Child's Nervous System最新文献

{"title":"Mechanisms of hydrocephalus after intraventricular haemorrhage: a review.","authors":"Wenchao Wu, Qingsong Li","doi":"10.1007/s00381-024-06711-2","DOIUrl":"10.1007/s00381-024-06711-2","url":null,"abstract":"<p><p>Intraventricular haemorrhage (IVH) is bleeding within the ventricular system, which in adults is usually mainly secondary to cerebral haemorrhage and subarachnoid haemorrhage. Hydrocephalus is one of the most common complications of intraventricular haemorrhage, which is characterised by an increase in intracranial pressure due to an increased accumulation of cerebrospinal fluid within the ventricular system, and is closely related to the patient's prognosis. Surgical methods such as shunt surgery have been used to treat secondary hydrocephalus in recent years and have been effective in improving the survival and prognosis of patients with hydrocephalus. However, complications such as shunt blockage and intracranial infection are often faced after surgery. Moreover, little is known about the mechanism of hydrocephalus secondary to intraventricular haemorrhage. This review discusses the mechanisms regarding the occurrence of secondary hydrocephalus after intraventricular haemorrhage in adults in terms of blood clot obstruction, altered cerebrospinal fluid dynamics, inflammation, and blood composition.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"49"},"PeriodicalIF":1.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827463","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":"Subarachnoid puncture via the anterior fontanelle with intrathecal vancomycin for refractory purulent meningitis: a pediatric case report.","authors":"Yan Li, Xinghui Yang, Yongping Xie, Guolan Huang, Xiaohui Fang, Lisu Huang","doi":"10.1007/s00381-024-06668-2","DOIUrl":"https://doi.org/10.1007/s00381-024-06668-2","url":null,"abstract":"<p><p>This case report presents a novel treatment approach for refractory purulent meningitis in a 1-month-old infant caused by penicillin-sensitive group B Streptococcus. Despite initial treatment with intravenous antibiotics, including penicillin and vancomycin, the infant experienced persistent symptoms and bilateral subdural effusions. Conventional therapies failed to resolve these issues, leading to the use of a new technique: subarachnoid puncture via the anterior fontanelle combined with intrathecal vancomycin administration. This minimally invasive procedure allowed for targeted antibiotic delivery, significantly reducing subdural effusions and improving cerebrospinal fluid parameters. The infant showed substantial clinical improvement and was discharged after 68 days with no complications during a 3-month follow-up. This approach offers a promising alternative to more invasive treatments such as craniotomy or subdural external drainage, though further research is needed to confirm its efficacy and safety in broader clinical contexts.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"50"},"PeriodicalIF":1.3,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827589","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":"Relationship between the volume of ventricles, brain parenchyma and neurocognition in children after hydrocephalus treatment.","authors":"Qinzhu Yang, Kun Huang, Gongwei Zhang, Xianjun Li, Yi Gao, Cailei Zhao","doi":"10.1007/s00381-024-06674-4","DOIUrl":"https://doi.org/10.1007/s00381-024-06674-4","url":null,"abstract":"<p><strong>Purpose: </strong>The treatment of hydrocephalus aims to facilitate optimal brain development and improve the overall condition of patients. To further evaluate the postoperative recovery process in individuals undergoing hydrocephalus treatment, we investigated the interplay between brain parenchymal and ventricular volumes, alongside neurocognitive parameters.</p><p><strong>Methods: </strong>In this study, 52 children under the age of 10 undergoing hydrocephalus treatment were included. All participants underwent T1w MR images and Gesell developmental schedule assessments. Initially, we investigated the correlation between patients' brain development and motor assessment scores. This analysis explored the association between cognition and both brain parenchymal and ventricular sizes. Furthermore, we investigated these relationships in the contexts of communicating and obstructive hydrocephalus. Finally, to quantitatively evaluate patients' brain development using more detailed texture information from imaging, we employed three different classification models for prediction. To compare their performances, we assessed these classification frameworks using a fourfold cross-validation method.</p><p><strong>Results: </strong>Leveraging the deep learning framework, both pre- and postoperative T1w MR images have demonstrated a significant predictive value in estimating patients' brain development, with the accuracy of 0.808 for postoperative images. In the statistical analysis, we identified a correlation between developmental assessments in children with communicating hydrocephalus and postoperative brain parenchymal volume.</p><p><strong>Conclusion: </strong>The findings indicate that postoperative evaluation of brain development is more closely associated with brain parenchymal and ventricular volumes than the Evans index. Additionally, deep learning frameworks exhibit promising potential as effective tools for accurately predicting patients' postoperative recovery.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"48"},"PeriodicalIF":1.3,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824017","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 outcomes of tethered cord syndrome in patients with normal conus medullaris and filum terminale without urologic symptoms.","authors":"Alper Tabanli, Emrah Akcay, Hakan Yilmaz, Seymen Ozdemir, Mesut Mete, Mehmet Selcuki","doi":"10.1007/s00381-024-06713-0","DOIUrl":"https://doi.org/10.1007/s00381-024-06713-0","url":null,"abstract":"<p><strong>Purpose: </strong>Tethered cord syndrome (TCS) typically presents with urologic symptoms and abnormal imaging findings. However, some patients present with normal conus medullaris level and filum terminale appearance on MRI. This research seeks to assess the intended surgical results in this particular group of TCS patients who do not present with urologic complaints, under the premise that the surgical approach goes a long way in preventing the onset of urologic abnormalities.</p><p><strong>Methods: </strong>This retrospective study included 59 operated patients with tethered cord syndrome who had a normal level terminating conus medullaris and a normal looking filum terminale without urologic symptoms. Of these patients, 38 were female and 21 were male. All patients underwent somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging (MRI). The surgical technique used was flavotomy, which involves cutting the filum terminale without performing a laminectomy.</p><p><strong>Results: </strong>The study population had a mean age of 22.5 years (SD = 13.2). During the mean postoperative follow-up period of 2.5 years, none of the patients developed urinary incontinence. Preoperative SSEP abnormalities included conduction block in 39 patients (66.1%), low amplitude in 12 patients (20.3%), and delayed N22 wave latency in 8 patients (13.5%). The surgical procedures were completed without morbidity or mortality, and all patients showed significant postoperative improvement in SSEP parameters.</p><p><strong>Conclusion: </strong>Our results indicate that even though the filum terminale might have a normal looking MRI, TCS can also occur due to some potential microscopic or structural abnormality. The study proves SSEP to be useful in TCS diagnosis and it also proposes that if surgery is done early before any urologic complaints arise, chances of their onset will be minimized. Such findings support the view that surgical measures should be entertained in symptomatic patients with abnormal SSEP but normal MRI.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"47"},"PeriodicalIF":1.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817428","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":"Primary Ewing's Sarcoma affecting the Central Nervous System: A single-center experience and Narrative review.","authors":"Sivaraman Kumarasamy, Kanwaljeet Garg, Pankaj Kumar Singh, Amandeep Kumar, Rajeev Sharma, Shweta Kedia, Shashwat Mishra, Sachin Borkar, Dattaraj Parmanad Sawarkar, Satish Kumar Verma, Subhash Gupta, Gurudutta Satyarthee, Ajay Garg, Meher C Sharma, Rajinder Kumar, Manmohan Singh, Ashish Suri, Poodipedi Sarat Chandra, Shashank Sharad Kale","doi":"10.1007/s00381-024-06707-y","DOIUrl":"10.1007/s00381-024-06707-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;Ewing's sarcoma (EWS) is a malignant round-cell tumor arising from the bone and soft tissue. It is a disease of children and young adults. EWS affecting the central nervous system (cranial and spinal column) is relatively rare with an annual incidence of approximately one case per million in the Western population. Due to their rarity, very few studies are available in the literature. We present our experience of managing 21 such cases, highlighting their clinical, and radiological findings, treatment strategy, and surgical outcomes in patients with primary EWS affecting the central nervous system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We retrospectively collected hospital records of patients with primary EWS affecting the CNS (cranial and spinal column), who had been surgically treated in our Neuroscience Center between 2015 and 2023. Patients' demographics, presentation, radiological findings, treatment strategy including surgery and biopsy followed by adjuvant therapy, and outcome at discharge, and the latest follow-up were analyzed from our database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were sixteen male and five female patients with a mean age of 18.22 ± 12.73 years (ranging from 6 months to 59 years). The commonest presentation was headache and vomiting in cranial lesions (5/13 patients, 38.46%), and back pain in spinal lesions (4/8 patients, 50%). The site of lesions was cranial in thirteen patients (61.9%) and spinal column in eight patients (38.1%). The commonest site was the frontal region in the cranial group (6 patients, 46.15%) and the lumbar region in the spinal group (4 patients, 50%). All patients underwent surgical intervention [tumor resection (18) and biopsy (3)]. Tumor resection was achieved in 18 patients (85.71%). The extent of resection was gross-total excision in 9 patients (42.86%), near-total excision in 5 patients (23.8%), and tumor decompression in 4 patients (19%). Four patients underwent spinal instrumentation. Fifteen patients (71.42%) received multiagent chemo-radiotherapy according to institute protocol. Five patients (23.8%) with poor KPS expired within 6 months of surgery and could not receive adjuvant therapy. Two patients (9.52%) improved symptomatically, and nine patients (42.86%) remained asymptomatic at a mean follow-up of 25.1 ± 29 months. One patient (4.76%) after receiving 2 cycles of adjuvant therapy had initial improvement but expired later due to disease progression. Four patients after adjuvant chemo-radiotherapy (19%) expired due to systemic spread.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Primary EWS affecting the central nervous system is a rare variety. A detailed radiological assessment can aid in adequate planning for safe maximal resection. Timely tissue diagnosis is essential for initiating early treatment. Radical excision followed by adjuvant therapy offers a favorable outcome. Postoperative adjuvant chemo-radiotherapy aids in optimal diseas","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"46"},"PeriodicalIF":1.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817424","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 neonatal brachial plexus palsy: A cohort study using the Pediatric Health Information System (PHIS) database.","authors":"Molly F MacIsaac, Joshua M Wright, Nicole K Le, Lee G Phillips, Allan J Belzberg, S Alex Rottgers, Jordan N Halsey","doi":"10.1007/s00381-024-06709-w","DOIUrl":"https://doi.org/10.1007/s00381-024-06709-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to explore demographic disparities, regional and institutional variations, surgical timing, narcotic use, and management trends in neonatal brachial plexus palsy (NBPP) patients due to limited published literature.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database of NBPP patients who underwent surgery within the first 2 years of life. Patients were stratified into two groups based on age at surgery: ≤ 8 months and > 8 months.</p><p><strong>Results: </strong>A total of 788 patients were identified, with a mean surgical age of 8.1 months. Black patients were disproportionately affected (29%), over twice their national birth rate (14%). Narcotic use was more common in younger patients (63% vs. 53%, p = 0.003), as well as in those treated in the West (71%, p = 0.001) and Northeast (73%, p = 0.004), and by plastic (74%, p < 0.0001) or orthopedic surgeons (69%, p = 0.002). Patients prescribed narcotics had longer hospital stays (1.7 vs. 1.2 days, p < 0.0001) and higher complication rates (7.9% vs. 3.1%, p = 0.009). Narcotic use decreased significantly over the study period (p = 0.002). Short-term outcomes, including complication and readmission rates, were similar across the three primary surgical specialties (plastic, orthopedic, and neurosurgery). High-volume centers had lower complication rates (1.5% vs. 5.4%, p = 0.002) and ICU admissions (5.8% vs. 18%, p < 0.0001) compared to medium-volume centers.</p><p><strong>Conclusion: </strong>While narcotic use was associated with longer stays and complications, short-term outcomes were consistent across specialties. Standardized care protocols may help improve patient outcomes.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"45"},"PeriodicalIF":1.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812074","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":"Hyperostotic meningiomas in children. A case-based update.","authors":"Fulvio Grilli, Hamzah Youssef Smaili, Federico Bianchi, Paolo Frassanito, Gianpiero Tamburrini, Luca Massimi","doi":"10.1007/s00381-024-06708-x","DOIUrl":"https://doi.org/10.1007/s00381-024-06708-x","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are rare tumors in children compared with adults. Their main peculiarities are the frequent convexity or intraventricular location, the common association with neurofibromatosis-2 (NF-2) and the relatively high rate of aggressive and/or hyperostotic variants. Hyperostosis may complicate the surgical management. The goal of this paper is to provide an update on the main characteristics and the management of hyperostotic meningiomas.</p><p><strong>Case description: </strong>A 7-year-old girl was admitted to our department because of a long-lasting history of left frontal skull bulging. Neuroimaging examinations revealed a huge hyperostotic meningioma with bony invasion and infiltration of the superior sagittal sinus. Genetic tests were positive for NF-2. The tumor (atypical meningioma) was gross totally resected. During the same operation, a custom-made cranioplasty was realized with the help of a frame-based craniectomy. The patient is asymptomatic and under oncological follow-up.</p><p><strong>Discussion and conclusion: </strong>Although generally rare, hyperostotic meningiomas are relatively common in children and clinically demanding because of their large size, the possible aggressive behavior and the need of a cranioplasty as additional surgical step. Therefore, a careful preoperative surgical planning is required, taking into account that the extent of surgical resection is an important prognostic factor. The long-term outcome is good.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"43"},"PeriodicalIF":1.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806168","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":"Progressive spontaneous regression of Chiari type I malformation associated with syringomyelia.","authors":"Diogo Goulart Corrêa, Luiz Celso Hygino da Cruz","doi":"10.1007/s00381-024-06717-w","DOIUrl":"https://doi.org/10.1007/s00381-024-06717-w","url":null,"abstract":"","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"44"},"PeriodicalIF":1.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806171","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":"Does machine learning improve prediction accuracy of the Endoscopic Third Ventriculostomy Success Score? A contemporary Hydrocephalus Clinical Research Network cohort study.","authors":"Armaan K Malhotra, Abhaya V Kulkarni, Leonard H Verhey, Ron W Reeder, Jay Riva-Cambrin, Hailey Jensen, Ian F Pollack, Michael McDowell, Brandon G Rocque, Mandeep S Tamber, Patrick J McDonald, Mark D Krieger, Jonathan A Pindrik, Albert M Isaacs, Jason S Hauptman, Samuel R Browd, William E Whitehead, Eric M Jackson, John C Wellons, Todd C Hankinson, Jason Chu, David D Limbrick, Jennifer M Strahle, John R W Kestle","doi":"10.1007/s00381-024-06667-3","DOIUrl":"https://doi.org/10.1007/s00381-024-06667-3","url":null,"abstract":"<p><strong>Purpose: </strong>This Hydrocephalus Clinical Research Network (HCRN) study had two aims: (1) to compare the predictive performance of the original ETV Success Score (ETVSS) using logistic regression modeling with other newer machine learning models and (2) to assess whether inclusion of imaging variables improves prediction performance using machine learning models.</p><p><strong>Methods: </strong>We identified children undergoing first-time ETV for hydrocephalus that were enrolled prospectively at HCRN sites between 200 and 2020. The primary outcome was ETV success 6 months after index surgery. The cohort was randomly divided into training (70%) and testing (30%) datasets. The classic ETVSS variables were used for logistic regression and machine learning models. Predictive performance of each model was evaluated on the testing dataset using area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>There were 752 patients that underwent first time ETV, of which 185 patients (24.6%) experienced ETV failure within 6 months. For aim 1, using the classic ETVSS variables, machine learning models did not outperform logistic regression with AUROC 0.60 (95% CI: 0.52-0.69) for Naïve Bayes (highest machine learning model performance) and 0.68 (95% CI: 0.60-0.76) for logistic regression. After inclusion of imaging features (aim 2), machine learning model prediction improved but remained no better than the above logistic regression with the highest AUROC of 0.67 (95% CI: 0.59-0.75) attained using Naïve Bayes architecture compared to 0.68 (95% CI: 0.59-0.76) for logistic regression.</p><p><strong>Conclusions: </strong>This contemporary multicenter observational cohort study demonstrated that machine learning modeling strategies did not improve performance of the ETVSS model over logistic regression.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"42"},"PeriodicalIF":1.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806164","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":"Technique and protocol for bedside neuroendoscopic lavage for post-hemorrhagic hydrocephalus: technical note.","authors":"Tracy M Flanders, Misun Hwang, Nickolas W Julian, Christina E Sarris, John J Flibotte, Sara B DeMauro, David A Munson, Lauren M Heimall, Yong C Collins, Jena M Bamberski, Meghan A Sturak, Eo V Trueblood, Gregory G Heuer","doi":"10.1007/s00381-024-06697-x","DOIUrl":"10.1007/s00381-024-06697-x","url":null,"abstract":"<p><p>Neuroendoscopic lavage (NEL) is a time-limited neurosurgical intervention that removes intraventricular blood in post-hemorrhagic hydrocephalus (PHH). Preterm neonates are medically complex and fragile, often precluding neurosurgical procedures due to concerns such as extubation risk and body temperature instability during even routine clinical care. In addition, transportation to the operating room can be difficult and risky. Given these factors, our institution developed and implemented a bedside technique to facilitate safe and timely NEL in the neonatal intensive care unit for the treatment of PHH.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"39"},"PeriodicalIF":1.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794535","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}