Pediatric Neurosurgery最新文献

{"title":"Gamma Knife Stereotactic Radiosurgery for Pediatric Meningiomas.","authors":"Regan M Shanahan, Chris Z Wei, Tracy Miller, Hansen Deng, Constantinos G Hadjipanayis, Ajay Niranjan, L Dade Lunsford","doi":"10.1159/000551777","DOIUrl":"10.1159/000551777","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the generally benign and slow-growing nature of many adult meningiomas, meningiomas in pediatric patients often exhibit more aggressive behavior. Gamma Knife stereotactic radiosurgery (SRS) is a non-invasive modality that is widely used as either an initial upfront or adjuvant management for meningiomas. We reviewed our 35-year meningioma experience to assess its role in pediatric patients.</p><p><strong>Methods: </strong>The authors reviewed the clinical and imaging data of 2,030 meningioma patients who underwent SRS between 1987 and 2022 at the University of Pittsburgh Medical Center (UPMC). We identified 9 patients <18 years (2 female; median age, 14.5 years). None of the patients had neurofibromatosis type 2. The neurological outcomes, overall survival, local tumor control, and development of adverse radiation effects were evaluated. Three patients received prior therapeutic radiation: one underwent prophylactic cranial irradiation for lymphoblastic leukemia, one received focal cranial irradiation for craniopharyngioma, and one underwent craniospinal irradiation for medulloblastoma. Seven patients had prior tumor resection, while two asymptomatic patients were diagnosed incidentally (one during craniopharyngioma surveillance imaging and the other after head trauma). The median cumulative tumor volume at SRS was 6.0 cc (range, 0.5-11.8 cc). The median margin dose prescribed was 14 Gy (range, 11-25 Gy).</p><p><strong>Results: </strong>At last follow-up, 5 patients were alive. Four patients had died, two from progressive intracranial disease and two from unrelated medical causes. The median overall survival was 8.9 years (range 2.0-16.2 years). The median progression free survival was 8.2 years (range 1.1-13.4 years). Five patients experienced tumor progression at a median of 2.1 years (range, 1.1-13.4 years) after SRS. After local tumor progression, 2 patients received repeat SRS, and the remaining patients required additional surgery, fractionated external beam radiotherapy, or chemotherapy. No patient developed adverse radiation effects, had malignant tumor transformation, or developed other types of CNS malignancies.</p><p><strong>Conclusion: </strong>Meningiomas are rare tumors in the pediatric age group and can exhibit aggressive behavior. Tumor control was achieved in 6 of 9 patients after one or more SRS procedures. SRS presents as a reasonable primary option or should be considered for early intervention after surgery. Patients and families should be counseled that multiple SRS sessions might be needed to achieve eventual tumor control.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655338","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":"Age Filtering Bias in a Retrospective Study of Pediatric Hydrocephalus.","authors":"Joshua Wang","doi":"10.1159/000551837","DOIUrl":"10.1159/000551837","url":null,"abstract":"","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596245","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":"Complex Type Split Cord Malformation: A Two-Center Study.","authors":"Pınar Aydin Ozturk, Harun Emre Sen, Abdurrahman Arpa, Muharrem Karatas, Barıs Aslanoglu, Kamuran Aydin, Sezer Onur Gunara, Volkan Etus","doi":"10.1159/000551495","DOIUrl":"10.1159/000551495","url":null,"abstract":"<p><strong>Introduction: </strong>Complex spinal dysraphism is the condition where multiple dysraphic pathologies are observed in the same patient. Complex type split cord malformation (SCM) is a compound dysraphic phenotype involving disruptions at multiple developmental stages, characterized by the co-occurrence of SCM and spina bifida aperta. This study aimed to understand the differences between complex SCMs from classical SCM cases in terms of embryological aspects, perioperative management, and follow-up.</p><p><strong>Methods: </strong>Patients with SCM associated with spina bifida aperta who were treated at Dicle University and Kocaeli University, Departments of Neurosurgery, between 2011 and 2025 were included in the study. Patient age (months), gender, presenting clinic, lesion localization, SCM type, number of affected vertebrae, neurological status, presence of tethered cord, presence of kyphoscoliosis, spina bifida aperta type, Chiari malformation, syringomyelia, presence of posterior fusion defect number of vertebrae with defect, hydrocephalus, accompanying intracranial pathologies, and additional anomalies were included in the study.</p><p><strong>Results: </strong>The study included 44 patients who underwent surgery for complex SCM. Of the patients, 81.8% were operated on during the neonatal period in the same session with spina bifida aperta surgery. Surgery was planned for 11.4% of patients for follow-up purposes and for 6.8% following detection of SCM on MRI performed due to gait disturbances. It was observed that 68.2% of patients were plegic/severely paretic, 22.7% had moderate paresis, and 9.1% had mild paresis/normally. Regarding the type of spina bifida aperta, 72.7% of patients had myelomeningocele, and 27.3% had myeloschisis. Type 1 SCM was detected in 79.5% of patients, type 2 SCM in 13.6%, and type 1.5 SCM in 6.8%. Additionally, 93.2% had tethered cord/thickened-fatty filum terminale, 90.9% had posterior fusion defects, 77.3% had hydrocephalus, 68.2% had kyphoscoliosis, 65.9% had Chiari malformation, 54.5% had syringomyelia, 45.5% had intracranial pathologies other than hydrocephalus, and 4.6% had lipoma.</p><p><strong>Conclusion: </strong>Complex SCMs should not be viewed solely as a spinal pathology; they should be evaluated multidisciplinarily in the perioperative period in terms of anomalies accompanying spina bifida aperta. In these cases that are diagnosed at a younger age, the incidence of type 1 SCM increases, while the frequency of occurrence in the lumbar region decreases and increases in the thoracic region. Furthermore, it has been determined that additional anomalies accompanying spina bifida aperta occur more frequently with complex SCMs.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476375","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":"Management of Congenital Occipital Exostosis in the Pediatric Patient: An Illustrative Case Report.","authors":"Olivia Patch, Evan Bowen, Tyler Giles, Kristin Weaver","doi":"10.1159/000551494","DOIUrl":"10.1159/000551494","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this article was to describe a case of an unusual congenital occipital bone defect in a pediatric patient and the corresponding neurosurgical management.</p><p><strong>Case presentation: </strong>The authors present a case of a 2-week-old male referred for neurosurgical evaluation after occipital bony prominences were detected on a postnatal exam. The patient was born full-term via uncomplicated vaginal delivery and underwent a head ultrasound, which disclosed an occipital heterotopic ossification. Physical exam revealed dimpling bilaterally over bony prominences at the occiput. Computed tomography and magnetic resonance image confirmed symmetric exostoses without clear intracranial involvement. However, fibrous adhesions were noted extending through the dermis, suggesting dermal involvement likely secondary to the bony changes, although no definitive sinus tracts were identified. The patient was monitored for the first year of life with no symptoms or developmental concerns. At follow-up at 15 months of age, the bony prominences and overlying fat pad were noticeably enlarged, which prompted corrective surgery. The exostosis was excised to restore normal occipital contour, and excess fat and skin were removed. Pathology revealed cartilage, cortical and trabecular bone, hematopoiesis, and mild intramedullary fibrosis. The surgery was successful with no complications, and the patient had an uneventful recovery. Postoperatively, the patient continues to meet developmental milestones without neurological deficits or complications.</p><p><strong>Conclusion: </strong>This case highlights the surgical management of an unusual occipital exostosis in an asymptomatic pediatric patient. It underscores the importance of individualized preoperative planning, comprehensive imaging, and ongoing clinical monitoring to assess changes over time.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476359","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":"10.1159/000551485","url":null,"abstract":"<p><strong>Introduction: </strong>Infant carriers (car seats, bouncy chairs) can cause injuries when used for other than their intended purpose.</p><p><strong>Methods: </strong>We studied children aged 0-24 months with carrier related injuries reported to the Pennsylvania Trauma Outcome Study (PTOS) dataset (2001-2022 inclusive).</p><p><strong>Results: </strong>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 Score was 9.3 (range 1-30). 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.</p><p><strong>Conclusion: </strong>Falls in, or from, infant carriers are a significant public health concern. Education, advocacy, and changes in carrier design may help reduce the frequency of these injuries.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"1-9"},"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><p><p>Introduction: 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>.</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><p><p>Introduction: 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. Case Presentation: 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. Conclusion: 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>.</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":"Pediatric Epilepsy Surgery: The Noninvasive Presurgical Evaluation.","authors":"Deepankar Mohanty, Michael Quach","doi":"10.1159/000548477","DOIUrl":"10.1159/000548477","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant epilepsy is a debilitating condition that afflicts individuals across all demographics, including children. The only recourse for many of these individuals is neurosurgery to reduce seizure burden, by either resecting or ablating the cerebral source or modulating it with a stimulator device. In either case, a thorough presurgical evaluation is required to identify brain regions of interest and construct an appropriate surgical plan. The scope of this evaluation has grown rapidly over the years as new and refined techniques have emerged. The aim of this article was to condense the most salient points regarding investigational tools used commonly in this process and provide a framework from which epilepsy management providers can tailor their own epilepsy surgery pathway.</p><p><strong>Summary: </strong>This article will discuss criteria to identify appropriate candidates for epilepsy surgery, as well as various techniques that are used to localize seizure onset, interictally active areas, dysfunctional regions, and eloquent cortex. Topics reviewed include neuroimaging (MRI, PET, SPECT), electrophysiology (EEG and MEG), and functional mapping procedures (fMRI, TMS, neuropsychologic evaluation, intracarotid amobarbital test).</p><p><strong>Key messages: </strong>A comprehensive, multimodal presurgical evaluation including imaging, electrophysiology, and functional mapping is essential to establish the bounds of the epileptogenic zone in relation to eloquent cortex.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"16-30"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058737","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":"Technical Neurosurgical Aspects of Pediatric Epilepsy Surgery Including Resections and Disconnections.","authors":"David Botros, Nebras M Warsi, Robert J Bollo","doi":"10.1159/000549430","DOIUrl":"10.1159/000549430","url":null,"abstract":"<p><p><p>Background: Epilepsy remains one of the most common neurological disorders in children, with approximately one-third of patients developing drug-resistant epilepsy (DRE) that may require surgical intervention. This review outlines the technical neurosurgical aspects of pediatric epilepsy surgery, focusing on resective and disconnection procedures. Summary: Successful epilepsy surgery relies on accurate identification of the hypothesized epileptogenic zone through comprehensive presurgical evaluation including clinical assessment, seizure semiology analysis, magnetic resonance imaging, electroencephalography (EEG), and neuropsychological testing. In complex cases, additional imaging modalities such as FDG-PET, SPECT, and MEG help establish the anatomo-electric-clinical network. Invasive monitoring using subdural grids or stereotactic EEG provides critical data for surgical planning in cases with discordant findings, potential involvement of eloquent tissue, or non-lesional epilepsy. Resective surgery is the primary intervention for focal, lesional epilepsy, with seizure freedom rates varying by location and etiology (70-80% for temporal lobe and tumor-associated epilepsy; 60% for extra-temporal lobe; 51% for non-lesional cases). Anterior temporal lobectomy, a cornerstone procedure, involves careful consideration of hemisphere dominance and selective approaches to mesial structures. Extent of resection is a critical determinant of outcome, with incomplete removal of epileptogenic tissue consistently identified as the leading cause of surgical failure. Disconnection procedures include anterior and posterior quadrant disconnections, hemispherectomy, and corpus callosotomy. Anterior quadrant disconnection isolates seizure foci within the frontal lobe, whereas posterior quadrant disconnection targets the temporal, parietal, and occipital lobes. Functional hemispherotomy has largely replaced anatomic hemispherectomy because it has a lower complication profile but maintains equivalent seizure freedom rates. Corpus callosotomy primarily targets generalized seizures, especially atonic seizures leading to drop attacks. Key Messages: Recent advances include minimally invasive techniques (such as laser ablation) and neuromodulation approaches (such as responsive neurostimulation and deep brain stimulation). Future directions will likely incorporate higher resolution imaging technologies and artificial intelligence driven signal processing to optimize outcomes and offer personalized treatment strategies that improve seizure control and quality of life for children with DRE. </p>.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"49-55"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514540","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":"A Review of Current Research and Barriers to Access: Exploring Disparities in Pediatric Epilepsy Surgery.","authors":"Nikita Das, Ali A Mohamed, Akshat Katyayan, Meena Vessell","doi":"10.1159/000549985","DOIUrl":"10.1159/000549985","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant epilepsy (DRE) impacts at least 30% of pediatric epilepsy patients, adversely affecting neurodevelopment and quality of life, as well as risk of sudden unexplained death in epilepsy (SUDEP). While surgical intervention has proven to be an effective treatment for DRE, disparities in access to surgical care persist. Compared to adults, pediatric patients face unique challenges, including delayed recognition of surgical candidacy, limited access to specialized epilepsy centers, complex care coordination, and socioeconomic barriers.</p><p><strong>Summary: </strong>This review explores the current state of pediatric epilepsy surgery, highlighting its effectiveness in achieving seizure freedom, improving neurocognitive outcomes, and reducing long-term healthcare costs. It further examines factors contributing to delays in surgical referrals, including physician and parental hesitancy, lack of access to specialized centers, and disparities in hospital resources.</p><p><strong>Key messages: </strong>Surgery is an effective treatment for pediatric DRE with a favorable risk profile, potential for seizure freedom, improved neurodevelopmental outcomes, and potential reduction in SUDEP risk. Yet, surgery remains underutilized due to disparities driven by socioeconomic status, insurance, race, geography, and systemic barriers such as limited provider awareness, inconsistent referrals, and uneven distribution of National Association of Epilepsy Centers Level 4 hospitals. Future efforts should focus on research to further define disparities and evaluate evidence for systems-based solutions, increasing accessibility of specialized centers, enhancing referring provider education, dissemination and regular revisitation of pediatric-specific epilepsy surgical guidelines for referral, and implementing policy reforms to improve insurance coverage and care coordination for this pediatric patient population.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"100-110"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710594","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}