000550661","url":null,"abstract":"<p><strong>Background: </strong>We often identify our vocation with a calling. Pediatric neurosurgeons are vulnerable to burnout and moral injury given the high emotional stakes, relentless pursuit of precision, and the enduring demands of patient care. Physician wellness is a prerequisite for safe, high-quality care, and professional longevity.</p><p><strong>Summary: </strong>This article highlights physician wellness as a critical issue in pediatric neurosurgery, explores the public health crisis of physician suicide and burnout, and outlines strategies to sustain performance and resilience through relationships, purpose, and self-compassion.</p><p><strong>Key messages: </strong>In this narrative reflective article, we make recommendations based on our personal experience and on the belief that wellness is not optional - it is essential to fulfill our calling as healers.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.3,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Aspects of Invasive Epilepsy Monitoring: Utility for Seizure Localization and Therapeutic Decision-Making.","authors":"Rohini Coorg, Elaine S Seto","doi":"10.1159/000550184","DOIUrl":"10.1159/000550184","url":null,"abstract":"<p><strong>Background: </strong>Children with drug-resistant epilepsy often require invasive monitoring to guide surgical interventions.</p><p><strong>Summary: </strong>Both subdural monitoring and stereoelectroencephalography (sEEG) have benefits and limitations in identifying seizure onset and mapping brain function. sEEG allows for more anatomically diffuse sampling, including deep structures like the thalamus. Monitoring leads to a better understanding of epileptic networks and their proximity to eloquent cortex. This often guides the decision between resective/ablative therapies and neuromodulation. There is increasing interest in the use of thalamic stimulation in neuromodulation, although pediatric data are limited.</p><p><strong>Key message: </strong>The increase in invasive monitoring in the USA coupled with the emergence of additional surgical treatments offers new hope to children with refractory epilepsy.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.3,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Old Lesions and New Targets: sEEG-Identified Onsets in Traditionally Inoperable Epilepsy Lesions and Associated Surgical Outcomes.","authors":"Yosef M Dastagirzada, Spencer Frome, Daniel J Curry, Howard L Weiner","doi":"10.1159/000551277","DOIUrl":"10.1159/000551277","url":null,"abstract":"<p><strong>Background: </strong>Patients with epilepsy who do not respond to pharmacotherapy are often offered a noninvasive diagnostic workup to localize an epileptogenic focus that might be treated with resection, neuromodulation, or ablation. Yet in many cases, this evaluation fails to identify surgical candidates.</p><p><strong>Summary: </strong>Patients with tuberous sclerosis, periventricular nodular heterotopia, or polymicrogyria may have clearly visible lesions on MRI, but the resulting epileptogenic onset zones/networks are often too complex for scalp electroencephalography to decode. Similarly, seizures arising from the cingulate gyrus originate in deep structures that are inaccessible to noninvasive techniques. In post-traumatic epilepsy without a dominant lesion such as mesial temporal sclerosis, injury is often too diffuse to define a clear seizure-onset zone. Stereoelectroencephalography (sEEG), with its ability to map deep brain networks in detail, offers a unique solution for these challenging cases.</p><p><strong>Key messages: </strong>In this review, we highlight how sEEG has expanded surgical options and provided hope for seizure freedom in patients once considered medically and surgically untreatable, and we aim to encourage further study into its potential applications.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"92-102"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shunt Complications in Syndromic versus Non-Syndromic Pediatric Hydrocephalus: A Propensity-Matched Multicenter Analysis of 35,234 Patients.","authors":"Barbara Buccilli, Amna Hussein, Khaled M Taghlabi, Monique Mitchell, Diogo Haddad Santos, Raphael Bertani, Wellingson Paiva, Renato Anghinah, Amir H Faraji","doi":"10.1159/000550188","DOIUrl":"10.1159/000550188","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric hydrocephalus is associated with congenital malformation syndromes, which may alter cerebrospinal fluid dynamics and increase the complexity of surgical management. We aimed to compare rates of shunt placement, reprogramming, revision, removal, and dysfunction in pediatric patients with hydrocephalus, with and without congenital syndromes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using TriNetX, identifying pediatric patients with hydrocephalus. Cohort 1 included patients with congenital syndromes (N = 17,617). Cohort 2 included matched patients without syndromes (N = 17,617). Propensity score matching was performed across demographic and clinical variables. Outcomes included shunt placement, reprogramming, revision, removal, and dysfunction. Risk measures were calculated at 1-year follow-up.</p><p><strong>Results: </strong>Shunt placement was similar between cohorts. However, syndromic patients had significantly higher rates of reprogramming (10.0% vs. 4.2%; odds ratio [OR]: 2.52; p < 0.001), revision (9.3% vs. 3.3%; OR: 3.03; p < 0.001), removal (2.0% vs. 0.9%; OR: 2.24; p < 0.001), and dysfunction (23.5% vs. 10.9%; OR: 2.52; p < 0.001). Intervention-free survival was lower in syndromic patients for all outcomes except initial shunt placement. Across single congenital syndromes, patients with hydrocephalus demonstrated elevated rates of shunt-related complications compared to matched controls. In conditions like Arnold-Chiari and encephalocele, the rates of shunt dysfunction exceeded 30%, with OR above 3.0 and highly significant p values. Alport syndrome, arhinencephaly, and craniosynostosis showed elevated risks for reprogramming, revision, and dysfunction. Down syndrome demonstrated higher dysfunction rates (27.1% vs. 14.3%; OR: 2.22). Despite identical shunt placement rates, the downstream need for surgical intervention diverged sharply, highlighting high-risk phenotypes.</p><p><strong>Conclusion: </strong>Pediatric hydrocephalus associated with congenital syndromes carries a markedly higher risk of shunt-related complications. These findings support the need for clinical surveillance and individualized care strategies in this group.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":1.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring the Surgical Approach to Chiari I Malformation with Intraoperative Ultrasounds: Advantages, Limitations, and Controversies.","authors":"Fabio Zeoli, Paolo Frassanito, Rosa Linda Rinaldi, Ivane Tsiskaridze, Gianpiero Tamburrini","doi":"10.1159/000550058","DOIUrl":"10.1159/000550058","url":null,"abstract":"<p><strong>Introduction: </strong>Decompression of posterior cranial fossa remains the mainstay of surgical treatment of Chiari malformation type I, though several surgical maneuvers have been differently combined to bony decompression aiming to increase the efficacy of surgery. In this context, intraoperative ultrasound (IOUS) claims to offer real-time feedback of adequacy of surgical decompression, thus accordingly tailoring the aggressiveness of surgery. The present review aims to highlight benefits, limitations, and areas in need of further investigation.</p><p><strong>Materials and methods: </strong>A comprehensive literature search of PubMed, Scopus, and Google Scholar was performed for studies published in English in the last 30 years. The following keywords, including MeSH terms, were used to retrieve eligible papers: \"Chiari Malformation Type I,\" \"posterior fossa decompression,\" and \"ultrasonography.\"</p><p><strong>Results: </strong>A total of 3,189 results were collected. Duplicate records were then removed (n = 1,591). A total of 1,598 papers were screened, and 1,531 records were excluded through title and abstract screening; 65 studies were considered relevant to our research question and were assessed for eligibility. Finally, 23 articles were included in the review.</p><p><strong>Conclusions: </strong>IOUS has been frequently used to evaluate the adequacy of surgical decompression, though this qualitative assessment remains subjective with obvious inter-operator variability. On the other side, a quantitative assessment has been more rarely used through the literature, as this approach is difficult to reproduce. Despite the obvious advantages of IOUS, further investigation is required to standardize this approach.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.3,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}