Pediatric Neurosurgery最新文献

{"title":"Recurrent Pediatric Pilocytic Astrocytoma with BRAFV600E and TP53 Mutations: Case Report and Literature Review.","authors":"Yazid Maghrabi, Saleh Baeesa, Alaa Alkhotani, Rakan Bokhari, Taghreed Alsinani, Ahmed Bamaga, Mohammed M Karami, Dahlia Mirdad, Maher Kurdi","doi":"10.1159/000553295","DOIUrl":"10.1159/000553295","url":null,"abstract":"<p><strong>Introduction: </strong>Pilocytic astrocytoma (PA) is the most common pediatric brain tumor and is generally associated with favorable outcomes following complete surgical resection. Most tumors harbor MAPK pathway alterations, particularly BRAF-KIAA1549 fusion. However, emerging evidence suggests that PAs with BRAFV600E and TP53 mutations may exhibit more aggressive biological behavior and an increased risk of recurrence. We report a recurrent pediatric PA harboring concurrent BRAFV600E and TP53 mutations and discuss the potential clinical significance of this molecular profile.</p><p><strong>Case presentation: </strong>A 10-year-old child underwent gross total resection of a cerebellar PA. Histopathological examination confirmed the diagnosis of PA. Molecular analysis demonstrated concurrent BRAFV600E and TP53 mutations. Despite initial complete resection, the patient developed early tumor recurrence during follow-up. The recurrent lesion showed features consistent with PA without evidence of high-grade transformation. The clinical course suggests a more aggressive biological behavior than typically expected for conventional PA.</p><p><strong>Conclusion: </strong>This case highlights the potential prognostic significance of concurrent BRAFV600E and TP53 mutations in PA. The coexistence of these alterations may identify a subset of pediatric patients at increased risk of tumor regrowth despite gross total resection. Comprehensive molecular profiling may improve risk stratification, guide surveillance strategies, and enhance understanding of the biological heterogeneity of PA.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334545","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":"Graft-Free Internal-to-External Carotid Artery Transposition for a Giant Extracranial Carotid Artery Aneurysm in an Infant: A 13-Year Follow-Up Demonstrating Durable Patency and Growth Compatibility.","authors":"Tatsuya Kobayashi, Yasuo Aihara, Kentaro Chiba, Koji Yamaguchi, Yoshikazu Okada, Takakazu Kawamata","doi":"10.1159/000552816","DOIUrl":"10.1159/000552816","url":null,"abstract":"<p><strong>Introduction: </strong>Extracranial carotid artery aneurysms (ECAAs) are exceedingly rare in children, with only a limited number of cases reported worldwide. Surgical reconstruction in infancy poses unique challenges owing to vascular fragility and the need for long-term growth compatibility.</p><p><strong>Case presentation: </strong>We report the case of a 1-year-old boy with a large right ECAA who was treated with graft-free internal-to-external carotid artery (ICA-to-ECA) transposition. The aneurysm was completely resected, the proximal ICA was ligated, and the distal ICA was anastomosed adjacent to the ECA. Microsurgical reconstruction was performed under temporary clipping, with an occlusion time of 22 min. Postoperative angiography confirmed excellent flow through the transposed vessel. Serial imaging over a 13-year follow-up period demonstrated persistent patency without stenosis or proportional diameter growth of the reconstructed ICA, with no neurological complications or ischemic events. The anastomotic segment enlarged proportionally to the patient's cervical growth, indicating successful long-term biological integration.</p><p><strong>Conclusion: </strong>This case represents one of the longest documented follow-ups of pediatric ECAA reconstruction using native arterial tissues. Direct ICA-to-ECA transposition provides a durable, infection-free, and growth-adaptive solution superior to prosthetic or vein graft repair. This outcome underscores the central tenet of pediatric neurosurgery: surgical innovation must harmonize with a child's lifelong development.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-18"},"PeriodicalIF":1.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213493","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":"Case Report: Occipital Mature Teratoma Mimicking Encephalocele in an Infant.","authors":"Hannah Haile, Arjun R Adapa, Vlad A Korben, Phyllis L Faust, Peter Canoll, Neil A Feldstein","doi":"10.1159/000552835","DOIUrl":"10.1159/000552835","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial teratomas are rare congenital neoplasms that typically arise in midline structures such as the pineal and suprasellar regions. Occipital region teratomas are exceedingly uncommon.</p><p><strong>Case presentation: </strong>We report a case of a full-term neonate born with an occipital region mass initially presumed to be an encephalocele. Postnatal surgical resection revealed a mature teratoma. At 8 months of age, the patient showed no evidence of tumor recurrence.</p><p><strong>Conclusion: </strong>This case illustrates the unique clinical and operative considerations in managing rare congenital occipital region lesions.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213479","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":"Response to \"Age Filtering Bias in a Retrospective Study of Pediatric Hydrocephalus\".","authors":"Barbara Buccilli","doi":"10.1159/000552621","DOIUrl":"10.1159/000552621","url":null,"abstract":"","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":1.3,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058268","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":"Re: Implementation of Virtual Reality for Postoperative Recovery in an Adolescent Idiopathic Scoliosis Population - Reply to Daungsupawong and Wiwanitkit.","authors":"Prabhath Mannam, David S Hersh","doi":"10.1159/000552597","DOIUrl":"10.1159/000552597","url":null,"abstract":"","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":1.3,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989889","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":"Tailored Surgical Approach for Moyamoya in Very Young Children: A Single-Center Retrospective Analysis and Algorithm Proposal.","authors":"Maria Sole Venanzi, Rosamaria Ferrarotto, Sergio Capelli, Gianluca Piatelli, Andrea Rossi, Marco Pavanello","doi":"10.1159/000552534","DOIUrl":"10.1159/000552534","url":null,"abstract":"<p><strong>Introduction: </strong>MoyaMoya Disease (MMD) is a progressive cerebrovascular disorder characterized by stenosis of the arteries of the circle of Willis with development of collateral vessels. When associated with other conditions, it is termed MoyaMoya syndrome (MMS). Recommendations for surgical interventions in pediatric cases remain limited. Early onset, especially in children younger than 3 years, is linked to poorer outcomes. Drawing from our institutional experience, we propose a treatment algorithm to optimize revascularization strategies in children, with particular focus on this high-risk subgroup.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with MMD or MMS who underwent surgical revascularization before the age of 3 at our institution between January 2015 and July 2023. Data included demographics, clinical presentation, surgical techniques, complications, and outcomes.</p><p><strong>Results: </strong>Sixteen patients underwent surgery. Transient ischemic attacks and seizures were the most frequent onset symptoms (45.7% each), followed by intellectual disability (25%). Magnetic resonance imaging (MRI) revealed ischemic lesions in 75% of cases and posterior circulation involvement in 5 patients. The mean surgical age was 2.1 ± 0.9 years. Indirect revascularization was the primary surgical approach, with two patients receiving a combined direct and indirect bypass. At follow-up (5.6 ± 1.8 years old), 50% remained asymptomatic. MRI showed improved perfusion in 66% of patients, and progression was observed in two.</p><p><strong>Conclusion: </strong>Children under 3 years old with MMD/MMS present an aggressive clinical, \"unstable\" disease course, with higher rates of preoperative infarction, posterior cerebral artery involvement, and recurrent strokes. These features correlate with poor outcomes, particularly when surgery is delayed, likely due to the metabolic vulnerability of the immature brain. Given the lack of standardized surgical guidelines, our study supports early surgical intervention, using indirect or combined revascularization techniques. We propose a tailor algorithm on affected vascular territories, incorporating direct bypass procedures, when feasible.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.3,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977254","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":"Team Building in Pediatric Neurosurgery.","authors":"Chima O Oluigbo, Albert Tu","doi":"10.1159/000552384","DOIUrl":"10.1159/000552384","url":null,"abstract":"<p><strong>Background: </strong>Pediatric neurosurgery is practiced in a complex, demanding, and high-stakes environment. Consequential and high-impact decisions are made while undertaking delicate operations on very young and vulnerable patients.</p><p><strong>Summary: </strong>The team dynamics in pediatric neurosurgery - how the team communicates, functions under stress, adapts and supports each member - is the prime determinant for success in this high-stakes milieu.</p><p><strong>Key messages: </strong>Building an effective team in pediatric neurosurgery requires focused vision and mission alignment, effective communication infrastructure, inspirational and transformative leadership as well as efficient mechanisms for conflict management, and burnout prevention.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846216","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":"Striving for Meaning and Purpose in Mentoring.","authors":"Kimberly Hamilton, Renee Reynolds, Susan Durham","doi":"10.1159/000552004","DOIUrl":"10.1159/000552004","url":null,"abstract":"<p><strong>Background: </strong>Mentorship plays an important role in the career development of a surgeon, shaping technical skills, professional identity and career paths. The needs and roles of both the mentee and the mentor change over the course of a professional career but the most successful form of mentorship includes a receptive mentee and a mentor who is engaged and dedicated to the process.</p><p><strong>Summary: </strong>We present a reflective commentary by three pediatric neurosurgeons at early, mid, and late career phases on the evolution of finding meaning and purpose in mentoring throughout a pediatric neurosurgical career.</p><p><strong>Key message: </strong>Mentorship is dynamic and bidirectional throughout one's career. It maximizes professional growth for both the mentor and mentee and ultimately enriches the specialty.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789713","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":"Pediatric Meningiomas: Clinicopathological Spectrum, Long-Term Outcomes, and Recurrence Predictors.","authors":"Jeena Joseph, Swaminathan Ganesh, Krishnaprabhu Raju","doi":"10.1159/000551876","DOIUrl":"10.1159/000551876","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric meningiomas are rare tumors with clinical and biological features distinct from adult meningiomas. This study reviews 20-year experience of managing pediatric meningiomas at a tertiary referral center, focusing on their clinical characteristics, pathological features, treatment outcomes, and prognostic factors.</p><p><strong>Methods: </strong>A retrospective analysis of 47 pediatric patients (<18 years) diagnosed with meningiomas between January 2005 and December 2024 was performed. Data on demographics, clinical presentation, radiological features, tumor location, histopathology, extent of resection, adjuvant therapy, and outcomes were collected. Recurrence rate and event-free survival were analyzed using Kaplan-Meier estimates, and predictors of recurrence were assessed with univariate and multivariate analyses.</p><p><strong>Results: </strong>Pediatric cases accounted for 3.9% of all meningiomas treated during the study period (47/1,194). The median age was 13 years (IQR, 10-15), with a slight female predominance (55.3%). Neurofibromatosis was present in 21% of patients. Most tumors were supratentorial (76.6%), and 19% were intraventricular. The mean tumor volume in the series was 61.4 ± 75.2 cm3. High-grade meningiomas (WHO grade II and III) comprised 61.7% of cases. Gross total resection was achieved in 82.9%, and 53.2% received adjuvant radiotherapy. At a median follow-up of 41 months (IQR, 20-74 months), recurrence occurred in 21.3% of patients. On multivariate analysis, higher MIB-1 labeling index and longer follow-up duration were independent predictors of recurrence.</p><p><strong>Conclusion: </strong>Pediatric meningiomas, though rare, often display aggressive histopathology and a high risk of recurrence despite gross total resection. Multivariate analysis identified the MIB-1 labeling index and longer follow-up duration as independent predictors of recurrence, highlighting the importance of proliferative activity and extended surveillance in long-term disease control. These findings underscore the importance of biomarker-driven risk stratification and ongoing post-treatment monitoring in pediatric meningioma management.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":1.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147678477","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":"Selective Dorsal Rhizotomy in Children with Hereditary Spastic Paraplegia.","authors":"Amanda N Stanton, Nathan S Fredricks, Anthony M Price, George W Koutsouras, Macey Martin, Heidi Chen, Alice P Lawrence, Elizabeth N Martin, Robert P Naftel","doi":"10.1159/000551915","DOIUrl":"10.1159/000551915","url":null,"abstract":"<p><strong>Introduction: </strong>While selective dorsal rhizotomy (SDR) improves spasticity, the benefit in hereditary spastic paraplegia (HSP) remains unclear. This study describes a single institution's outcomes and experience with SDR in children with HSP.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of pediatric patients (≤18 years) with HSP who underwent SDR at Monroe Carell Jr. Children's Hospital between July 2013 and January 2024. Patients were evaluated with standardized assessments, including the Modified Ashworth Scale (MAS), Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure-66 (GMFM-66), Manual Ability Classification System (MACS), Functional Mobility Scale (FMS), 10-Meter Walk Test (10MWT), Pediatric Balance Scale (PBS), and Pediatric Quality of Life (PedsQL) Cerebral Palsy Module.</p><p><strong>Results: </strong>Six patients (2 males, 4 females) aged 4-14 years underwent SDR, with a median follow-up of 17.65 months (range 11.8-38.9). Our cohort had four ATL1 and two SPAST mutations. Five patients had uncomplicated HSP, while 1 had complicated HSP. A median of 60% of rootlets were cut bilaterally (range 56-63). No major surgical complications occurred. Median MAS decreased from 16 preoperatively to 0 postoperatively. GMFM-66 improved from 74.8 to 79.1. In FMS testing, three patients achieved independent ambulation across all surfaces. 10MWT times improved from a median of 5.6 to 4.7 s. MACS scores improved in one patient and were otherwise stable. Balance scores remained stable or improved. Absolute PedsQL scores improved in 5 patients, with pain and fatigue showing greatest reduction. At follow-up, only 1 patient required orthotic support, compared to four preoperatively.</p><p><strong>Conclusion: </strong>SDR may offer marked reductions in spasticity, with associated improvements in ambulation, functional mobility, quality of life, and orthotic dependence. SDR was safe and well tolerated. Larger studies are needed to confirm statistical significance, define long-term efficacy, and optimize patient selection.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655270","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}