Child's Nervous System最新文献

{"title":"Performance of the neutrophil-lymphocyte ratio as a predictor of severity and mortality in children and adolescents with traumatic brain injury.","authors":"José Roberto Tude Melo, Melina Houlis Hao Masini, Jean Gonçalves de Oliveira, José Carlos Esteves Veiga","doi":"10.1007/s00381-024-06556-9","DOIUrl":"10.1007/s00381-024-06556-9","url":null,"abstract":"<p><strong>Purpose: </strong>An inflammatory cascade associated with the systemic neutrophil response can be triggered after traumatic brain injury (TBI), causing neuronal dysfunction, which is considered to be related to the prognosis of the victims. The scope of this research is to identify the performance of the neutrophil-lymphocyte ratio (NLR) as a predictor of prognosis considering TBI severity and death as outcomes in a group of pediatric patients.</p><p><strong>Methods: </strong>We retrospectively evaluated NLR through a consecutive review of the medical records (cross-sectional study) of children and adolescents aged < 17 years victims of TBI. To determine the highest NLR value identified as a predictor, different cutoff points were tested for each outcome. The cutoff points were defined based on the area under curve (AUC) of the receiver operating characteristic (ROC).</p><p><strong>Results: </strong>Among the 82 children with TBI included in the sample, the performance of AUC-ROC was 0.72 when evaluating NLR as a predictor of TBI severity, with NLR cutoff point of 3, and 0.76 when considering mortality as the outcome, with an increase in the cutoff point to 11.</p><p><strong>Conclusion: </strong>NLR can be considered a biomarker of brain injury in children and adolescent victims of TBI. Patients with NLR ≥ 3 had a fivefold higher probability of severe TBI and patients with NLR ≥ 11 experienced a ninefold higher risk of death.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4251-4257"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854990","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":"Carboplatin desensitization in the era of target therapies: still worthwhile?","authors":"Natália Dassi, Fernanda Sales da Cunha, Andrea Maria Cappellano, Chayanne Andrade de Araujo, Denise Neiva Santos de Aquino, Daniela Barbosa de Almeida, Nasjla Saba da Silva, Luis Felipe Chiaverini Ensina","doi":"10.1007/s00381-024-06564-9","DOIUrl":"10.1007/s00381-024-06564-9","url":null,"abstract":"<p><strong>Purpose: </strong>Unresectable pediatric low-grade gliomas (LGG) usually need adjuvant therapy, and carboplatin hypersensitivity reaction (HR) commonly leads to premature treatment cessation of a standard chemotherapy regimen. In the molecular era, advances in understanding tumor genetic characteristics allowed the development of targeted therapies for this group of tumors; however, cost-effectiveness assessment of treatments, especially in low-income countries, is crucial. The aim is to describe the results of carboplatin desensitization protocol in a single center in a middle-income country.</p><p><strong>Method: </strong>Prospective analysis of children with LGG submitted to carboplatin desensitization from December 2017 to June 2020 with follow-up until April 2024.</p><p><strong>Results: </strong>Nine patients were included. The mean age was 11 years. Five patients were male. Seven had optic pathway and two cervicomedullary location. Six had histologic diagnosis and four molecular analyses. The incidence of carboplatin reactions during the study period was 39.1%. Six patients underwent skin prick test, three with positive results. The first HR occurred, on average, around the 9th cycle of treatment. All patients had cutaneous symptoms, and five out of nine had anaphylaxis as the first reaction. 77.7% of the patients completed the protocol, and the clinical benefit rate (stable disease and partial response) was 88.8%. Six patients further required other lines of therapy. Monthly, the total cost for carboplatin was $409.09, and for target therapies (dabrafenib plus trametinib), $4929.28 to $5548.57.</p><p><strong>Conclusion: </strong>Our study presented an interesting and cost-effective option where desensitization allowed children with HR to be treated with first-line therapy, avoiding the discontinuation of an effective treatment.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4259-4264"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896938","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":"Symptomatic cerebral vasospasm after posterior fossa surgery in pediatric patients: single-center study and systematic literature review.","authors":"Arthur R Kurzbuch, Azizia Wahedi, Amedeo Calisto, Shailendra Magdum","doi":"10.1007/s00381-024-06630-2","DOIUrl":"10.1007/s00381-024-06630-2","url":null,"abstract":"<p><strong>Purpose: </strong>The most common cause of cerebral vasospasm is subarachnoid hemorrhage, less frequently it occurs after trauma, infection, and tumor resection. Vasospasm in children is rare and has not been systematically investigated in posterior fossa surgery.</p><p><strong>Methods: </strong>The authors undertook a single-center retrospective study of all the pediatric patients who underwent surgery on the posterior fossa and presented with postoperative symptomatic vasospasm in the period from January 2018 to February 2024. Subsequently, a systematic literature review in accordance with the PRISMA guidelines was performed in the PubMed and Scopus databases to identify the published papers on symptomatic vasospasm after posterior fossa surgery in children.</p><p><strong>Results: </strong>Of the 178 patients who underwent surgery on the posterior fossa, only one patient was diagnosed with symptomatic diffuse vasospasm on postoperative day 21. The systematic literature review provided further 9 children. The underlying pathology comprised 8 intra-axial lesions with 4 medulloblastomas, 1 schwannoma in the medulla oblongata, 1 pilocytic astrocytoma, 1 primitive neuroectodermal tumor, and 1 arteriovenous malformation. The extra-axial lesions were 1 hypoglossal schwannoma and 1 oculomotor nerve schwannoma.</p><p><strong>Conclusion: </strong>Iatrogenic symptomatic vasospasm after posterior fossa surgery in children is a rare complication with an outcome ranging from complete recovery to the death of the patient. It is important for all staff involved in the care of patients undergoing surgery on the posterior fossa to be aware of this rare postoperative complication. The small number of patients affected does not allow a substantiated conclusion to be drawn about predictive risk factors.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4211-4223"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342665","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":"The pivotal role of neurosurgeons in transitional care: A comprehensive tertiary healthcare institution's experience.","authors":"Zakir Chew, Huiling Linda Lim, Shakran Mahmood, Srujana Vedicherla, Miriam Santiago Kimpo, Hian Tat Ong, Vincent Dw Nga","doi":"10.1007/s00381-024-06638-8","DOIUrl":"10.1007/s00381-024-06638-8","url":null,"abstract":"<p><strong>Purpose: </strong>Transitional care (TC) is increasingly crucial, particularly in neurosurgery, where optimal follow-through of patients' care is paramount. Challenges of transition are exacerbated by the complexity of neurosurgical conditions, with pediatric and adult neurosurgery often managed separately by different attending neurosurgeons or in different institutions. While numerous models for transitioning have been proposed, several barriers persist, impeding successful transfer from pediatric to adult settings. Our review focuses on important roles neurosurgeons can play in facilitating successful transition, exploring some existing TC models, with emphasis on the benefits of maintaining a single provider.</p><p><strong>Methods: </strong>Clinic visits data between 2019 to 2023 of patients between the ages of 16 to 26 was compiled retrospectively. Successful transition was defined as continued follow-up moving from pediatric to adulthood with lost to follow-up being that of unsuccessful transition. Age, diagnosis and whether patients were successfully transitioned or lost to follow-up were documented.</p><p><strong>Results: </strong>1829 neurosurgical patients between the ages of 16 to 26 were identified over 5 years. A snapshot review identified 78 adolescent patients deemed to require follow-up into adulthood. 13 patients had epilepsy, 32 central nervous system (CNS) tumors, 17 congenital conditions, 14 neurovascular, and 2 patients had idiopathic intracranial hypertension. All 78 were noted to have successfully transited into their adulthood (age 21 and beyond). Having the same providers; having pediatric and adult neurosurgery within the same institution, was the single most important factor in facilitating successful transition.</p><p><strong>Conclusion: </strong>Neurosurgeons in institutions, particularly those with experience and competencies in both pediatric and adult care, can serve as crucial anchors during the transitional period. At our institution, the implementation of this continuity of care model has demonstrated remarkable success. Institutions with both pediatric and adult services would be uniquely positioned to develop and implement effective transitional care.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4271-4278"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379072","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":"A patient with heterochronous double primary tumor of basal ganglia germ cell tumors followed by diffuse hemispheric glioma: a case report.","authors":"Ziting He, Xian Jiang, Zhouyu Wang, Ningning Luo, Ye Song","doi":"10.1007/s00381-024-06644-w","DOIUrl":"10.1007/s00381-024-06644-w","url":null,"abstract":"<p><strong>Background: </strong>Basal ganglia germ cell tumor (BGGCT) is a rare central nervous system (CNS) tumor. Diffuse hemispheric gliomas, H3 G34-mutant (DHGs) is an invasive glioma involving the cerebral hemispheres. The diagnosis of DHGs depends on the integration of histopathology and molecular pathology.</p><p><strong>Case report: </strong>We reported a patient with an initial diagnosis of BGGCT that was sensitive to subsequent chemoradiotherapy. Unfortunately, a second high-grade glioma was found on magnetic resonance imaging (MRI) six years later. Subsequently, the tumor was completely removed after surgery and the following histopathology plus next generation sequencing (NGS) testing confirmed the diagnosis of DHGs. Interestingly, we found a germline likely pathogenic variant in FANCA. After surgery, the patient received Stupp regimen. The patient had a relapse 13 months after the Stupp regimen and was doing well after surgery.</p><p><strong>Conclusions: </strong>This is the first report of a patient with heterochronous double primary tumor of BGGCT followed by DHGs.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4315-4321"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521119","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":"Endoscopic endonasal resection of olfactory tract hamartoma for pediatric epilepsy.","authors":"Adam J Kundishora, Benjamin C Reeves, David K Lerner, Phillip B Storm, Marisa S Prelack, James N Palmer, Nithin D Adappa, Benjamin C Kennedy","doi":"10.1007/s00381-024-06595-2","DOIUrl":"10.1007/s00381-024-06595-2","url":null,"abstract":"<p><strong>Background: </strong>Non-hypothalamic glioneural hamartomas are rare entities known to cause medically refractory epilepsy. Olfactory bulb hamartomas, in particular, are exceptionally rare.</p><p><strong>Methods: </strong>We describe a case of an olfactory bulb hamartoma that was surgically resected at our institution. We also performed a literature review of all glioneural hamartomas and discuss the clinical presentation, diagnosis, and management of these lesions.</p><p><strong>Results: </strong>Herein, we present the unusual case of a typically developing 17-year-old boy with a near life-long history of drug-resistant epilepsy, found to have a 0.8 × 1.0 cm right olfactory bulb hamartoma. Endoscopic endonasal trans-cribriform resection of the lesion led to seizure freedom in the 6-month follow-up period (Engel class 1 outcome). Comprehensive literature review revealed only one other sporadic case, which was also successfully treated with total surgical resection.</p><p><strong>Conclusions: </strong>Our case of an olfactory bulb hamartoma adds to the limited literature currently available, illustrating key clinical characteristics of these exceedingly rare lesions and outlining an effective, minimally invasive, and low-morbidity treatment strategy.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"3915-3921"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104825","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":"Life-threatening presentation of an acute cerebellar ischemic stroke secondary to a protein C deficiency.","authors":"Houda Ajmi, Nada Oueslati, Mohamed Chabaane, Nadia Arifa","doi":"10.1007/s00381-024-06640-0","DOIUrl":"10.1007/s00381-024-06640-0","url":null,"abstract":"<p><p>Acute cerebellar ischemic stroke is a rare disease in children. Typically, patients present with ataxia and cranial nerve palsy. Rarely, some patients show a severe intracranial hypertension syndrome with a life-threatening clinical presentation. We report a case of a 2-year-old male child who was admitted for deterioration of his consciousness level and vomiting. Cerebral imaging revealed a right cerebellar and brainstem infarction with an obstructive hydrocephalus and a tonsillar herniation. Angiography identified an occlusion of the right anterior inferior cerebellar artery. The child was referred to a neurosurgeon for the treatment of acute hydrocephalus and posterior fossa craniectomy. Etiological investigations revealed a protein C deficiency. Initially, the patient was maintained under fluid restriction and received mannitol several times as he had clinical and radiological signs of intracranial hypertension. He was also kept on mechanical ventilation and monitored. However, the evolution was complicated by the occurrence of a thrombosis of the vena cava and the renal vein.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4381-4384"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371121","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":"Chondroblastoma of the occipital bone with aneurysmal bone cyst: A rare case report.","authors":"Dexi Bi, Zihao Wang, Zhibo Dai, Shichun Yang, Gao Zeng, Ligang Wang","doi":"10.1007/s00381-024-06632-0","DOIUrl":"10.1007/s00381-024-06632-0","url":null,"abstract":"<p><strong>Background: </strong>Chondroblastoma is a rare, benign bone tumor originating from immature chondrocytes, typically found in the epiphyseal plates of long bones. Its occurrence in the skull, particularly the occipital bone, is extremely rare.</p><p><strong>Case presentation: </strong>We report a 10-year-old girl presenting with paroxysmal dizziness, occipital pain, and a palpable mass. Imaging studies revealed an osteolytic lesion in the occipital bone with a multiloculated appearance, indicating a concomitant aneurysmal bone cyst. The patient underwent craniotomy with complete tumor excision. Postoperative follow-up showed no neurological deficits or complications and MRI confirmed no recurrence.</p><p><strong>Conclusion: </strong>This case highlights the rare presentation of occipital bone chondroblastoma and emphasizes the importance of early surgical intervention for positive outcomes in pediatric patients.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4323-4327"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582356","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":"Endoscopic third ventriculostomy assisted by augmented reality.","authors":"Kiefer Forseth, Sabrina Chriqui, Michael Levy","doi":"10.1007/s00381-024-06606-2","DOIUrl":"10.1007/s00381-024-06606-2","url":null,"abstract":"<p><p>Augmented reality (AR) technology has witnessed remarkable advancements in recent years, revolutionizing various fields, including medicine and surgery. In neurosurgery, AR holds immense promise for improving the accuracy, efficiency, and safety of various procedures. Augmented reality allows a user to visualize digital information such as 3D models, superimposed on their real-world field of view. Lately, there has been increased use of this technology for various procedures such as tumor resection, ventriculostomy, and pedicle screw insertion. Despite this, integration of AR into the field of neurosurgery is still in its infancy. As such, it is imperative that physicians continue to explore and document new clinical uses of AR. In this report, we describe the novel integration of AR into an endoscopic third ventriculostomy (ETV) case. ETV is a minimally invasive technique used to treat hydrocephalus, which involves creating a new pathway for cerebrospinal fluid (CSF) drainage within the brain's ventricular system. The integration of AR into ETV procedures offers unprecedented opportunities to enhance surgical visualization, navigation, and decision-making, ultimately leading to improved patient outcomes. Traditionally, neurosurgeons rely on pre-operative imaging, intraoperative neuronavigation systems, and their anatomical knowledge to perform an ETV. However, the complex neuroanatomy and variability among patients pose challenges to accurate navigation and spatial orientation prior to and during surgery. AR technology addresses these challenges by overlaying digital information-such as three-dimensional models, anatomical landmarks, and surgical trajectories-onto the surgeon's view of the patient in real-time.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4385-4388"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371120","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 hemispherotomy on quality of life and burden of caregivers in children and adolescents: a retrospective observational study.","authors":"Bruna Frizzera Daniel, Suenia Timotheo Figueiredo Leal, Américo Ceiki Sakamoto, Ursula Thomé, Hélio Rubens Machado, Marcelo Volpon Santos, Antônio Carlos Dos Santos, Ana Paula Andrade Hamad","doi":"10.1007/s00381-024-06593-4","DOIUrl":"10.1007/s00381-024-06593-4","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate QOL and caregiver burden of children and teenagers submitted to hemispherotomy for pharmacoresistant epilepsy, by comparing pre and post-surgical intervention data.</p><p><strong>Materials and methods: </strong>Retrospective analysis of pediatric patients submitted to surgical hemispherotomy before intervention (preOP) and their follow-up at 6 months (6 M PO) and 2 years (2Y PO) after surgery. QOL was evaluated through the Quality of Life in Childhood Epilepsy (QVCE-50) questionnaire and caregiver burden, through the Zarit Burden Interview (ZBI) tool.</p><p><strong>Results: </strong>Twenty-two patients were included in the study. Sixteen patients (72%) were classified as Engel I at 2Y PO follow-up. QVCE-50 scale showed improvement of total QOL at 2Y PO. In relation to QVCE-50-specific domains, there was an improvement in the physical domain and in the cognitive-education a decrease in psychological and a stabilization in social/familiar domain scores. The majority of caregivers classified their burden as mild to moderate, with no PO improvement.</p><p><strong>Conclusions: </strong>Hemispherotomy represents an effective seizure control treatment, as well as it contributes to improvement of QOL, particularly in the physical domain and in spite of children's physical and cognitive limitations. However, no improvement in caregiver burden was observed, probably due to the chronic condition of these patients, which might be worsened by social issues.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":" ","pages":"4161-4168"},"PeriodicalIF":1.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153234","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}