Child's Nervous System最新文献

{"title":"Resting-state functional MRI in pediatric epilepsy: a narrative review.","authors":"Daniel P Sexton, James T Voyvodic, Elizabeth Tong, Edna Andrews, Gerald A Grant","doi":"10.1007/s00381-025-06774-9","DOIUrl":"https://doi.org/10.1007/s00381-025-06774-9","url":null,"abstract":"<p><p>The role of connectivity in the function and development of the human brain has been intensely studied over the last two decades. These findings have begun to be translated to the clinical setting, particularly in the context of epilepsy. Determining connectivity in the epileptic brain can be challenging and is even more difficult in the pediatric patient. In pediatric epilepsy, resting-state functional magnetic resonance imaging (rs-fMRI) has emerged as a powerful method for determining connectivity. Resting-state fMRI is a non-invasive method of determining correlated activity (functional connectivity) between brain regions in a task-free manner. This modality is especially useful in the pediatric population as it can be done under sedation and requires minimal cooperation from the patient. Over the last decade, rs-fMRI has been increasingly used and studied in pediatric epilepsy. In this article, we review this recent work and discuss the current state of rs-fMRI in the diagnosis and management of the different pediatric epilepsy syndromes. We first provide an overview of rs-fMRI in practice, including the different methods of analysis. We then describe the connectivity findings in pediatric epilepsy that have been revealed by rs-fMRI and the current state of rs-fMRI use in practice. Finally, we discuss what rs-fMRI has revealed about postoperative changes in connectivity and provide several recommendations for future research.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"116"},"PeriodicalIF":1.3,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439635","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":"Indirect bypass for revascularization in Hutchinson-Gilford progeria syndrome: an illustrative case.","authors":"Sunny Abdelmageed, Nicole Villalba, Jonathan Scoville, Joshua Baker, Ali Shaibani, Noopur Gangopadhayay, Jennifer McGrath, Sandi Lam","doi":"10.1007/s00381-024-06705-0","DOIUrl":"https://doi.org/10.1007/s00381-024-06705-0","url":null,"abstract":"<p><strong>Purpose: </strong>Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder characterized by premature aging. Cerebral hypoperfusion and stroke have been described in HGPS however revascularization techniques have not been reported from a neurosurgical perspective in HGPS patients.</p><p><strong>Methods: </strong>We present a case of a pediatric patient with HGPS who underwent cerebral bypass along with a review of the literature.</p><p><strong>Results: </strong>Cerebral hypoperfusion and resulting ischemic strokes have been reported in children with HGPS, as early as 4 years old. Medical treatment, including antiplatelet agents, following standard ischemic stroke guidelines has been commonly reported. There is a paucity of literature regarding surgical management of cerebral hypoperfusion in HGPS patients. As an illustrative case we report a 4-year-old boy with HGPS who presented with acute left ischemic stroke from ipsilateral internal carotid artery stenosis and arteriopathy. He underwent encephaloduroarteriosynangiosis for indirect cerebral artery bypass, with neoangiogenesis on follow up imaging and with good clinical status. Wound healing in this patient became a challenging complication, with multidisciplinary input required for successful resolution.</p><p><strong>Conclusion: </strong>Children with HGPS can present with cerebral hypoperfusion due to cerebral flow deficits and indirect bypass can be cautiously considered as an option to restore cerebral blood flow. Neoangiogenesis and collateralization can occur in patients with HGPS following indirect bypass, though tissue fragility in this population makes them at high risk for wound healing issues. We discuss preoperative and perioperative considerations, as well as medical and surgical maneuvers undertaken to achieve successful healing.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"113"},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439562","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":"Intra-tumoral hemorrhage after endoscopic third ventriculostomy in a child with WNT-activated medulloblastoma: case report and literature review.","authors":"Pietro Spennato, Massimiliano Porzio, Lucia De Martino, Alessia Imperato, Giulia Meccariello, Giuseppe Cinalli","doi":"10.1007/s00381-025-06771-y","DOIUrl":"https://doi.org/10.1007/s00381-025-06771-y","url":null,"abstract":"<p><p>Intratumoral hemorrhage is a known complication of cerebrospinal fluid (CSF) drainage surgeries, such as ventriculoperitoneal shunts or external ventricular drainage, which are usually associated with upward herniation of the posterior fossa contents. In contrast, this is extremely rare after an endoscopic third ventriculostomy (ETV). This technique should drain the CSF in a more physiological way by limiting the pressure gradient between the infratentorial and supratentorial compartments, thus avoiding upward herniation of the tumor and intratumoral hemorrhage. Only three cases of intratumoral hemorrhage after ETV have been reported in the literature. Here, we describe a 9-year-old boy affected by hydrocephalus secondary to a large posterior fossa tumor who presented intratumoral hemorrhage after ETV. He required urgent hematoma evacuation and tumor removal. Histological and molecular diagnosis was WNT-activated medulloblastoma, a tumor associated with an increased risk of hemorrhage.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"114"},"PeriodicalIF":1.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439493","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":"Posterior fossa astroblastoma: a case report of an extremely rare tumor with challenging diagnosis in a child and a review of literature.","authors":"Ehab Shabo, Saida Zoubaa, Gerrit H Gielen, Ralf Clauberg, Christian Wispel, Torsten Pietsch, Hartmut Vatter, Sevgi Sarikaya-Seiwert","doi":"10.1007/s00381-025-06768-7","DOIUrl":"10.1007/s00381-025-06768-7","url":null,"abstract":"<p><p>A 7-year-old boy presented to the hospital with recurrent nausea and vomiting over 2 weeks. A cranial MRI revealed a large heterogeneous lesion in the posterior fossa extending from the fourth ventricle to the foramen magnum with contact to the brainstem. The lesion showed moderate diffusion restriction and multiple small cystic components. The child underwent gross total resection. The primary histological findings suggested proliferative active tumor without further definition. The extended histological examination 3 weeks later confirmed the diagnosis of astroblastoma. Due to complete resection and full recovery of the patient, watchful waiting with radiological follow-up was recommended. Astroblastoma is an extremely rare tumor especially in the posterior fossa. However, it should be considered as a differential diagnosis in every tumor presenting the discussed radiological and histological features, especially in young aged patients.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"112"},"PeriodicalIF":1.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425080","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":"Management of pediatric brachial plexus injuries: A cohort study utilizing the trauma quality improvement program (TQIP) database.","authors":"Molly F MacIsaac, Raissa Li, Kinsey A Rice, Lee G Phillips, Allan J Belzberg, Christopher W Snyder, S Alex Rottgers, Jordan N Halsey","doi":"10.1007/s00381-025-06767-8","DOIUrl":"https://doi.org/10.1007/s00381-025-06767-8","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric brachial plexus injuries (BPI) are uncommon, representing about 10% of BPIs overall and 0.1% of pediatric trauma cases. These injuries often result from high-energy trauma and are unique to neonatal and adult cases. This study aims to provide a contemporary, large-scale analysis of pediatric BPI mechanisms and management patterns.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) database was used to identify pediatric BPI cases from 2017 to 2020. Mechanisms of injury (MOI), concomitant injuries, imaging, and treatment intervention were determined. Pediatric age groups were defined as children (0-9 years), young adolescents (10-14), and older adolescents (15-17).</p><p><strong>Results: </strong>Of the 746,817 recorded pediatric trauma cases in TQIP, 285 BPI cases were identified (0.038%), with the majority (55%) in older adolescents. Firearm injuries accounted for 23% of cases, surpassing sports (22%) and MVAs (21%) as the leading mechanisms. Children under 10 years were most affected by MVAs (20%), young adolescents by sports (32%), and older adolescents by firearms (30%). Associated injuries included orthopedic (44%), head (40%), and vascular (24%) injuries. Imaging was performed in 82% of cases, with CT (57%) and MRI (50%) being the most common. Immediate BPI repair was rare (4.3%), mainly occurring in cases with concurrent vascular injuries (91%).</p><p><strong>Discussion: </strong>Pediatric BPIs are increasingly linked to firearms and often present alongside complex polytrauma, requiring specialized care. Immediate repair is rare, typically reserved for cases with vascular injury. These findings emphasize the need for further research to refine management, particularly in high-energy and firearm-related BPIs.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"111"},"PeriodicalIF":1.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cerebral ganglioglioma epilepsy surgery: enhancing seizure outcomes through optimized resection applying high-field intraoperative magnetic resonance imaging.","authors":"Arthur R Kurzbuch, Ben Cooper, John Kitchen, Andrea McLaren, Volker Tronnier, Jonathan R Ellenbogen","doi":"10.1007/s00381-025-06766-9","DOIUrl":"https://doi.org/10.1007/s00381-025-06766-9","url":null,"abstract":"<p><strong>Purpose: </strong>Gangliogliomas are rare, slow-growing brain tumors frequently associated with seizures in pediatric patients. This study evaluated the utility of high-field intraoperative magnetic resonance imaging (ioMRI) in the surgical management of ganglioglioma-related drug-resistant epilepsy in children. Specifically, it sought to determine whether ioMRI improves outcomes by optimizing the extent of resection, enhancing seizure control, reducing reoperations, and minimizing complications.</p><p><strong>Methods: </strong>This retrospective single-center study included 14 pediatric patients with cerebral ganglioglioma who underwent epilepsy surgery with ioMRI from 2014 to 2022. The median age was 11.5 years (range 3-16 years). Patient demographics, the rate of continued ioMRI-guided surgery, the extent of resection, histology, complications, reoperations, and seizure outcomes at 1 year postoperatively were assessed.</p><p><strong>Results: </strong>Residual tumor was detected using ioMRI in 9 of 14 patients (64.3%), leading to further resection. Complete tumor resection was achieved in 12 patients (100%) as intended, while two patients underwent planned tumor debulking. Temporary neurological deficits were observed in two patients, with no permanent deficits documented. One patient required reoperation, and another was scheduled for one. The median follow-up duration was 43 months (range 12-65 months). Seizure outcomes were classified as Engel I in 9 of 10 (90%) and Engel III in 1 of 10 patients (10%). Four patients were lost to follow-up.</p><p><strong>Conclusion: </strong>The use of ioMRI in pediatric epilepsy surgery for ganglioglioma facilitated more complete resections, contributing to favorable seizure outcomes and a low complication rate. These findings support ioMRI as a valuable tool in optimizing surgical management for this patient population.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"110"},"PeriodicalIF":1.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398312","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":"Spinal rhabdomyosarcoma in a child at the site of a lumbosacral lipoma: a rare entity.","authors":"Francesca Vitulli, Panduranga Seetahal-Maraj, Islam Adbelfattah, Paola Angelini, Julie Chandra, Jean Marie U-King-Im, Andrew King, Difei Wang, Cristina Bleil, Bassel Zebian","doi":"10.1007/s00381-025-06756-x","DOIUrl":"10.1007/s00381-025-06756-x","url":null,"abstract":"<p><p>Malignant tumours arising at the site of closed neural tube defects are extremely rare and have only been described three times in the literature. We report the case of a child with a congenital lumbosacral lipoma, a dermal sinus tract and low-lying spinal cord who was initially treated non-operatively due in part to non-attendance and who then presented at 2 years of age with recurrent urinary tract infections with intermittent pyrexia, back pain and difficulty walking. A craniospinal MRI was performed with suspicion of infection at the site of the closed neural tube defect (in view of the dermal sinus tract) and leptomeningeal spread to the rest of the spine and brain. An urgent lumbar laminectomy for untethering of the spinal cord and washout under intraoperative neuro-monitoring was performed. A solid mass was encountered in the lumbosacral canal and debulked. It was initially thought to represent solid granulomatous inflammatory tissue. Histopathological examination was, however, consistent with embryonal rhabdomyosarcoma. After multidisciplinary team discussion, chemotherapy was initiated. She developed hydrocephalus which required treatment initially endoscopically and later with a shunt. Unfortunately, she passed away 69 days after diagnosis due to disease progression despite chemotherapy. Rhabdomyosarcomas at the site of a lipomatous malformation are extremely rare and may arise from striated muscle cells within the lipoma. The underlying mechanisms are unclear. Urgent repeat imaging in patients with lipomas and rapid deterioration is essential to rule out this rare but devastating phenomenon.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"109"},"PeriodicalIF":1.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381702","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":"Impact of choroid plexus coagulation on the success of endoscopic third ventriculostomy in children with hydrocephalus: a single-center retrospective observational cohort study.","authors":"Artur Henrique Galvao Bruno da Cunha, Marcelo Moraes Valença, Pedro Lucas Negromonte Guerra, Inaê Carolline Silveira da Silva","doi":"10.1007/s00381-025-06755-y","DOIUrl":"https://doi.org/10.1007/s00381-025-06755-y","url":null,"abstract":"<p><strong>Introduction: </strong>Hydrocephalus is a common condition in childhood, often treated with ventriculoperitoneal shunts (VPS). Endoscopic third ventriculostomy (ETV) has emerged as an effective alternative, and the addition of choroid plexus coagulation (CPC) is believed to enhance its success, particularly in children under 6 months.</p><p><strong>Methods: </strong>In this observational study, a retrospective analysis was conducted on 167 pediatric patients who underwent ETV, with and without CPC, at the Hospital da Restauração in Pernambuco. The primary outcome was to evaluate the success rates of ETV and ETV + CPC at immediate postoperative or outcome at discharge and 6-month follow-up. Statistical analyses, including chi-square, univariate, and multivariate logistic regression, were employed to assess correlations between dependent and independent variables.</p><p><strong>Results: </strong>ETV + CPC showed a significantly higher success rate in the immediate postoperative period (91%) compared to ETV alone (75%) (p = 0.007). After 6 months, success rates were similar for both groups (67% for ETV + CPC and 66% for ETV), with no significant difference (p = 0.855). Univariate and multivariate analyses revealed that the type of surgery (ETV + CPC vs. ETV) was a significant predictor of immediate postoperative success (OR 2.81, 95%CI 1.18-6.72, p = 0.020). Age and sex did not correlate significantly with surgical outcomes.</p><p><strong>Conclusion: </strong>The addition of CPC to ETV significantly enhances immediate postoperative success in young children with hydrocephalus. Although long-term outcomes equalized, these findings suggest that CPC can be a valuable adjunct in optimizing short-term results.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"108"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370566","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":"Impact of the COVID-19 pandemic on the incidence of pediatric intracranial empyemas in Spain.","authors":"Marina Fidalgo de la Rosa, Gregorio Catalán Uribarrena, Pablo Martín Munarriz, Sara Iglesias Moroño, Marc Valera Melé, Juana María Vidal Miñano, Alicia Godoy Hurtado, María Elena López García, Marta Guzmán, Cristina Ferreras García, Dalila Forte","doi":"10.1007/s00381-025-06763-y","DOIUrl":"https://doi.org/10.1007/s00381-025-06763-y","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial infections due to sinusitis and otitis, although rare, can progress rapidly and result in significant morbidity, necessitating multifaceted management including extended antibiotic therapy and surgical intervention. Predominantly affecting infants and older children, these infections have seen a perceived increase in incidence following the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Objectives: </strong>Our study aims to describe the clinical and epidemiological characteristics of intracranial infections secondary to sinusitis or otitis in the pediatric population and assess changes in incidence and clinical presentation post-pandemic. Specific objectives include analyzing neurosurgical management practices, the role of ENT-neurosurgery cooperation, incidence of epileptic seizures, and management of associated venous thrombosis.</p><p><strong>Materials and methods: </strong>A retrospective multicentric study was conducted in hospitals across the Iberian Peninsula, including data from January 2018 to December 2022. Data were divided into pre-lockdown (January 2018 to March 2020) and post-lockdown (March 2020 to December 2022) periods for analysis.</p><p><strong>Results: </strong>The study included 60 pediatric cases (38 post-pandemic and 22 pre-pandemic). The average age was 9.8 years, with a male predominance (61.67%). Sinusitis was the most frequent cause (86%), and the frontal region was the most common site of infection (75%). Neurological symptoms were more prevalent post-pandemic (55.26% versus 23.68%). The primary pathogen was S. intermedius (29.6%). Most patients required neurosurgical intervention (81.7%), with a significant portion undergoing combined ENT-neurosurgery procedures (52.9%). The average antibiotic treatment duration was 6.6 weeks. Complications included venous sinus thrombosis (20%) and seizures (39.2%). Mortality was 3.3%.</p><p><strong>Conclusion: </strong>Although there was a perceived increase in cases post-pandemic, our study observed a normalization of incidence after the lockdown, with a decrease in diagnoses during confinement. The accepted antibiotic regimen lasts 6 weeks, extendable to 8 weeks in non-surgical patients, with at least 2 weeks of intravenous treatment. Sinus surgery combined with antibiotics may suffice to avoid craniotomy in some cases, while combined surgery has a lower reoperation rate in others. Anticoagulation should be individualized and discontinued upon recanalization. Prophylactic antiepileptic drug use remains controversial and should be tailored to patients with specific risk factors. Prolonged antiepileptic drug (AED) therapy may be warranted for those with early seizures and hemorrhagic lesions, whereas others may gradually taper off AEDs after the acute stage.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"107"},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363787","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":"Validating the modified Canadian Preoperative Prediction Rule for Hydrocephalus for accurate hydrocephalus prediction in a statewide pediatric brain tumor cohort.","authors":"Barnabas Obeng-Gyasi, Trenton A Line, Anoop S Chinthala, Jignesh Tailor","doi":"10.1007/s00381-025-06761-0","DOIUrl":"https://doi.org/10.1007/s00381-025-06761-0","url":null,"abstract":"<p><strong>Purpose: </strong>The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was developed to predict the need for permanent CSF diversion in children with posterior fossa tumors (PFT). This study aimed to externally validate the mCPPRH in a cohort of 113 pediatric patients with PFTs.</p><p><strong>Methods: </strong>We conducted a retrospective analysis, calculating the mCPPRH score for each patient and performing receiver operating characteristic (ROC) curve analysis to assess the tool's discriminative ability. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using a cutoff score of ≥ 5. Multivariable logistic regression with bidirectional stepwise selection was used to evaluate individual components of the score. The mCPPRH components were modified and the performance of adjusted tools was compared to the original.</p><p><strong>Results: </strong>Of the 113 patients, 35 (31.0%) required permanent CSF diversion. The mCPPRH demonstrated acceptable discriminative ability (AUC = 0.701, 95% CI 0.608-0.795, p < 0.0003). Sensitivity was 34.1%, specificity 89.7%, positive predictive value 60%, and negative predictive value 75.3%. Initial regression identified no significant predictors. In stepwise regression, moderate-severe hydrocephalus independently predicted permanent CSF diversion (OR 6.37, 95% CI 1.71-41.55, p = 0.02). Increasing the age cutoff to < 5 years, removing tumor diagnosis, and modifying hydrocephalus weighting improved performance (AUC = 0.768, sensitivity 71.4%, specificity 75.6%).</p><p><strong>Conclusions: </strong>The mCPPRH demonstrates acceptable discriminative ability (AUC 0.701) in our cohort, with particular utility in identifying low-risk patients. However, its poor sensitivity (34.1%) and variable predictor performance suggest that additional clinical factors should be considered for treatment planning, particularly in higher-risk cases. Further modification of mCPPRH components is suggested to improve its utility.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"105"},"PeriodicalIF":1.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188408","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}