Pediatric Neurosurgery最新文献

{"title":"Boundaries, Balance, and the Courage to Say No.","authors":"Zulma Tovar-Spinoza","doi":"10.1159/000550282","DOIUrl":"10.1159/000550282","url":null,"abstract":"<p><p><p>Background: Burnout and overcommitment are increasingly recognized challenges in neurosurgery, particularly among women and underrepresented groups. Summary: This article reflects on professional lessons regarding the importance of boundaries, balance, and the courage to say no as essential components of wellness and sustainable careers in neurosurgery. The discussion highlights systemic pressures, gender disparities, and strategies for resilience. Key Messages: Boundaries are safeguards, not barriers; saying no is an act of leadership; redefining success beyond volume metrics is critical for long-term wellness. </p>.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"182-184"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147504644","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":"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":"56-66"},"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":"Erratum.","authors":"","doi":"10.1159/000551586","DOIUrl":"10.1159/000551586","url":null,"abstract":"<p><p>The article \"Technical Neurosurgical Aspects of Pediatric Epilepsy Surgery Including Resections and Disconnections\" [Pediatr Neurosurg. 2025; https://doi.org/10.1159/000549430] by Botros et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been updated.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"185-186"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789659","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":"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><p><p>Introduction: 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>.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"154-161"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","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":"Acoustic Emission Foreshocks and Aftershocks from Skull Fracture Caused by Surgical Clamping.","authors":"Andrew P Bunger, Olivia G Hartz, Michael M McDowell","doi":"10.1159/000549987","DOIUrl":"10.1159/000549987","url":null,"abstract":"<p><strong>Introduction: </strong>The clamping force for surgical head immobilization must be sufficiently large enough to prevent slippage but not to induce fracturing. Motivated by an unmet need to detect skull fractures during surgery to trigger remedial action, we sought to demonstrate a method of viable measurement and interpretation of acoustic emissions (AEs) generated by a fracturing skull prior, during, and after a fracture.</p><p><strong>Methods: </strong>Escalating clamping force via skull pins affixed to an Integra Life Sciences Mayfield® skull clamp was applied to a formalin-fixed cadaveric head. Variable and pathologic skull thickness was simulated by drilling the skull to reduce thickness at pin locations on the frontal or temporal bone. AE was monitored via an in-house developed device.</p><p><strong>Results: </strong>This method produced a mixture of \"punch-out type\" skull fractures with some occurrences of larger area \"cave-in\" type fractures. The recorded AE waveforms, amplitudes, and temporal patterns showed the skull can fail not only immediately upon application of clamping but also in delayed manners seconds or minutes after force application. A stereotypical, escalating rate of event occurrence and amplitude was detectable prior to delayed fractures (foreshocks) up to a peak event correlating with macroscopic fracture. A stereotypical hyperbolic decay of event rates was detectable immediately post-fracture (aftershocks). Other acoustic sources like drilling were distinguishable.</p><p><strong>Conclusion: </strong>Skull fractures produce stereotypical AE, possibly identifiable intra-operatively. Detecting patterns indicative of impending or recent fracture may allow for immediate intervention, avoiding severe complications. This represents the first reported evidence of detectable foreshock and aftershock AE sequences from bone fracture and points to striking parallels with seismicity generated by earthquakes, thus enabling tools from geophysics to be applied to detect imminent and recent bone failure.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"127-136"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696358","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":"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":"166-175"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245948/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Interictal Data in Guiding Pediatric Epilepsy Surgery.","authors":"Emma K Hartman, Ethan W Ocasio, Carolina Lopes, Marcella Ruppert-Gomez, Eun-Hyoung Park, Scellig S Stone, Joseph R Madsen","doi":"10.1159/000549099","DOIUrl":"10.1159/000549099","url":null,"abstract":"<p><strong>Background: </strong>In pediatric patients with drug-resistant epilepsy, successful localization of the seizure onset zone (SOZ) is critical to surgical planning and outcome prognostication. SOZ localization requires the identification of seizures captured through intracranial electroencephalography (iEEG), necessitating prolonged hospital stays for invasive monitoring and two-stage surgical procedures at minimum. Localization of SOZ in automated fashion using only interictal data would enable a substantial reduction in the time required for pre-resection iEEG recording. Using iEEG to model brain functional connectivity (FC) is an approach that has shown significant potential.</p><p><strong>Summary: </strong>We conduct a literature review on directed FC methods and their use in preoperative SOZ localization. Granger Causality, an approach originally used to analyze economic time series, has evolved into multiple similar methodologies for directed FC graph creation. Several modalities show strong correlations between electrodes with specific FC patterns and SOZs, but there is no current tool that can reliably predict SOZs from interictal iEEG data.</p><p><strong>Key messages: </strong>Multiple studies show a pattern of increased inward FC in electrodes located in the SOZ during interictal periods, with reversed information flow during seizures, suggesting the increased inward flow toward the SOZ may represent inhibitory pathways, which, when absent, lead to a more epileptogenic state. Further analysis of the changes in directed FC across longer periods may help elucidate how to select optimal segments for localization.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"41-48"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349969","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":"Hemispherotomy for Drug-Resistant Epilepsy in a Low-Resource Setting: Surgical Outcomes and Quality of Life in 23 Children Treated in a Hybrid Program in Panama.","authors":"Emmajane G Rhodenhiser, David Bonda, Carmen Baez, Hannah K Weiss, Yosef Dastagirzada, Guzman Aranda, Laurent Bruggeman, Ameeta Grover, Shaun D Rodgers, Ruben Kuzniecky, Yvonne Zelenka-Kuzniecky, Howard L Weiner, Eveline Teresa Hidalgo","doi":"10.1159/000548718","DOIUrl":"10.1159/000548718","url":null,"abstract":"<p><strong>Introduction: </strong>Hemispherotomy is an effective treatment for children with drug-resistant epilepsy (DRE). While hemispherotomy techniques and indications have evolved, access remains predominantly constrained to high-resource settings.</p><p><strong>Methods: </strong>We performed a retrospective analysis of children who underwent hemispherotomy from 2011 to 2023 by a hybrid team, including local Panamanian and US neurologists, neurosurgeons, and EEG technicians and analyzed surgical, epilepsy, and quality of life (QoL) parameters. Follow-up data were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) guidelines for children with epilepsy.</p><p><strong>Results: </strong>Twenty-three children underwent hemispherotomy. The median age at surgery was 10 years (range 2-20). The median follow-up time was 6 years (range 1-13). The etiology of DRE included malformations of cortical development in 14 children (60.8%), including 8 (34.8%) with schizencephaly, and secondary causes in 9 children (39.1%). Seizure frequency improved for all 23 children (100%): Engel I was achieved in 15 children (65.2%), Engel II (26.1%) in six children, and Engel III (8.7%) in two children. Patients with seizure freedom had significantly fewer preoperative seizures per day than patients with seizure recurrence. Complications occurred in six children (26.1%): 2 wound infections, 2 meningitis, 1 femoral vein thrombosis, and 1 wound hematoma with return to OR. There were no perioperative mortality and no postoperative hydrocephalus or CSF diversion. QoL-related outcomes were available for 16 children: 16/16 (100%) reported that the surgery was a worthwhile and repeatable choice, 14 (87.5%) reported improved cognitive function, the median QOLCE-16 score was 62.5 ± 21.</p><p><strong>Conclusion: </strong>Hemispherotomy for DRE in selected children is a safe and effective surgery in a public children's hospital in a low-resource setting. At last follow-up, the majority of children were seizure-free, and all children had decreased seizure frequency. Families reported improved cognitive function, improved QoL and high satisfaction with their decision to pursue this surgery.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"86-99"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13218697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214479","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><p><p>Background: 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. Summary: 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. Key Messages: 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>.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"176-181"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","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":"The Role of Hospitality in Neurosurgery.","authors":"Yosef M Dastagirzada, Howard L Weiner","doi":"10.1159/000549683","DOIUrl":"10.1159/000549683","url":null,"abstract":"<p><strong>Background: </strong>\"Business, like life, is all about how you make people feel. It's that simple and it's that hard\" says Danny Meyer, the restauranteur and CEO of the Union Square Hospitality Group in New York. Similarly, Maya Angelou famously said that people will never forget how you made them feel, though they may forget what you said or did. In neurosurgery, we are doing two things at once: something very technical and something very human. The core thesis of this hospitality philosophy is that whereas the technical aspect of our job is critically important, it represents 49% of our success. The human aspect of our work represents 51%, ever so slightly more important.</p><p><strong>Summary: </strong>We will explore how hospitality has impacted the practice of and a career in neurosurgery over a 35-year period, based on the principles outlined by Danny Meyer in his 2006 book Setting the Table. We will define the difference between service, the technical delivery of a product (e.g., a surgical procedure), and hospitality, how the delivery of that service makes someone feel; if someone feels you are on their side, hospitality is present. We will also define the 51% rule for hiring: one is invited onto our team based 49% on technical skill and 51% on these hospitality-related human qualities (optimistic warmth, intelligence, work ethic, empathy, self-awareness, and integrity).</p><p><strong>Key messages: </strong>Hospitality has played a transformative role in a neurosurgery career: in developing a destination academic practice, managing complications, overcoming challenges, and in building an outstanding team. In our opinion, hospitality plays a significant role in pediatric neurosurgery, driving growth in activity and excellence. As Danny says \"it takes both great service and great hospitality to rise to the top.\"</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"162-165"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642729","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}