Journal of neurosurgery. Pediatrics最新文献

Objective: Stereo-electroencephalography (sEEG) is a minimally invasive technique for intracranial monitoring that was traditionally reserved for adults but is increasingly used in very young pediatric patients with drug-resistant epilepsy. The aim of this study was to evaluate its safety, feasibility, and technical considerations in pediatric patients younger than 3 years.

Methods: The authors reviewed the records of 21 children younger than 3 years who underwent sEEG monitoring at Lucile Packard Children's Hospital between February 2013 and March 2025. Data were collected from patients' clinical records and operative reports. Skull thickness was measured at the thinnest point under electrodes. Primary outcome variables were 1) sEEG-related complications, and 2) electrode placement entry point error (EPE) and target point error (TPE).

Results: Twenty-one patients (67% male) had a mean ± SE age at seizure onset of 0.5 ± 0.5 years (range birth-1.6 years). Patients underwent 23 sEEG surgeries at a mean age of 2.2 ± 0.1 years (range 0.9-2.7 years). The Mayfield headframe with the Infinity Support System was used in 65% of cases. Overall, a mean of 19 ± 1 (range 9-27) depth electrodes were placed per patient. In total, 443 electrodes were placed, most often in the frontal (189 electrodes, 43%) and temporal (121 electrodes, 27%) regions. A total of 440 bolts were used, and the most common sizes were 20 mm (68%) and 13 mm (18%); 3 electrodes were placed without bolts. The mean skull thickness at the thinnest point of electrode placement was 2.0 ± 0.1 mm (range 1.5-3.2 mm). For 417 electrodes available for analysis, the mean EPE was 1.9 ± 0.1 mm, and the mean TPE was 2.8 ± 0.1 mm. Aside from a CSF leak from a bolt in 1 patient, there were no complications. The most common procedures included open resection (61% of sEEG cases) and laser ablation (30%). Procedures were performed at a mean of 43 ± 11 days (range 0-150 days) after sEEG removal, with a mean patient age of 2.3 ± 0.1 years (range 1.2-2.9 years).

Conclusions: This study supports the safety and feasibility of sEEG in children younger than 3 years, even in those with a skull thickness < 2 mm. Moreover, the authors report the youngest patient in the literature to have undergone sEEG at 11 months, without complications. The minimum skull thickness in which an electrode was successfully secured with a bolt was 1.5 mm. With appropriate technical adaptations, sEEG can be accurately performed in children younger than 3 years.

Objective: Pediatric movement disorders (PMDs) frequently require escalating neurosurgical therapies. Institutional studies describe local preintervention evaluation for selected PMDs; however, no international consensus guidelines exist. The authors aimed to review preintervention screening for PMDs and present a suggested preintervention framework for children with PMDs who might benefit from neurosurgery.

Methods: A scoping review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines adapted for scoping reviews (PRISMA-ScR) and the JBI scoping methodology to compile information about the preoperative evaluation of PMDs across various institutions. Data were synthesized and a preintervention framework was developed.

Results: Twenty-one studies were included. Presurgical evaluations included multidisciplinary evaluation, imaging, physical therapy, occupational therapy, gait analysis, nutritional analysis, and genetic analysis. These data were used to create presurgical algorithms for pediatric hypertonia defined by dystonia, spasticity, or mixed hypertonia. Each diagnosis-specific algorithm guides the clinician through the recommended evaluation and toward the appropriate neurosurgery.

Conclusions: An evidence-based, structured, diagnosis-related presurgical algorithm for PMDs could mirror existing approaches for medically refractory epilepsy and improve patient care via standardization of indications, workup, and recommendations. This scoping review identifies gaps in all major aspects regarding the presurgical workup of PMDs and suggested surgical plans.

Objective: The association between moyamoya disease (MMD) and hypertension has been studied as hospital-based case series without comparison to the general population. The aim of this study was to compare the prevalence and incidence of hypertension between pediatric patients with MMD and the general pediatric population.

Methods: Data from the South Korea National Health Insurance Service was used to compare hypertension prevalence and incidence between pediatric patients with MMD (2008-2019) and the general pediatric population (2010). MMD was defined using ICD-10 code I67.5 and the Rare and Intractable Disease code V128. Hypertension was identified by ICD-10 codes I10-I15 alongside antihypertensive medication claims. Prevalence and incidence rates were calculated for each year and age group (1-4, 5-9, 10-14, and 15-19 years). Indirect standardization was used to calculate prevalence and incidence rate ratios between the pediatric MMD cohort and the general population.

Results: The study included 3645 pediatric patients (2041 female, mean age 11.26 years) with MMD. Compared with the general pediatric population, there was a higher proportion of patients in the 5-14 years age range and more females in the MMD cohort. Chronic kidney disease, diabetes, renal artery stenosis, hyperthyroidism, and lupus were more prevalent comorbidities in patients with MMD. Hypertension prevalence and incidence were consistently higher in patients with MMD across all age groups. The standardized prevalence ratio was 43.79 (95% CI 40.56-47.01), indicating that patients with MMD had nearly 44 times higher prevalence of hypertension than expected. The standardized incidence ratio was 31.33 (95% CI 27.39-35.27), indicating that patients with MMD had approximately 31 times higher incidence of hypertension than expected.

Conclusions: Pediatric patients with MMD in the Korean population have a significantly higher hypertension burden and risk, emphasizing the need for prioritized hypertension management.

Objective: By implementing a new, real-time reporting surveillance system to capture patients born in an extensive regional healthcare system, the authors evaluated the incidence of brachial plexus birth injury (BPBI). They hypothesized that the true incidence of BPBI is higher than previously reported.

Methods: A prospective surveillance system was established in obstetric units and affiliated tertiary-level neonatal ICUs (NICUs) at 2 sites within the authors' healthcare system to ensure the capture of every BPBI. If the infant was born at either site, this reporting system was used so that the patient underwent evaluation by a brachial plexus surgeon at birth and allowed for continuous follow-up by a multidisciplinary brachial plexus team to prevent losses to follow-up.

Results: A total of 392 patients were captured by the reporting system between November 2021 and November 2024. After analysis of the flagged patients, 236 (60.2%) patients had isolated shoulder dystocia; 108 (27.5%) had simultaneous shoulder dystocia and BPBI; 18 (4.6%) had BPBI alone; 11 (2.8%) had shoulder dystocia and a fracture; 10 (2.5%) had BPBI, shoulder dystocia, and a fracture; 3 (0.8%) had isolated humeral or clavicular fracture; 3 (0.8%) had BPBI and a fracture; and 3 (0.8%) had none of the above. Three patients were excluded from analysis due to loss to follow-up. Based on the 9776 live births at the 2 sites during the study period, the incidence of patients diagnosed with a BPBI at birth (n = 142) was calculated to be 14.5 per 1000 live births; 35 patients exhibited persistent BPBI symptoms beyond 2 months of age, resulting in an incidence of 3.6 per 1000 live births for persistent BPBI.

Conclusions: This surveillance system more precisely identifies the incidence of BPBI than previously reported. It reveals the common frequency with which children encounter neuropraxia at birth. This study highlights the need for multidisciplinary institutional implementation of surveillance mechanisms to properly capture each BPBI for appropriate and timely intervention.

Objective: Limited data exist regarding the outcomes of early decompressive craniectomy (DC) in pediatric patients who have sustained severe traumatic brain injury (TBI). In this study, using data from the Approaches and Decisions in Acute Pediatric TBI Trial (ADAPT), the authors' primary hypothesis was that there was no significant difference in long-term outcomes in children who underwent early versus late DC following severe TBI.

Methods: All pediatric patients with severe TBI who underwent DC within the first 7 days of their ICU stay were included in this study. Early DC was defined as a DC performed within 24 hours of admission. Late DC was defined as DC performed after 24 hours. A propensity score-matching methodology was used to analyze the results.

Results: Of the 1000 enrolled patients in the ADAPT, 273 patients qualified for this study. Propensity score matching created 44 pairs of patients. Pair-matched analysis showed no significant difference in in-hospital mortality (5 [11.4%] vs 6 [13.6%], p > 0.99), 30-day mortality (4 [9.1%] vs 5 [11.4%], p > 0.99), and 60-day mortality (6 [13.6%] vs 5 [11.4%], p > 0.99) between the early and the late groups. The 6-month Glasgow Outcome Scale-Extended (GOS-E) score (favorable scores 1-4: 14 [42.4%] vs 10 [27.8%], p = 0.306) between the groups was similar. There were no significant differences identified between the groups regarding the ICU stay (median [95% CI] 15 [13-21] vs 15 [13-22] days, p = 0.558). There was a significant difference between early and late DC in hospital length of stay (median [95% CI] 24 [18-30] vs 31 [19-39] days, p = 0.049).

Conclusions: Early DC did not show any significant long-term benefit in terms of mortality or GOS-E score but resulted in a shorter hospital length of stay.

Objective: Cerebral cavernous malformations (CCMs) are groups of blood vessels that develop abnormally in both the brain and/or spinal cord. Currently, MRI and/or CT are the primary methods for assessing CCMs. Plasma-based biomarkers could serve as a complement to standard imaging techniques by providing a quantitative and molecular-based technique to detect disease at lower cost. Therefore, the authors evaluated cell division cycle 42 binding protein beta (CDC42BPB) as a potential novel plasma biomarker for CCMs.

Methods: Plasma samples were obtained from patients with pathological analysis-confirmed CCM (n = 10, age 1-16 years) and compared to controls (n = 24, age 1-19 years). The protein levels were measured using the Olink Proximity Extension Assay. Findings were confirmed with ELISA. CDC42BPB expression was further analyzed with Western blot and immunohistochemistry analysis in patient-derived primary cells and CCM tissues, respectively.

Results: CCM patients exhibited significantly higher CDC42BPB plasma levels compared to controls (approximately 6-fold greater expression, p = 0.004). Furthermore, the high CDC42BPB plasma expression was concordant with the protein levels in CCM tissues and patient-derived primary cells.

Conclusions: The authors present data supporting the measurement of CDC42BPB plasma level as a putative biomarker for CCMs. These findings have implications relevant to improving diagnosis, follow-up, and molecular pathophysiological analysis.

Objective: Up to 30% of children with focal epilepsy have drug-resistant epilepsy and may be candidates for epilepsy surgery. Intraoperative electrocorticography (iECoG) is a method to acutely delineate the epileptogenic zone during epilepsy resections, but its effectiveness is debated. The authors assessed the association between iECoG findings and seizure outcomes in pediatric epilepsy patients undergoing resective epilepsy surgery.

Methods: The authors conducted a retrospective cohort analysis of 115 patients at UPMC Children's Hospital of Pittsburgh who underwent resective epilepsy surgery for focal epilepsy. They assigned patients to subgroups based on the extent of resection in concordance with iECoG findings. Patients in group A had postresection iECoG without epileptiform activity at the margins. Patients in group B had persistent epileptiform activity on postresection iECoG and underwent an extended resection. Patients in group C had persistent epileptiform activity on postresection iECoG, but further resection was contraindicated due to involvement of eloquent cortex.

Results: The primary outcome was seizure freedom at 1 year (Engel class I), which was achieved in 64% (n = 74) of all patients; however, there was no statistically significant difference in seizure freedom or antiseizure medication reduction between the three groups. Notably, there was also no significant relationship between patient group and transient or long-term postoperative complications, such as unexpected postoperative deficits, infection, or symptomatic intracranial hemorrhage.

Conclusions: The authors found no statistically significant difference between groups A, B, and C regarding postoperative seizure reduction and freedom. While iECoG provides a biomarker for the purposes of resection, in this cohort, iECoG findings were not associated with postoperative seizure freedom.