Pediatric Neurosurgery最新文献

{"title":"Evaluation of the Endoscopic Third Ventriculostomy Success Score for Pediatric Hydrocephalus: Experience from a Singapore Children's Hospital.","authors":"Jensen Ang, Felicia H Z Chua, Sharmila Devi, David C Y Low, Wan Tew Seow, Sharon Y Y Low","doi":"10.1159/000546994","DOIUrl":"10.1159/000546994","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic third ventriculostomy (ETV) is a well-established neurosurgical procedure. Concurrently, the Endoscopic Third Ventriculostomy Success Score (ETVSS) is a recognized validation tool commonly used to prognosticate the efficacy of this intervention. The main aims of this study are to review our institutional experience with ETV for pediatric hydrocephalus and evaluate its correlation with the ETVSS. Secondary aims include identification of other factors that are not part of the existing ETVSS and to corroborate our findings with contemporary literature.</p><p><strong>Methods: </strong>This is a single-institution, retrospective study. Patients under 19 years old who underwent ETV were included. Variables of interest such as patient characteristics, hydrocephalus etiology, procedural details, perioperative complications, neuroimaging features, and outcomes were collected. Radiological parameters curated from the literature such as third ventricular floor bowing, lamina terminalis bowing, third ventricular morphology index, and presence of prepontine adhesions (PPAs) are also included. For this study, the primary outcome measure is \"ETV success,\" defined as no need for shunt insertion to divert CSF at any point in time after ETV. Subsequent outcome of each ETV is correlated with the ETVSS. Additional factors are also independently assessed for their impact on the ETVSS in our study cohort.</p><p><strong>Results: </strong>Sixty-nine ETV cases were recruited for this study whereby ETV was successful in 63.8% (n = 44) cases. At 12 months' follow-up, their ETV stomas remained patent. Of note, 24.6% (n = 17) ETV failures occurred within 30 days of the procedure. In our series, ETV success correlated well with ETVSS. The ETV success rate was 0% for post-infectious and post-hemorrhagic etiologies. For the cases of ETV failure, definitive CSF diversion procedures were necessary within 3 months from their initial ETV. Logistic regression analysis showed ETVSS (odds ratio 1.068, p = 0.037) and the presence of PPA (p = 0.02) significantly correlated with ETV success.</p><p><strong>Conclusion: </strong>Our institutional experience in the use of ETV for pediatric hydrocephalus corroborates with findings from contemporary literature. In the context of our study, the ETVSS is applicable and the absence of PPA on neuroimaging demonstrates good correlation with ETV success.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"64-73"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369557","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":"Identifying Risk Factors for New-Onset Postoperative Seizures in Pediatric Brain Tumor Patients: A Comprehensive Retrospective Analysis.","authors":"Ibtisam Yahya, Kirsten M Van Baarsen, Hanneke M Van Santen, Sjef Van Gestel, Eelco W Hoving, Kim Boshuisen","doi":"10.1159/000548209","DOIUrl":"10.1159/000548209","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical resection of intracranial tumors in pediatric patients poses the potential risk of new-onset postoperative seizures, prompting debates over the prophylactic use of anti-seizure medication (ASMs). This retrospective study focusses on the incidence and risk factors associated with the occurrence of new-onset postoperative seizures within 30 days following surgery in pediatric patients with brain tumors who did not receive ASM prophylaxis pre- and perioperatively.</p><p><strong>Methods: </strong>A meticulous review of clinical records spanning from June 2018 to December 2022 was conducted, examining data from pediatric patients undergoing craniotomies for intracranial tumors. Patients with preoperative seizures or those taking perioperative ASMs were excluded. The data encompassed demographic details, preoperative variables, tumor characteristics, surgical intricacies, and clinical course including 30-day mortality. The primary outcome was the incidence of new-onset postoperative seizures, further categorized as early (within 1 week) or late (1 week to 30 days). Univariate and multivariate logistic regression analyses were used to explore correlations between various variables and seizure outcomes.</p><p><strong>Results: </strong>In a cohort of 306 cases, the incidence of new-onset postoperative seizures was 7.8% of whom 4.2% experienced early seizures. Of them, 3 patients developed status epilepticus. Multivariate analysis identified several significant risk factors including postoperative hyponatremia, supratentorial tumor localization, and young age, especially age under 1 year.</p><p><strong>Conclusion: </strong>In this retrospective study, we identified supratentorial tumor localization, hyponatremia and age younger than 1 year as risk factors for new-onset postoperative seizures among pediatric patients. Especially in infants below the age of 1 year, we recommend meticulous monitoring of postoperative sodium levels and noninvasive epilepsy monitoring after supratentorial tumor resection. Future prospective studies are needed to explore the potential effectiveness of administering perioperative prophylactic antiepileptic drugs (ASMs) within this specific subset of the pediatric population.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"127-137"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979099","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":"Subtotal Resection with Proton-Beam Radiotherapy for Treatment of Pineal Parenchymal Tumor of Intermediate Differentiation in a Pediatric Patient.","authors":"Daniel E Fulkerson, Abigail Heck, Natalie Hauser, Daniel H Fulkerson","doi":"10.1159/000545882","DOIUrl":"10.1159/000545882","url":null,"abstract":"<p><strong>Introduction: </strong>Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare, pinealocyte-derived brain tumors that occur primarily in adults. The clinical prognosis fits somewhere between the benign pineocytoma and highly malignant pineoblastoma. There is very little published literature regarding this tumor in children and the existing pediatric information is enfolded with adult data in single-center reviews. The most common treatment recommendation for adults is aggressive resection, possibly followed by craniospinal irradiation (CSI) and/or chemotherapy. However, the adult literature is inconsistent, often contradictory, and does not address specific considerations in pediatric patients. To our knowledge, there are no papers specifically addressing the management and clinical considerations of PPTID in pediatric patients. As such, the optimal treatment strategy in children is unknown.</p><p><strong>Case presentation: </strong>We describe the treatment of a 6-year-old child who presented with obstructive hydrocephalus from a PPTID. The child was treated with a partial tumor resection followed by localized proton beam radiation. He has been followed for 8 years. Clinically, he is doing well, and his most recent MRI shows negligible residual tumor with no sign of recurrence.</p><p><strong>Conclusions: </strong>Our case suggests safe resection followed by proton beam radiotherapy may be effective in treating children with this exceedingly rare entity. While further study is needed, this strategy may avoid unnecessary surgical risk and the consequences of CSI on the developing pediatric nervous system.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"32-37"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058559","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":"Neuroendoscopic Surgical Treatment of Cerebellar Vermis Tumors in Pediatric Patients: A Case Series.","authors":"Yu Zeng, Fang Liu, Zhuo Chen, Xiaohua Zhang, Sheng Zhao, Jian Liu, Chao Wang","doi":"10.1159/000545466","DOIUrl":"10.1159/000545466","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroendoscopy is gaining traction as a minimally invasive technique for the resection of cerebellar vermis tumors. This study investigates the effectiveness and clinical experience of neuroendoscopic surgery for cerebellar vermis tumor resection.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 18 patients with cerebellar vermis tumors treated using the German STORZ neuroendoscope between January 2021 and January 2024 at the Department of Neurosurgery, Guizhou Provincial People's Hospital, and Guizhou Hospital of Shanghai Children's Center. The surgical outcomes, pathological diagnoses, postoperative complications, and follow-up results were analyzed.</p><p><strong>Results: </strong>Of the 18 patients, total resection was achieved in 16 cases, subtotal resection in 1 case, and biopsy in 1 case. Postoperative pathology revealed 9 cases of medulloblastoma, 3 cases of ependymoma, and 5 cases of astrocytoma (2 WHO grade I, 2 grade II, and 1 grade III), along with 1 benign cerebellar lesion. Postoperative complications included malignant arrhythmia (1 case), cerebellar mutism (4 cases), and ataxia (13 cases). During the 1-36 months of follow-up, 2 patients developed communicating hydrocephalus, which improved following ventriculoperitoneal shunt placement. Recovery of cerebellar mutism occurred within an average of 21 days, while ataxia improved on average within 50 days. Tumor recurrence was observed in 3 patients.</p><p><strong>Conclusion: </strong>Neuroendoscopic resection of cerebellar vermis tumors, performed by skilled operators, provides effective surgical exposure and offers a viable alternative to traditional microscopy with satisfactory clinical outcomes.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"17-24"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712177","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":"Invasive Intracranial Electroencephalography Monitoring in the Child with a Bleeding Disorder: Challenges and Considerations.","authors":"Georgia Wong, Stephanie Gurevich, Saige Teti, Michael F Guerrera, Tesfaye Zelleke, William D Gaillard, Chima O Oluigbo","doi":"10.1159/000543194","DOIUrl":"10.1159/000543194","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary bleeding disorders stem from the absence or insufficient levels of particular clotting proteins, essential for facilitating coagulation in the clotting cascade. Among the most prevalent are hemophilia A (deficiency of factor VIII), hemophilia B (deficiency of factor IX), and von Willebrand disease (VWD). Management of pharmacoresistant epilepsy is more difficult in a patient with bleeding disorder due to increased risk of bleeding during surgery. While patients who have both a bleeding disorder and epilepsy are rare, reporting on the management of these patients who may require intracranial monitoring for pharmacoresistant epilepsy offers valuable insights into the challenges and considerations necessary for safely navigating the complex intersection of bleeding risk and seizure control.</p><p><strong>Case presentation: </strong>Two patients with bleeding disorders (VWD and factor XI deficiency) underwent invasive intracranial monitoring for medical refractory epilepsy followed by epilepsy focus resection surgery. Both patients were found to have a bleeding disorder during their preoperative laboratory work. After abnormal laboratories were reported, both patients were referred to hematology for further evaluation and surgical planning. The first patient was a 10-year-old boy with medically refractory focal epilepsy who was found to have type IIM VWD. He underwent surgery for subdural grid placement followed by resection on postoperative day 6. He required wilate® (human von Willebrand factor/coagulation factor VIII complex) infusions from the day of surgery prior to surgery through postoperative day 14. The second case was a 2-year-old boy with a history of tuberous sclerosis and medically refractory epilepsy who was found to have factor XI deficiency (hemophilia C) who required fresh frozen plasma and platelet transfusions throughout his hospitalization. He underwent surgery for sEEG followed by resection of the tubers. Both patients remained stable throughout their invasive monitoring and completed epilepsy resection surgeries without reported complications. Both patients achieved seizure freedom after surgery since their most recent follow-up of 1 month and 13 months.</p><p><strong>Conclusion: </strong>The two patients successfully underwent invasive neuromonitoring with subdural grids and sEEG for seizure focus identification followed by resective epilepsy surgery without bleeding complications while achieving seizure freedom. While epilepsy patients with a bleeding disorder should not automatically be denied surgery due to the increased risk of hemorrhage, it is crucial that any decision is based on a comprehensive, multidisciplinary evaluation. This case report highlights the potential for future meta-analysis and further conversations regarding improved protocols for patients with bleeding disorders.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"38-44"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911121","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":"Comparison of Outcomes between Infants above and below 5 Months of Age Undergoing Endoscopic Craniectomy for Sagittal Suture Synostosis.","authors":"Isabella Watson, Ananth P Abraham, A Hana Miller, Paul Steinbok, Ashutosh Singhal","doi":"10.1159/000549250","DOIUrl":"10.1159/000549250","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic strip craniectomy followed by molding helmet therapy for sagittal suture synostosis is thought to be most effective in infants 3-4 months of age. However, infants often present to a neurosurgeon beyond this time period. The aim of this study was to compare morphological outcomes in older infants (5-7 months of age) with younger infants, in a series of babies who were operated endoscopically for sagittal suture synostosis.</p><p><strong>Methods: </strong>The prospectively maintained Pediatric Neurosurgery Clinical Database at BC Children's Hospital was interrogated and 81 pediatric patients who had undergone an endoscopic craniectomy between 2010 and 2021 for sagittal craniosynostosis and had follow-up of at least 1 year were identified. Eleven of these patients received surgical intervention when they were 5 months of age or older (median 5.4 months, range 5.0-6.4). Morphological indices, duration of helmet therapy, and reoperation rates were compared between the early and late intervention groups.</p><p><strong>Results: </strong>Both the early intervention (surgery before 5 months of age, n = 70) and the late intervention (surgery at 5 months or later, n = 11) groups had comparable average preoperative cephalic index (CI) (early - 67.1 vs. late - 69.4), change in CI (early - 6.7 vs. late - 4.7), and 2-year follow-up CI (early - 73.8 vs. late - 74.1). Both groups had similar average helmeting duration (6.6 vs. 6.1 months). Of the 11 late intervention patients, none required reoperation but poor cosmetic outcome was noted in 1 patient. The early intervention group had 1 patient who required a secondary cranial vault reconstruction due to persistent scaphocephaly.</p><p><strong>Conclusion: </strong>Infants who received an endoscopic craniectomy for sagittal suture synostosis after 5 months of age showed no statistically significant difference in morphological outcomes compared to the early intervention group.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"147-152"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145543941","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":"Novel Application of Connectomics to the Surgical Management of Pediatric Arteriovenous Malformations.","authors":"Shoaib A Syed, Fawaz Al-Mufti, Simon J Hanft, Chirag D Gandhi, Jared M Pisapia","doi":"10.1159/000547100","DOIUrl":"10.1159/000547100","url":null,"abstract":"<p><strong>Introduction: </strong>The emergence of connectomics in neurosurgery has allowed for construction of detailed maps of white matter connections, incorporating both structural and functional connectivity patterns. The advantage of mapping cerebral vascular lesions to guide surgical approach shows great potential. We aim to identify the clinical utility of connectomics for the surgical treatment of pediatric arteriovenous malformations (AVMs).</p><p><strong>Case presentation: </strong>We present two illustrative cases of the application of connectomics to the management of cerebral AVM in a 9-year-old and 8-year-old female. Using magnetic resonance anatomic and diffusion tensor imaging, a machine learning algorithm generated patient-specific representations of the corticospinal tract for the first patient, and the optic radiations for the second patient. The default mode network and language network were also examined for each patient. The imaging output served as an adjunct to guide operative decision-making. It assisted with selection of the superior parietal lobule as the operative corridor for the first case. Furthermore, it alerted the surgeon to white matter tracts in close proximity to the AVM nidus during resection. Finally, it aided in risk versus benefit analysis regarding treatment approach, such as craniotomy for resection for the first patient versus radiosurgery for the second patient. Both patients had favorable neurologic outcomes at the available follow-up period.</p><p><strong>Conclusion: </strong>Use of the software integrated well with clinical workflow. The output was used for planning and overlaid on the intraoperative neuro-navigation system. It improved visualization of eloquent regions, especially those networks not visible on standard anatomic imaging. Future studies will focus on expanding the cohort, conducting in pre- and postoperative connectomic analysis with correlation to clinical outcome measures, and incorporating functional magnetic resonance imaging.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"95-106"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499343","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":"Mild Head Trauma in a Paediatric Hospital: Analysis of the PECARN Rule, Traumatic Lesions on Head CT, and Functional Sequelae.","authors":"Pedro Abreu, Dalila Forte, Miguel Correia, Mário Matos, Amets Sagarribay","doi":"10.1159/000547384","DOIUrl":"10.1159/000547384","url":null,"abstract":"<p><strong>Introduction: </strong>Mild head trauma is frequent in Paediatrics and its management varies widely across clinicians. Questions regarding patients' management, outcomes, head trauma prevention, the adequacy of computerized tomography (CT) prescription and the adherence to the Pediatric Emergency Care Applied Research Network (PECARN) rule are still discussed.</p><p><strong>Methods: </strong>We performed a retrospective observational study of mild head trauma patients who underwent head CT, characterizing the presenting signs and symptoms, mechanisms of injury, head CT lesions, and outcomes. Statistical associations between signs and symptoms, CT lesions, PECARN risk groups and outcomes were explored.</p><p><strong>Results: </strong>Three hundred and eleven patients were included, with 18.8% of patients under 2 years having CT traumatic lesions, against 7.9% of patients over 2 years old. The majority were aligned skull fractures. Parietal/temporal/occipital scalp haematoma, being under 3 months of age, and the presence of more than 2 vomits on admission, were associated with head CT traumatic lesions (OR 6.39, OR 2.84, OR 2.84, respectively). Clinically important lesions were rare (0.56%) and associated to the PECARN high-risk group (p = 0.005). All patients had no functional sequelae. The most common causes of head trauma were bed falls and ground falls. Baby stroller/egg falls due to no retention system usage were not rare and most bicycle fall victims were not wearing a helmet.</p><p><strong>Conclusion: </strong>This study reinforces the usefulness of PECARN rule guiding CT scans prescription and patients´ management. Parietal/temporal/occipital scalp haematoma, being under 3 months of age and having more than two vomits are associated traumatic CT findings. Preventable head trauma frequency underlines the need for public policies reinforcement.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"107-113"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683611","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":"Utility of Combining Frailty and Comorbid Disease Indices to Better Predict Outcomes following Craniotomy for Pediatric Primary Brain Tumors.","authors":"Alan Nguyen, Michelot Michel, Shane Shahrestani, Andre Boyke, Catherine M Garcia, Simon Menaker, Moise Danielpour, David Bonda","doi":"10.1159/000548771","DOIUrl":"10.1159/000548771","url":null,"abstract":"<p><strong>Introduction: </strong>There are no predictive outcome scales that have been validated in pediatric patients with brain tumors. An index can help identify children with increased risk for negative postoperative results. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty and the Elixhauser Comorbidity Index (ECI) have been used independently in adult brain tumor patients to identify patients who are at an increased risk for detrimental outcomes. We investigated whether JHACG and ECI can better predict hospital length of stay (LOS), nonroutine discharge, and 1-year readmission in pediatric patients undergoing craniotomy for primary brain tumors.</p><p><strong>Methods: </strong>The Nationwide Readmissions Database was queried for pediatric brain tumor resections between 2016 and 2019. In total, 237 and 1,235 patients with benign and malignant tumors were identified, respectively. Frailty, ECI, and Frailty+ECI were assessed as predictors using generalized linear mixed-effects models. Receiver operating characteristic curves evaluated predictive performance.</p><p><strong>Results: </strong>Frailty+ECI, frailty, and ECI scores similarly predicted hospital LOS, nonroutine discharge, and 1-year readmission in the benign tumor cohort. In the malignant cohort, Frailty+ECI (area under the curve [AUC] 0.895) outperformed frailty alone (AUC 0.742, p = 0.001) but performed similar to ECI score alone (AUC 0.893, p = 0.438) in predicting hospital LOS. Concerning nonroutine discharge prediction, Frailty+ECI (AUC 0.871) also outperformed frailty alone (AUC 0.744, p = 0.04) while performing similarly to ECI score alone (AUC 0.869, p = 0.871). All indices performed in a similar way to predict 1-year readmission in this cohort.</p><p><strong>Conclusion: </strong>Our study showed that Frailty+ECI demonstrated a robust ability to predict hospital LOS and nonroutine discharge disposition in pediatric patients undergoing malignant brain tumor resection. These findings suggest that combining these indices may improve the prediction of postoperative outcomes in this population. While further studies are warranted, these findings can be used as a risk assessment index to coordinate care plans with the patient and their family after an operation.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"138-146"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226433","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":"Infradentate Approach to the Fourth Ventricle with Tubular Retraction System for Medulloblastoma: Feasibility of a Minimally Invasive Technique to Avoid Anatomical Complications in a Pediatric Patient.","authors":"J Javier Cuéllar-Hernández, Omar R Ortega-Ruiz, Luis Alejandro Pérez-Ruano, Paulo Tabera-Tarello, Javier Terrazo-Lluch","doi":"10.1159/000545010","DOIUrl":"10.1159/000545010","url":null,"abstract":"<p><strong>Introduction: </strong>Medulloblastoma is the most common malignant tumor in the pediatric population. Current treatment of these lesions includes maximum safe resection, chemotherapy, and radiotherapy. Quality of life for these patients as well as postoperative complications remains with poorer prognosis compared to other posterior fossa tumors. Therefore, the surgical approach should be tailored to diminish the probability of coursing with postoperative complications such as cerebellar mutism. Minimally invasive techniques with tubular retractors have been described for supratentorial lesions. However, evidence remains scarce for lesions in the posterior fossa. Similarly, there are no available reports of the use of these techniques in pediatric patients.</p><p><strong>Case presentation: </strong>We present the case of an 11-year-old girl with a medulloblastoma. An infradentate approach was elected as the course of action looking to reduce the risk of postoperative cerebellar mutism syndrome. In the 2-year follow-up, the patient remained asymptomatic with no cerebellar signs nor recurrence of the lesion.</p><p><strong>Conclusion: </strong>We present the first case of a medulloblastoma treated with tubular ports in our center looking to discuss its feasibility for the treatment of posterior fossa tumors in pediatric patients. To the best of our knowledge, this is the first report of transcranial ports used in a pediatric patient for the resection of a medulloblastoma. Infradentate tubular resection could be a feasible and reproducible approach in pediatric patients, reducing the risk of injury to anatomical structures and cerebellar mutism.</p>","PeriodicalId":54631,"journal":{"name":"Pediatric Neurosurgery","volume":" ","pages":"45-50"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544422","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}