Pediatric Neurosurgery最新文献

{"title":"Letter to the Editor regarding the Article \"Comparison of Follow-Up Length-Matched Single-Center Myelomeningocele Postnatal Closure Cohort to the Management of Myelomeningocele Study (MOMS) Trial Results\".","authors":"Stephanie Greene, Jasmine L Hect, Kristin Weaver, Michael M McDowell","doi":"10.1159/000529013","DOIUrl":"https://doi.org/10.1159/000529013","url":null,"abstract":"NA.","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 1","pages":"61-64"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9566976","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":"Comparison between MRI and the Combination of 2D and 3D US in the Prenatal Diagnosis of Closed Spina Bifida.","authors":"Weiping Zhang, Jingling Wang, Hui Wu, Li Chen","doi":"10.1159/000533205","DOIUrl":"10.1159/000533205","url":null,"abstract":"<p><strong>Introduction: </strong>Closed spina bifida (CSB) is a rare condition with a challenging prenatal diagnosis. Herein, we assess the conventional two-dimensional (2D) ultrasound (US) combined with three-dimensional (3D) ultrasound (US) and magnetic resonance imaging (MRI) in the prenatal diagnosis of CSB.</p><p><strong>Methods: </strong>In this retrospective study, we included 20 cases of fetal CSB confirmed by postnatal MRI, post-mortem pathological examination, or postpartum surgery. Prenatal 2D US complemented with the 3D US was performed in all fetuses to evaluate the characteristics of the conus, vertebral arch, and scoliosis. Moreover, MRI was performed to establish the split vertebrae, with or without a bulging mass. Thereafter, we compared the performance of the US and MRI.</p><p><strong>Results: </strong>Diagnosis accuracy of US was comparable with MRI (70% vs. 75%, κ = 0.62); US detected more cases with interpediculate distance ≥95% (55% vs. 35%, κ = 0.22) than MRI. On the other hand, MRI had a superior capacity for identifying vertebral arch fissures (20% vs. 35%, κ = 0.39). MRI and ultrasound had good agreement in the conus medullaris (65% vs. 70%, κ = 0.42) and scoliosis (45% vs. 35%, κ = 0.59). Both US and MRI detected 1 (5.0%) case with \"lemon sign\" and \"banana sign.\" The missed diagnosis rates of US and MRI were 15% (3/20) and 5% (1/20), respectively. The misdiagnosis rates of US and MRI were 15.0% (3/20) and 20.0% (4/20), respectively.</p><p><strong>Conclusion: </strong>Both MRI and 2D US combined with the 3D US had excellent performance in prenatal diagnosis of CSB.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"392-400"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10224134","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":"Use of a Prophylactic Retrograde-Flushing Device in High-Risk Pediatric Patients with Ventriculoperitoneal Shunts: A Technical Note.","authors":"Michael Vinzani,&nbsp;Mohammed Alshareef,&nbsp;Ramin Eskandari","doi":"10.1159/000530869","DOIUrl":"https://doi.org/10.1159/000530869","url":null,"abstract":"<p><strong>Introduction: </strong>Ventriculoperitoneal shunt (VPS) malfunction rates are as high as 40% in the first year with posthemorrhagic hydrocephalus (PHH) patients having the highest proximal occlusion risk. Debris, protein, and cellular ingrowth most commonly obstruct the proximal ventricular catheter and/or valve. Historically, no preventative methods have demonstrated efficacy. We present a technical note and case series describing the use of a retrograde proximal flushing device and prophylactic flushing protocol to maintain ventricular catheter patency and reduce proximal shunt occlusions.</p><p><strong>Methods: </strong>We present our 2.8-4-year follow-up data on the first 9 pediatric cases of ReFlow (Anuncia Inc, Scottsdale, AZ) device implantation combined with routine prophylactic flushing. Rationale for device implantation, patient selection, surgical procedure details, postoperative follow-up, and prophylactic flushing protocol are discussed as well as pre- and postimplantation ventricular catheter obstruction rates. We include a technical note on the device setup and prophylactic flushing protocol.</p><p><strong>Results: </strong>Patient average age was 5.6 years and all patients had PHH. Minimal follow-up was 2.8 years (range 2.8-4 years). Prophylactic flushing was initiated between 2 and 14 days after ReFlow implantation and has continued as of the last follow-up. In 7 patients, ReFlow implantation occurred during the revision of an existing shunt and in two, implantation was coincident with initial VPS placement. In the 2 years preceding ReFlow and prophylactic flushing, 14 proximal shunt failures occurred in the 7 patients with existing VPS. This was reduced to only one proximal shunt failure in all 9 patients during the full follow-up period after ReFlow and prophylactic flushing.</p><p><strong>Conclusion: </strong>Pediatric VPS placement carries high rates of proximal catheter occlusion, often leading to emergency surgery, morbidity, or even death. The ReFlow device along with routine prophylactic flushing may reduce proximal obstruction and need for revision surgery. Higher patient numbers and longer follow-up periods are necessary to further elucidate the safety and effect of such a device on longer term shunt failures and revision surgery.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 3","pages":"136-141"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10113658","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":"Images in Pediatric Neurosurgery: Occult Intraosseous Dermoid Cyst at the Nasofrontal Junction.","authors":"Yusuke S Hori,&nbsp;John S Albanese,&nbsp;John G Meara,&nbsp;Mark R Proctor","doi":"10.1159/000528440","DOIUrl":"https://doi.org/10.1159/000528440","url":null,"abstract":"INTRODUCTION\u0000An extension of the dermoid cyst below the nasal bone has been identified in 10% of patients in a large series of nasal dermoid cysts, but these are generally easily identifiable and connected to the tract. To date, no previous reports have documented a case with intraosseous dermoid cyst which was completely hidden in the nasal bone.\u0000\u0000\u0000CASE PRESENTATION\u0000An 8 year-old previously healthy female was initially found to have a small pit on her nasal dorsum. The lesion developed local infection and she was initially treated with antibiotics two years prior to the current presentation. The lesion was diagnosed as a dermal sinus tract, and surgical removal was conducted at an outside hospital. In retrospect the pre-operative work-up imaging showed an occult intraosseous nasal bone extension, however, this was not appreciated at the initial surgery. She experienced repeat infections and underwent a second surgery with exploration under the nasal bones, however, the patient experienced recurrent postoperative local infections. The family presented to our institution for a second opinion. Our images interestingly illustrate the nasal dermoid cyst extending into the nasal bone at the nasofrontal junction without detectable extraosseous sub-nasal bone extension on the imaging. The patient proceeded with a third surgery for complete removal of the lesion via an extended vertical nasal incision. The nasal bones were removed in their entirety, the occult dermoid cyst with a small tract was located in the nasal bones and the undersurface of the bones were completely debrided. No intracranial extension was observed after careful investigation of the skull base. Particulate corticocancellous bone was used with fibrin sealant to reconstruct the defect. The nasal bones were then replaced. The pathology results were consistent with a dermoid cyst. The post-operative course was uncomplicated and she has not had a recurrence after the third surgery.\u0000\u0000\u0000DISCUSSION/CONCLUSION\u0000This case, despite an exploration under the nasal bones, initially received incomplete resection and experienced multiple infections because of failure to appreciate the portion hidden in the nasal bones. Our case was successfully treated with ostectomy of nasal bones without recurrence and complications. This procedure allows unobstructed visualization of the entire cyst leading to the complete removal of the lesion. This is an instructive case to show that portions of the cyst may remain hidden and lead to recurrent infection, and complete resection with sufficient exposure of the entire lesion is needed to successfully treat this condition.","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 1","pages":"58-60"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9575277","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":"Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Infantile Hydrocephalus: An Experience from Mali.","authors":"Oumar Diallo,&nbsp;Mahamadou Dama,&nbsp;Landry Konan,&nbsp;Oumar Coulibaly,&nbsp;Daouda Sissoko,&nbsp;Abdoulaye Hima Maiga","doi":"10.1159/000529453","DOIUrl":"https://doi.org/10.1159/000529453","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric hydrocephalus is a common disease in sub-Saharan Africa. In Mali, 350-400 new cases are diagnosed in our center yearly. With a total land mass of 1,241,000 km2, patients in remote areas must travel up to 1,500 km to access neurosurgical care. Hence, treatment and follow-ups of \"shunted\" patients are difficult. In this context, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) provides an opportunity for an affordable and less constraining treatment for hydrocephalus children under 12 months of age.</p><p><strong>Methods: </strong>We performed a retrospective analysis of ETV/CPC performed on infants from July 2013 to January 2015. Patients were followed postoperatively on day 15, month 6, and month 12. Statistical analysis was conducted using Prism 9 GraphPad software. ETV successes were categorized according to the patient's age into 3 groups: ≤3 months, 3-6 months, and 6-12 months. Statistical significance was defined at p < 0.05.</p><p><strong>Results: </strong>During the study period, 199 patients were included with 40% of patients aged between 0 and 6 months. The head circumference ranged from 35 cm to 79 cm. The etiology was congenital malformation in 55%. ETV/CPC was a success in 69% of 6- to 12-month-old patients, 54% in the 3- to 6-month-old patients, and 29% in ≤3-month-old patients. Overall, 94 (47%) patients were successfully treated without a shunt. The postoperative infection rate was 1% and mortality at 12 months was 8%.</p><p><strong>Conclusion: </strong>In a low-income environment such as Mali, ETV/CPC stands as a viable and alternative treatment option for pediatric hydrocephalus patients; our findings suggest that age is an important factor in predicting ETV success.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 1","pages":"38-44"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9581307","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":"Double Lumbar Localization of Myelomeningocele: Case Report.","authors":"Nadjib Belfatmi,&nbsp;Ahmed S Motawei,&nbsp;Ayoub Rezkallah,&nbsp;Nour Djihane Benarous,&nbsp;Adnan Hassan Ahmed,&nbsp;Sherief Ghozy,&nbsp;Mohamed A Zaazoue,&nbsp;Mohamed Si Saber","doi":"10.1159/000530726","DOIUrl":"https://doi.org/10.1159/000530726","url":null,"abstract":"<p><strong>Introduction: </strong>Myelomeningocele (MMC) is a malformation resulting from the neural tube's failure to close during embryonic development, and the majority of the cases of neural tube defects (NTDs) were prevalent as single location lesions along the spine; however, multiple NTDs (MNTDs) are a very rare condition. Only a few cases of MNTDs were found in the literature.</p><p><strong>Case presentation: </strong>We report the case of a 2-month-old male infant prenatally diagnosed with MMC, presented with two unconnected lumbar and lumbosacral epidermal, soft, dome-shaped swellings located on both sides of the midline (paravertebral) covered by intact skin. MRI revealed double MMC at the level of L4-L5, with spinal nerve roots. The patient underwent surgical repair of the defects by replacing the spinal cord and its nerve roots inside the thecal sac and recreating a covering layer around the neural structures to resemble thecal sac. The outcome was favorable, and postoperative head CT scan did not show any complication.</p><p><strong>Conclusion: </strong>Our case report is considered the first from Algeria to report the condition and the first to report the occurrence of double lesions in the same spine region. MMC can be associated with neurological deficits or other congenital anomalies, thus it is necessary to thoroughly examine such patients. However, there was no antenatal folic acid deficiency in our case. We recommend antenatal care with adequate folic acid supplementation given that its deficiency during pregnancy is considered a ubiquitous risk factor for the condition. The optimal timing for surgery of MMC cases is 8 ± 5 days. Prenatal intrauterine repair of the condition provides favorable outcomes but carries high fetal and maternal risks. Surgical repair should include the sac removal, the reconstruction of the placode, and the closure of the overlying meninges. With early diagnosis and proper repair of such cases, MMC has good prognosis and favorable outcomes.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 2","pages":"97-104"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741025","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":"Review of Pediatric Extraosseous Chordomas with a Unique, Illustrative Case.","authors":"Benjamin J Lee,&nbsp;Audrey Grossen,&nbsp;Helen Shi,&nbsp;Sara Abu Mehsen,&nbsp;Zhongxin Yu,&nbsp;Kar-Ming A Fung,&nbsp;Khairuddin Memon,&nbsp;Joanna E Gernsback","doi":"10.1159/000528761","DOIUrl":"https://doi.org/10.1159/000528761","url":null,"abstract":"<p><strong>Introduction: </strong>Chordoma is a rare, aggressive tumor that is believed to originate from notochord remnants. It can occur anywhere from the clivus to the sacrum and often recurs even after resection and radiotherapy. We present a unique case that initially suggested a different pathology based on imaging and presentation but was found to be a chordoma on gross and pathological analysis.</p><p><strong>Case presentation: </strong>An 11-year-old girl presented outpatient for scoliosis evaluation and was found to have what appeared to be a right L4 peripheral nerve sheath tumor on MRI, causing dextroconvex scoliosis. She underwent a gross total resection via a retroperitoneal approach and was found to have what appeared to be an extraosseous, extradural, extra-spinal canal lumbar chordoma. Immunohistochemical features on surgical pathology were consistent with chordoma. The patient was referred to radiation oncology for adjuvant radiotherapy and pediatric hematology/oncology for recurrence monitoring.</p><p><strong>Discussion: </strong>Our case is the first to present in such a manner, was shown to be external to the spinal canal, encasing the nerve root, and was the first such case in a pediatric patient. We reviewed the growing body of literature on spinal extraosseous chordomas and their characteristics within the pediatric patient population. We also reviewed chordoma pathogenesis theories as well as current and future treatment options.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 1","pages":"29-37"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9527697","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":"Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with Decompressive Craniectomy.","authors":"Ryan D Morgan,&nbsp;Reagan A Collins,&nbsp;Laszlo Nagy","doi":"10.1159/000529682","DOIUrl":"https://doi.org/10.1159/000529682","url":null,"abstract":"Introduction: Most people who are infected with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are asymptomatic or present with mild upper respiratory symptoms. This is especially true in the pediatric population; however, rarely, a massive cytokine storm can develop, causing multisystem inflammatory syndrome associated with COVID (MIS-C). Furthermore, children may also suffer from acute ischemic strokes secondary to SARS-CoV-2 infection. Case Presentation: Here, we present a 2-year-old male who was admitted to the hospital with MIS-C and evidence of a previous SARS-CoV-2 infection. On postadmission day 2, the patient was in cardiogenic shock, had acute kidney injury, liver dysfunction, and metabolic acidosis. He had concurrent altered mental status, and his computed tomography scan showed ischemic infarcts in the territory of the right middle cerebral artery and superior cerebellar artery bilaterally. Magnetic resonance angiography confirmed occlusion of the right middle cerebral artery and right superior cerebellar artery. He underwent an emergent decompressive craniectomy due to rapid deterioration and cerebral edema. After the procedure, he continued to improve and was discharged with moderate disability that improved during outpatient rehab. Conclusion: Though rare in children, SARS-CoV-2 can lead to AIS, especially in the presence of underlying risk factors such as MIS-C and hypercoagulopathy. AIS can be associated with severe mortality and morbidity; however, even in this severe case of AIS, the patient was successfully treated with a decompressive craniectomy.","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":"58 1","pages":"53-57"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9529085","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":"Contemporary Knowledge Update of Pediatric Neuro-Oncology Management: An Overview for Neurosurgeons.","authors":"Nir Shimony, Lissa Baird, Moise Danielpour, George I Jallo","doi":"10.1159/000534283","DOIUrl":"10.1159/000534283","url":null,"abstract":"","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"237-239"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161062","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":"Current Open Trials and Molecular Update for Pediatric Embryonal Tumors.","authors":"Tom Rosenberg, Tabitha Cooney","doi":"10.1159/000531256","DOIUrl":"10.1159/000531256","url":null,"abstract":"<p><strong>Background: </strong>Embryonal tumors are highly malignant cancers of the central nervous system, with a relatively high incidence in infants and young children. Even with intensive multimodal treatment, the prognosis of many types is guarded, and treatment-related toxicity is significant. Recent advances in molecular diagnostics allowed the discovery of novel entities and inter-tumor subgroups, with opportunities for improved risk-stratification and treatment approaches.</p><p><strong>Summary: </strong>Medulloblastomas separate into four distinct subgroups with distinct clinicopathologic characteristics, and data from recent clinical trials for newly diagnosed medulloblastoma support subgroup-specific treatment approaches. Atypical teratoid rhabdoid tumor (ATRT), embryonal tumor with multilayered rosettes (ETMR), and pineoblastoma, as well as other rare embryonal tumors, can be distinguished from histologically similar tumors by virtue of characteristic molecular findings, with DNA methylation analysis providing a strong adjunct in indeterminate cases. Methylation analysis can also allow further subgrouping of ATRT and pineoblastoma. Despite the dire need to improve outcomes for patients with these tumors, their rarity and lack of actionable targets lead to a paucity of clinical trials and novel therapeutics.</p><p><strong>Key messages: </strong>(1) Embryonal tumors can be accurately diagnosed with pediatric-specific sequencing techniques. (2) Medulloblastoma risk stratification and treatment decisions should take into account molecular subgroups. (3) There is a dire need for a novel collaborative clinical trial design to improve outcomes is rare pediatric embryonal tumors.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"299-306"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9532785","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}