Child's Nervous System最新文献

{"title":"Pial arteriovenous fistula with a large intraparenchymal hemorrhage in a 9-year-old child: a case report and case-based mini review.","authors":"Manina M Etter, Raphael Guzman, Marios-Nikos Psychogios, Jehuda Soleman","doi":"10.1007/s00381-025-06784-7","DOIUrl":"10.1007/s00381-025-06784-7","url":null,"abstract":"<p><strong>Background: </strong>Pial arteriovenous fistulas are rare cerebrovascular malformations, predominantly occurring in the pediatric population. The spectrum of symptoms is broad, ranging from incidental findings to intracranial hemorrhage. However, accurate diagnosis and optimal treatment require, among other factors, dynamic imaging modalities and interdisciplinary management.</p><p><strong>Case presentation: </strong>We describe a case of a 9-year-old patient presenting with acute spontaneous headache and apathy. MRI revealed a right temporal intraparenchymal hemorrhage, without signs of an underlying vascular pathology. Cerebral angiography was performed, revealing a suspected pial arteriovenous fistula. The patient was scheduled for surgical hematoma removal and resection of the pial fistula, with intraoperative angiographic control. After hematoma removal and resection of the pial fistula, intraoperative cerebral angiography revealed an additional fistula point that had not been appreciated on the initial preoperative angiography. The craniotomy was extended and the remaining fistula was resected. Final intraoperative angiography confirmed complete resection of the pial fistula.</p><p><strong>Conclusion: </strong>Pediatric pial arteriovenous fistulas are rare, complex, and challenging arteriovenous lesions. Accurate diagnosis and an interdisciplinary management are essential. However, consensus on the diagnostic workflow and treatment approach remains lacking. Therefore, we report our case and propose a diagnostic and therapeutic workup for ruptured vascular intracranial anomalies in children.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"132"},"PeriodicalIF":1.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647509","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":"Selective dorsal rhizotomy from indication to rehabilitation: a worldwide survey.","authors":"Liza M M van Dijk, K Mariam Slot, Tom F Novacheck, Annemieke I Buizer, Nelleke G Langerak","doi":"10.1007/s00381-025-06786-5","DOIUrl":"10.1007/s00381-025-06786-5","url":null,"abstract":"<p><strong>Purpose: </strong>Selective dorsal rhizotomy (SDR) is a neurosurgical treatment used worldwide to reduce spasticity. The procedure has undergone many changes since its introduction in the early 1900s, and currently, different centers vary in many aspects of the procedure. We surveyed centers on different continents regarding SDR indications, surgical techniques, and postoperative rehabilitation.</p><p><strong>Methods: </strong>Ten centers worldwide with SDR experience participated in an online survey preparing for a pre-conference workshop in 2022. The main topics were patient characteristics, the selection process, surgery, and rehabilitation.</p><p><strong>Results: </strong>Universal suitable candidates for SDR were patients with bilateral spastic cerebral palsy, Gross Motor Function Classification System levels II or III, ages 5 to 7 years, and adequate strength, motor control, and access to postoperative rehabilitation. Centers differed in additional inclusion and exclusion criteria and the use of diagnostic tools. Both single- and multilevel approaches were used, with electrophysiological monitoring applied in all approaches. Intensive rehabilitation was recommended after surgery, followed by a less intensive program, with variations in duration, therapy frequency, modalities used, and follow-up periods.</p><p><strong>Conclusion: </strong>This survey demonstrated many similarities in several aspects of the SDR procedure in centers performing SDR worldwide, while considerable variability was also seen. The results emphasize the need for standardized reporting of SDR procedures and outcome measures to enable international comparative studies. A Delphi procedure could be a first step to reaching a consensus on outcome measurements, which may lead to a consensus regarding the most suitable candidates, surgical techniques, and rehabilitation programs to improve functional outcomes.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"133"},"PeriodicalIF":1.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647512","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":"Clinical and surgical outcomes of pediatric Cushing's disease following endoscopic transsphenoidal surgery.","authors":"Guive Sharifi, Elham Paraandavaji, Mohammad Mehdi Mousavi Nasab, Esmaeil Mohammadi, Neginalsadat Sadeghi, Seyed Mohammad Tavangar, Mohammad Reza Mohajeri Tehrani, Nader Akbari Dilmaghani","doi":"10.1007/s00381-025-06790-9","DOIUrl":"https://doi.org/10.1007/s00381-025-06790-9","url":null,"abstract":"<p><strong>Background: </strong>Cushing's disease (CD) is characterized by hypercortisolism due to excessive adrenocorticotropic hormone (ACTH) secretion from a pituitary adenoma. Though more common in adults, pediatric cases constitute approximately 5% of those seen in adults. Early diagnosis and treatment are critical due to the severe impacts on growth and development in children. Endoscopic transsphenoidal surgery (ETSS) is the preferred first-line treatment for both children and adults.</p><p><strong>Methods: </strong>From 2011 to 2024, 3280 patients with pituitary adenoma underwent surgery using the ETSS technique at Loghman Hospital of Tehran, including 213 CD cases, of which 22 were pediatric (under 18 years old). This retrospective study analyzed clinical data such as age, gender, presenting symptoms, family and medical history, imaging characteristics, surgical findings, pathology, follow-up, and postoperative outcomes. Diagnostic criteria included biochemical tests, MRI imaging, and inferior petrosal sinus sampling.</p><p><strong>Results: </strong>Out of 22 pediatric patients, 16 were females and 6 males, with an average age of 14.73 years. Obesity was the initial clinical manifestation in 59% of the patients. According to the Hardy-Wilson classification, 18.2% of patients were stage E, 9.09% stage C, and the rest (excluding MRI-negative patients) stage A. ETSS was performed on all patients, with total hypophysectomy in 18.2% and hemi-hypophysectomy in 9.09%. Postoperative complications included cerebrospinal fluid leakage in 13.63% of patients. Remission was achieved in 95.45% of patients, with a recurrence rate of 4.54%. Hormone imbalances post-surgery included hypocortisolism (50%), hypothyroidism (45.45%), and hypogonadism (13.63%).</p><p><strong>Conclusion: </strong>ETSS is an effective and safe treatment for pediatric CD, achieving high remission rates and minimal complications. This study highlights the importance of specialized surgical care in managing pediatric CD and underscores the need for early diagnosis and intervention. Further studies are warranted to evaluate long-term outcomes and optimize treatment protocols.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"130"},"PeriodicalIF":1.3,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647507","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":"Spontaneous regression of epileptogenic pilocytic astrocytoma with FGFR1-TACC1 fusion.","authors":"Ko Horikoshi, Yasushi Iimura, Hiroharu Suzuki, Mario Suzuki, Hidenori Sugano, Akihide Kondo","doi":"10.1007/s00381-025-06789-2","DOIUrl":"10.1007/s00381-025-06789-2","url":null,"abstract":"<p><strong>Introduction: </strong>Pilocytic astrocytoma (PA) is the most common pediatric tumor, typically located in the cerebellum, with spontaneous regression observed mainly in patients with neurofibromatosis type 1 (NF1). However, spontaneous regression of PA without NF1 is rarely reported.</p><p><strong>Case presentation: </strong>Here, we describe a case of spontaneous regression of PA without NF1, located in the left frontal lobe with FGFR1-TACC1 fusion, in a 14-year-old boy who presented with epilepsy. Initial MRI revealed a lesion in the left middle frontal gyrus, and subsequent follow-up MRI demonstrated spontaneous regression. Despite this regression, the patient's seizures persisted, leading to epileptic focus resection. Pathological examination confirmed PA with characteristic histological findings and FGFR1-TACC1 fusion.</p><p><strong>Conclusion: </strong>This case suggests that FGFR1-TACC1 fusion may be linked to spontaneous regression of PA, even in the absence of NF1. Surgical intervention may remain necessary in cases of epilepsy associated with PA, regardless of tumor regression.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"129"},"PeriodicalIF":1.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630213","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":"Postoperative word-finding difficulties in children with posterior fossa tumours: a crosslinguistic European cohort study.","authors":"K Persson, J Grønbæk, I Tiberg, Å Fyrberg, C Castor, B Andreozzi, R Frič, P Hauser, R Kiudeliene, C Mallucci, R Mathiasen, P Nyman, B Pizer, A Sehested, D Boeg Thomsen","doi":"10.1007/s00381-025-06787-4","DOIUrl":"10.1007/s00381-025-06787-4","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior fossa tumour (PFT) surgery carries a risk of mutism or severely reduced speech. As for higher-cognitive language functions, word-finding difficulties have been reported, but no study has compared pre- and postoperative word-finding speeds to identify impairment caused by surgery. The current study investigated changes in word-finding ability associated with PFT surgery and examined factors affecting postoperative ability.</p><p><strong>Method: </strong>We included 184 children aged 5:0-17:9 years undergoing PFT surgery and assessed word-finding ability before and after surgery using a speeded picture-naming test. We compared postoperative word-finding performance with both preoperative performance and age-specific norms and examined factors affecting word-finding ability.</p><p><strong>Results: </strong>We found no significant difference between pre- and postoperative performance, reflecting that some children exhibited better word-finding ability after surgery, others poorer. After surgery, 95% of the children performed two standard deviations above (slower than) age-specific norms. Tumour location in the fourth ventricle negatively affected postoperative word-finding ability (B = -4.09, p < 0.05).</p><p><strong>Conclusion: </strong>For some children, PFT surgery leads to postoperative word-finding difficulties, emphasizing the importance of postoperative language assessments and interventions. Fourth-ventricle tumour location emerged as a risk factor for poorer postoperative word-finding ability, likely reflecting surgical damage to the dentato-thalamo-cortical pathway (DTCP).</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"128"},"PeriodicalIF":1.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613729","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":"Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period - a retrospective study of 372 pediatric patients from a single institution.","authors":"Jingzhe Yuan, Haoqi Zeng, Kaiyu Fan, Xu Han, Jian Gong, Yunwei Ou","doi":"10.1007/s00381-025-06783-8","DOIUrl":"https://doi.org/10.1007/s00381-025-06783-8","url":null,"abstract":"<p><strong>Objective: </strong>Common treatments for obstructive hydrocephalus caused by malignant midline intracranial tumors during the perioperative period include ventriculoperitoneal shunt (VPS) placement, endoscopic third ventriculostomy (ETV), and direct tumor resection. The purpose of this study is to determine whether it is necessary to treat hydrocephalus before tumor resection and to clarify which treatment is most effective.</p><p><strong>Methods: </strong>Data from 372 pediatric patients (under 18 years) with obstructive hydrocephalus due to malignant midline intracranial tumors, referred to the Department of Pediatric Neurosurgery at Beijing Tiantan Hospital between January 2018 and September 2019, were collected. Their clinical features and outcomes were analyzed statistically.</p><p><strong>Results: </strong>A total of 372 pediatric patients were treated for obstructive hydrocephalus. Of these, 215 patients underwent preoperative VPS placement; the success rate of preoperative VPS placement was 98.1% (211/215), with a mean recurrence duration of 63.5 ± 15.7 days. Forty patients underwent preoperative ETV; the success rate of preoperative ETV was 90.0% (36/40), with a mean recurrence duration of 53.8 ± 44.9 days. In total, 117 patients underwent direct tumor resection; the recurrence rate of hydrocephalus post-resection was 20.5% (24/117), with a mean recurrence duration of 125.0 ± 170.8 days. The recurrence rate of hydrocephalus in patients who required re-shunting after VPS placement was significantly lower than that in patients requiring re-shunting after ETV (p = 0.013).</p><p><strong>Conclusion: </strong>Malignant midline intracranial tumors in pediatric patients often lead to obstructive hydrocephalus, and preoperative interventions, such as VPS placement, are more effective in reducing recurrence rates compared to direct tumor resection. VPS and ETV are both safe and effective treatments, with VPS showing a lower recurrence rate. The findings are primarily applicable to suprasellar, pineal, and fourth ventricular tumors, and further research is needed to explore hydrocephalus management in other midline tumor locations.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"127"},"PeriodicalIF":1.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603806","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":"Surgical treatment of subependymal giant cell astrocytoma in patients with tuberous sclerosis complex-an institutional experience and results.","authors":"Mia Tuft, Ylva Østby Berger, Pål Bache Marthinsen, Bernt Johan Due-Tønnessen, Radek Frič","doi":"10.1007/s00381-025-06779-4","DOIUrl":"10.1007/s00381-025-06779-4","url":null,"abstract":"<p><strong>Objective: </strong>Subependymal giant cell astrocytomas (SEGA) are present in patients with tuberous sclerosis complex (TSC), occasionally requiring surgical removal. The study aimed to analyze the results from our series of children undergoing surgery for SEGA.</p><p><strong>Methods: </strong>We retrospectively identified children with TSC undergoing resection of SEGA at Oslo University Hospital between 1982 and 2016. Patient charts, radiological images, epilepsy, and neuropsychological reports were reviewed.</p><p><strong>Results: </strong>Out of 208 patients with TSC, 18 (9%) underwent resection of SEGA. Due to missing data, we could only analyze results from 14 surgeries in 11 children (median age 6 years, range 0-19; male/female ratio 2.7:1). The tumours were bilateral in four (36%) patients. The tumour diameter was a median of 19 mm (10-104 mm). The surgical approach was transcortical in eight (57%) and transcallosal in six surgeries (43%). Gross total resection was achieved in 12 (86%) of surgeries. There was no mortality or major morbidity related to surgery except for one case of chronic subdural hematoma, but out of two patients with ventriculoperitoneal shunts, one developed shunt infection, and both experienced shunt failures during the follow-up. During the follow-up (median 11 years, range 1-21), three patients (27%) underwent repeated surgery. We could not document any significant impact of the surgery on patients' cognitive functioning or the grade of epilepsy.</p><p><strong>Conclusions: </strong>Resection of SEGA in children with TSC was associated with a low complication rate. We could not document any impact of surgery on patients' cognitive functioning or grade of epilepsy. However, the neuropsychological data were limited in most cases. Neuropsychological assessment should be performed before the surgery and be a part of follow-up after surgery.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"126"},"PeriodicalIF":1.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540288","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":"Effective bilateral neuroendoscopic approach for managing intermittent triventricular hydrocephalus with septated choroid plexus cysts of the third ventricle: a case report and comprehensive literature review.","authors":"A Awaf, T Alghassab, M Jarebi","doi":"10.1007/s00381-025-06781-w","DOIUrl":"https://doi.org/10.1007/s00381-025-06781-w","url":null,"abstract":"<p><strong>Introduction: </strong>Choroid plexus cysts (CPCs) are rare, benign neuroepithelial cysts that can cause obstructive hydrocephalus, although most are asymptomatic. Symptomatic CPCs are uncommon, and hydrocephalus from these cysts, especially intermittent in nature, is rarely reported. Diagnosing CPC-induced intermittent hydrocephalus can be challenging due to the cysts' CSF-like content and thin walls, often requiring advanced MRI sequences for detection.</p><p><strong>Case report: </strong>We present the case of a previously healthy 6-month-old male who developed intermittent triventricular hydrocephalus, presenting with projectile vomiting, lethargy, a bulging fontanel, and limited upward gaze. CT imaging revealed ventricular enlargement, and MRI revealed a thin membrane and a suspected choroid plexus cyst located within the choroid plexus of the anterior roof of the third ventricle, which is consistent with the dynamic obstruction of cerebrospinal fluid flow. After initial symptom resolution, the patient experienced recurrence within 24 h. Bilateral neuroendoscopic surgery was performed, involving cyst fenestration, shrinkage, and preventive endoscopic third ventriculostomy (ETV). Pathology confirmed a choroid plexus cyst. Postoperative imaging showed resolution of hydrocephalus and disappearance of the cyst. At follow-ups over 18 months, the patient remained symptom-free with no recurrence.</p><p><strong>Discussion: </strong>This case highlights the challenges of diagnosing and managing intermittent hydrocephalus caused by a septated choroid plexus cyst. Neuroendoscopy offers a minimally invasive treatment for obstructive hydrocephalus, particularly with complex cystic lesions. Our case required a bilateral approach due to the cyst's septation, which posed unique surgical challenges. A literature review revealed similar favorable outcomes with endoscopic techniques, but our case stands out due to the rare presentation of a septated CPC.</p><p><strong>Conclusion: </strong>This report demonstrates the effectiveness of bilateral neuroendoscopic surgery in managing intermittent hydrocephalus caused by a septated choroid plexus cyst. The case underscores the importance of individualized surgical strategies and advanced imaging techniques in managing complex cases of hydrocephalus.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"125"},"PeriodicalIF":1.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522766","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 neurosurgery without pediatric neurosurgeons: a comparison of outcomes of pediatric brain tumor resections in Pakistan with a national US surgical database.","authors":"Hunaina Abid, Yusra Imran, Humza Thobani, Saqib Kamran Bakhshi, Amna Minhas, Mohammad Osama Khan, Tanya Minasian, Saleem Islam, Faraz Ali Khan","doi":"10.1007/s00381-025-06775-8","DOIUrl":"https://doi.org/10.1007/s00381-025-06775-8","url":null,"abstract":"<p><strong>Purpose: </strong>There are currently no specialized pediatric neurosurgeons in Pakistan. The extent to which this impacts the outcomes of children undergoing surgery for neurological conditions in the country is unclear. We aimed to investigate whether outcomes of brain tumor resections in children at our high-volume center in Pakistan were comparable to those performed by pediatric neurosurgeons in a large, validated US surgical database.</p><p><strong>Methods: </strong>A multi-center collaborative collected clinical data on supratentorial and infratentorial craniotomy procedures (SC and IC, respectively) for malignant brain tumors in children < 18 years at a single center in Pakistan from 2015 to 2022. Similarly, the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2021 dataset was queried to extract a comparable cohort of patients. Rates of adverse outcomes and quality metrics were compared between the groups using appropriate statistical tests.</p><p><strong>Results: </strong>We collected data on 105 Pakistan patients and 570 NSQIP-P patients. Patient demographics were similar for both groups. A total of 350 and 325 children underwent SC and IC, respectively. Postoperatively, children in the Pakistan cohort had worse neurological outcomes, including higher rates of postoperative seizures (SC, p < 0.001; IC, p = 0.003) and focal neurological deficits (SC, p = 0.003; IC, p < 0.001). Furthermore, Pakistani children undergoing SC had higher rates of postoperative mortality (p = 0.002), surgical site infections (p = 0.015), and deep wound infections (p = 0.027), while those undergoing IC had higher rates of unplanned intubations (p < 0.001) and prolonged postoperative mechanical ventilation > 48 h (p = 0.004) compared to their US counterparts captured in NSQIP-P data.</p><p><strong>Conclusion: </strong>Despite the availability of neuroimaging, cancer therapeutics, and intensive care at our center, children undergoing brain tumor resections had worse outcomes than their US counterparts. There is likely a need for specialized pediatric neurosurgical health services to improve outcomes of children undergoing complex neurosurgical procedures in Pakistan.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"124"},"PeriodicalIF":1.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514837","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":"Flexion-extension cervical MRI imaging in pediatric patients with achondroplasia unsupervised by neurosurgery or radiology, is it safe?","authors":"Aseel Masarwy, Christopher Watterson, Alexander Tuchman, Moise Danielpour","doi":"10.1007/s00381-025-06777-6","DOIUrl":"10.1007/s00381-025-06777-6","url":null,"abstract":"<p><strong>Background and purpose: </strong>Achondroplasia, a common form of skeletal dysplasia, can be associated with cervical spine compression and cerebrospinal fluid (CSF) flow compromise, potentially leading to neurological complications. Accurate assessment of the cervical spine is essential for identifying children at increased risk of neurological injury. However, concerns regarding the safety of dynamic MRI under anesthesia in young children have limited its use. This study evaluates the safety of dynamic MRI under anesthesia in pediatric patients with achondroplasia, utilizing the largest dataset reported to date.</p><p><strong>Materials and methods: </strong>In this retrospective study, we reviewed the medical records of 81 patients with achondroplasia who underwent a total of 124 flexion-extension MRIs under anesthesia. All imaging procedures were performed by MR technologists and anesthesiologists without direct supervision by a neurosurgeon or radiologist. Data reviewed included anesthesia type, neurological examinations by a senior pediatric neurosurgeon before and after imaging, surgical intervention, follow-up MRIs, and the presence of CSF obstruction at the craniocervical junction.</p><p><strong>Results: </strong>A total of 81 patient charts were reviewed (mean age, 2.03 ± 2 years; age range, 1 month to 6 years). Of the 124 flexion-extension MRIs, 113 were performed under general anesthesia, and 11 under sedation alone. Foramen magnum stenosis with CSF flow compromise was documented in 38 cases (46%). No adverse events, neurological deficits, or anesthesia-related complications were documented. Neurological examinations conducted by the senior author, a pediatric neurosurgeon, before and after imaging remained stable across all cases.</p><p><strong>Conclusion: </strong>Flexion-extension MRI did not result in adverse outcomes in this cohort of pediatric patients with achondroplasia. While these findings support the dynamic MRI's safety in appropriate settings, further studies are needed to validate these results and explore its broader application.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"122"},"PeriodicalIF":1.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11861419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491011","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}