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Laparotomy-assisted, two-port fetoscopic myelomeningocele repair: infant to preschool outcomes. 腹腔镜辅助下的双孔胎儿脊髓膜膨出修补术:从婴儿到学龄前儿童的疗效。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.3171/2024.7.PEDS24200
Magdalena Sanz-Cortes, William E Whitehead, Rebecca M Johnson, Guillermo Aldave, Heidi Castillo, Nilesh K Desai, Roopali Donepudi, Luc Joyeux, Alice King, Stephen F Kralik, Jacob Lepard, David G Mann, Samuel G McClugage, Ahmed A Nassr, Claire Naus, Gabrielle Nguyen, Jonathan Castillo, Vijay M Ravindra, Caitlin D Sutton, Howard L Weiner, Michael A Belfort

Objective: This study reports the infant to preschool outcomes of a laparotomy-assisted, two-port fetoscopic myelomeningocele (MMC) repair and compares the results with those of a contemporary, same-center cohort that underwent either fetal MMC surgery via hysterotomy or postnatal MMC repair.

Methods: All MMC closures between December 2011 and July 2021 were screened. Singleton pregnancies with hindbrain herniation and MMC between T1 and S1 were included. Fetuses were excluded for genetic abnormalities, severe kyphosis, and other congenital anomalies. The pregnant woman determined the method of MMC repair (fetoscopic, hysterotomy, or postnatal repair).

Results: Two hundred MMC closures met the study criteria (100 fetoscopic, 41 hysterotomy, and 59 postnatal). The median length of follow-up was beyond 46 months for all groups. The median gestational age at delivery was 38.1 weeks (IQR 35.1, 39.1 weeks) for the fetoscopic group, 35.7 weeks (IQR 33.6, 37.0 weeks) for the hysterotomy group, and 38.6 weeks (IQR 37.7, 39.0 weeks) for the postnatal group. Vaginal delivery occurred in 51% of the fetoscopic cases, and there were no instances of uterine dehiscence or rupture. Treatment for hydrocephalus in the 1st year occurred in 35% (95% CI 27%-50%) of fetoscopic, 33% (95% CI 20%-50%) of hysterotomy, and 81% (95% CI 70%-90%) of postnatal repair cases. At 30 months, patients who underwent fetal intervention were twice as likely to be community ambulators (with or without devices) as those who underwent postnatal repair (52% [95% CI 42%-62%] of fetoscopic, 54% [95% CI 39%-68%] of hysterotomy, and 24% [95% CI 14%-36%] of postnatal cases). Surgery for symptomatic tethered cord occurred in 12% (95% CI 7%-19%) of fetoscopic, 17% (95% CI 8%-31%) of hysterotomy, and 2% (95% CI 1%-8%) of postnatal repair cases. Surgery for symptomatic spinal inclusion cysts was required in 4% (95% CI 1%-9%) of fetoscopic, 7% (95% CI 2%-18%) of hysterotomy, and none (95% CI 0%-8%) of the postnatal cases.

Conclusions: Laparotomy-assisted, two-port fetoscopic repair provides significant benefits for maternal health. It negates the risk of uterine rupture for the index pregnancy and subsequent pregnancies and allows for vaginal delivery. The benefits to the fetus are the same as those of hysterotomy repairs, with a lower risk of prematurity. There was no difference in the rate of surgery for tethered cord or spinal inclusion cysts between fetoscopic and hysterotomy procedures. Overall, laparotomy-assisted, two-port fetoscopic repair is safer for the fetus and the mother than fetal MMC surgery via hysterotomy.

研究目的本研究报告了在腹腔镜辅助下进行的双孔胎儿脊髓膜膨出(MMC)修补术的婴儿至学龄前结果,并将其与通过子宫切开术进行胎儿脊髓膜膨出手术或产后脊髓膜膨出修补术的当代同中心队列结果进行了比较:方法: 筛选了 2011 年 12 月至 2021 年 7 月期间的所有 MMC 闭合手术。方法:筛查 2011 年 12 月至 2021 年 7 月期间的所有 MMC 闭合手术,纳入后脑疝且 MMC 位于 T1 和 S1 之间的单胎妊娠。排除遗传畸形、严重后凸和其他先天畸形的胎儿。孕妇决定 MMC 修复方法(胎儿镜、子宫切开术或产后修复):结果:符合研究标准的 MMC 闭合手术有 200 例(胎儿镜手术 100 例、宫腔镜手术 41 例、产后修复手术 59 例)。各组随访时间的中位数均超过 46 个月。胎儿镜组分娩时的中位胎龄为 38.1 周(IQR 35.1 至 39.1 周),子宫切开组为 35.7 周(IQR 33.6 至 37.0 周),产后组为 38.6 周(IQR 37.7 至 39.0 周)。51%的胎儿经阴道分娩,没有发生子宫开裂或破裂。在第一年接受脑积水治疗的病例中,35%(95% CI 27%-50%)的胎儿镜手术病例、33%(95% CI 20%-50%)的子宫切开手术病例和81%(95% CI 70%-90%)的产后修复手术病例都接受了脑积水治疗。30 个月时,接受胎儿干预的患者在社区行走(使用或不使用器械)的可能性是接受产后修复的患者的两倍(胎儿镜手术的 52% [95% CI 42%-62%]、子宫切开术的 54% [95% CI 39%-68%]、产后修复的 24% [95% CI 14%-36%])。12%(95% CI 7%-19%)的胎儿镜手术、17%(95% CI 8%-31%)的子宫切开术和2%(95% CI 1%-8%)的产后修复手术中出现了症状性拴系脊髓。4%(95% CI 1%-9%)的胎儿镜病例、7%(95% CI 2%-18%)的子宫切除病例和0%(95% CI 0%-8%)的产后修复病例需要对症状性脊柱包涵囊肿进行手术治疗:结论:腹腔镜辅助双孔胎儿镜修补术对产妇的健康大有裨益。结论:腹腔镜辅助双孔胎儿镜修补术对产妇的健康大有裨益,它消除了初次妊娠及以后妊娠发生子宫破裂的风险,并允许经阴道分娩。对胎儿的益处与子宫切开修补术相同,但早产风险较低。胎儿镜手术和子宫切开术在治疗系带或脊柱包涵囊肿的手术率上没有差异。总体而言,腹腔镜辅助下的双孔胎儿镜修补术对胎儿和母亲都比通过子宫切开术进行的胎儿MMC手术更安全。
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引用次数: 0
Caregiver-reported satisfaction with pediatric movement disorder surgery. 护理人员对小儿运动障碍手术的满意度报告。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.3171/2024.8.PEDS24329
Mahalia Dalmage, Celeste Lai, Jennifer Misasi, Isabel Lehmann, Jeffrey S Raskin

Objective: Patient- and surrogate-reported outcomes are increasingly recognized as important and historically limited dimensions of satisfaction with medical care. Evaluating caregiver satisfaction for cerebral palsy (CP) patients with pediatric movement disorders (PMDs) remains undefined, limited by a lack of appropriate tools and the heterogeneity of the patient population. The authors identified caregiver satisfaction with the neurosurgical management of PMDs as a key quality metric and report their results across an institutional experience.

Methods: A retrospective single-institution survey study was performed on caregivers of consecutive children who underwent PMD surgery from March 2022 to December 2023. The authors designed a brief 4-question satisfaction survey with dichotomous yes/no answers. The telephone survey solicited answers from primary caregivers, and contact attempts were made 3 times before labeling a nonresponder. Non-English speakers were included. The survey answers were correlated with demographic characteristics, clinical data, and complications. Descriptive statistics were performed using Excel.

Results: Seventy patients were identified in the study period with 50 associated caregivers voluntarily responding to the questionnaire (50/70 [71.4%]). Forty-six male and 24 female patients with a mean (range) age of 13.1 (2-34) years and a follow-up range of 3-20 months were included. All 50 caregivers reported satisfaction with the surgical care their child received: 100% confirmed they would refer others to the program and 94% confirmed that they would have the surgery again in retrospect. Ten caregivers (10/50 [20%]) recalled complications, but only 5 (5/50 [10%]) surgical complications resulted in hospital readmission.

Conclusions: Caregivers were overwhelmingly satisfied with the neurosurgical care for PMDs and would recommend the functional pediatric neurosurgery program to others. A large percentage would again submit to the surgery. There is a perception disparity between caregiver- and hospital-identified complications; it may be beneficial to emphasize expected adverse effects with caregivers prior to surgery. Caregiver satisfaction remains an important quality dimension and future research may benefit from more objective metrics.

目的:患者和代理报告的结果越来越被认为是医疗护理满意度的重要方面,但在历史上却受到限制。对患有小儿运动障碍(PMDs)的脑瘫(CP)患者护理人员满意度的评估仍未确定,这受到缺乏适当工具和患者群体异质性的限制。作者将护理人员对神经外科治疗小儿运动障碍的满意度作为一项关键的质量指标,并报告了他们在一家机构的经验结果:方法:作者对2022年3月至2023年12月期间接受PMD手术的连续患儿的护理人员进行了一项单一机构的回顾性调查研究。作者设计了一份简短的满意度调查,共有4个问题,答案为 "是"/"否 "二分法。电话调查征求主要护理人员的回答,在标记未回复者之前会尝试联系3次。非英语使用者也包括在内。调查答案与人口统计学特征、临床数据和并发症相关联。使用 Excel 进行描述性统计:研究期间共确定了 70 名患者,其中 50 名相关护理人员自愿回答了问卷(50/70 [71.4%])。46名男性患者和24名女性患者的平均年龄为13.1(2-34)岁,随访时间为3-20个月。所有 50 名护理人员都对其子女接受的手术护理表示满意:100%的护理人员确认他们会推荐其他人参加该项目,94%的护理人员确认他们会再次接受手术。10名护理人员(10/50 [20%])回忆起了并发症,但只有5名护理人员(5/50 [10%])因手术并发症而再次入院:绝大多数护理人员对小儿麻痹症患者的神经外科护理感到满意,并会向其他人推荐功能性小儿神经外科项目。很大一部分人愿意再次接受手术。护理人员和医院发现的并发症之间存在认知差异;在手术前向护理人员强调预期的不良反应可能会有好处。护理人员的满意度仍然是一个重要的质量维度,未来的研究可能会受益于更客观的指标。
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引用次数: 0
Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients. 早期系带松解对脊髓脊膜膨出症患者尿动力学检查结果和下尿路功能的影响
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.3171/2024.8.PEDS24173
Dan Ozaki, Tomomi Kimiwada, Toshiaki Hayashi, Takeyoshi Honta, Tomohiro Eriguchi, Shinako Takeda, Kiyohide Sakai, Reizo Shirane, Hidenori Endo

Objective: Detecting neurological deterioration and diagnosing tethered cord syndrome (TCS) in patients with myelomeningocele (MMC) can be challenging due to the presence of symptoms at birth and the lack of objective indicators. This retrospective analysis focused on urological manifestations and evaluated whether tethered cord release (TCR) for TCS at an early stage could improve or stabilize video urodynamic study (VUDS) findings and lower urinary tract function.

Methods: This study analyzed 55 of 64 children who underwent MMC repair at Miyagi Children's Hospital, Sendai, Japan, between 2003 and 2016. The follow-up duration for these children exceeded 6 years. Clinical records were reviewed, and surgical indicators and outcomes of TCR and preoperative and postoperative results of VUDS were evaluated.

Results: The duration of follow-up was mean ± SD (range) 12.6 ± 3.5 (6.0-19.0) years. TCR was performed on 27 (49.1%) of 55 patients with MMC, totaling 33 procedures. Five patients underwent 2 TCR procedures, whereas 1 received 3 TCR procedures. The mean ± SD (range) age was 7.5 ± 2.9 (2.2-12.7) years at the first TCR procedure (n = 27) and the mean (range) was 10.9 (10.1-11.7) years at the second TCR (n = 5); in addition, 1 patient underwent a third TCR procedure at age 15.9 years. There were no identified risk factors associated with the TCS. The first TCR procedure was performed due to worsened lower-extremity (LE) motor symptoms in 1 patient, worsened LE sensory symptoms in 3 patients, and worsened VUDS findings in 26 patients. After the procedure, LE motor symptoms improved in 1 patient (100%), LE sensory symptoms improved in 2 patients (66.7%), and VUDS findings improved in 18 patients (66.7%). Preoperative VUDS revealed urological deterioration characterized by a high-pressure bladder, reduced bladder capacity, increased detrusor overactivity (DO), and vesicoureteral reflux. Postoperative VUDS showed improvements in bladder function, including decreased bladder pressure and DO, increased bladder capacity, and compliance. None of the patients underwent augmentation cystoplasty or had renal dysfunction.

Conclusions: Routine VUDS can detect urological deterioration, which can be a significant indicator for early diagnosis of TCS. Performing TCR at an early stage is beneficial, not only to protect renal function but also to improve VUDS findings and lower urinary tract function in patients with MMC. It is important to explore a standardized approach for the diagnosis and treatment of TCS.

目的:由于脊髓脊膜膨出症(MMC)患者出生时即有症状且缺乏客观指标,因此检测神经系统恶化和诊断系带综合征(TCS)具有挑战性。这项回顾性分析主要关注泌尿系统表现,并评估在早期针对TCS进行系带松解术(TCR)是否能改善或稳定视频尿动力学检查(VUDS)结果和下尿路功能:本研究分析了2003年至2016年期间在日本仙台市宫城儿童医院接受MMC修复术的64名患儿中的55名。这些患儿的随访时间超过 6 年。研究人员回顾了临床记录,评估了TCR的手术指标和结果以及VUDS的术前术后结果:随访时间平均为(± SD)12.6±3.5(6.0-19.0)年。在55例MMC患者中,有27例(49.1%)接受了TCR手术,共计33例。其中 5 名患者接受了 2 次 TCR 手术,1 名患者接受了 3 次 TCR 手术。首次接受 TCR 治疗时的平均年龄为 7.5±2.9 (2.2-12.7)岁(27 人),第二次接受 TCR 治疗时的平均年龄为 10.9 (10.1-11.7)岁(5 人);此外,1 名患者在 15.9 岁时接受了第三次 TCR 治疗。没有发现与 TCS 相关的风险因素。1 名患者的下肢运动症状恶化,3 名患者的下肢感觉症状恶化,26 名患者的 VUDS 结果恶化,因此进行了第一次 TCR 手术。术后,1 名患者的下肢运动症状有所改善(100%),2 名患者的下肢感觉症状有所改善(66.7%),18 名患者的 VUDS 结果有所改善(66.7%)。术前 VUDS 显示泌尿系统恶化,表现为高压膀胱、膀胱容量减少、逼尿肌过度活动(DO)增加和膀胱输尿管反流。术后 VUDS 显示膀胱功能有所改善,包括膀胱压力和 DO 下降、膀胱容量增加以及顺应性增强。所有患者均未接受膀胱成形术或出现肾功能障碍:结论:常规 VUDS 可检测泌尿系统恶化情况,是早期诊断 TCS 的重要指标。早期进行 TCR 有益,不仅能保护肾功能,还能改善 MMC 患者的 VUDS 结果和下尿路功能。探索TCS诊断和治疗的标准化方法非常重要。
{"title":"Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients.","authors":"Dan Ozaki, Tomomi Kimiwada, Toshiaki Hayashi, Takeyoshi Honta, Tomohiro Eriguchi, Shinako Takeda, Kiyohide Sakai, Reizo Shirane, Hidenori Endo","doi":"10.3171/2024.8.PEDS24173","DOIUrl":"https://doi.org/10.3171/2024.8.PEDS24173","url":null,"abstract":"<p><strong>Objective: </strong>Detecting neurological deterioration and diagnosing tethered cord syndrome (TCS) in patients with myelomeningocele (MMC) can be challenging due to the presence of symptoms at birth and the lack of objective indicators. This retrospective analysis focused on urological manifestations and evaluated whether tethered cord release (TCR) for TCS at an early stage could improve or stabilize video urodynamic study (VUDS) findings and lower urinary tract function.</p><p><strong>Methods: </strong>This study analyzed 55 of 64 children who underwent MMC repair at Miyagi Children's Hospital, Sendai, Japan, between 2003 and 2016. The follow-up duration for these children exceeded 6 years. Clinical records were reviewed, and surgical indicators and outcomes of TCR and preoperative and postoperative results of VUDS were evaluated.</p><p><strong>Results: </strong>The duration of follow-up was mean ± SD (range) 12.6 ± 3.5 (6.0-19.0) years. TCR was performed on 27 (49.1%) of 55 patients with MMC, totaling 33 procedures. Five patients underwent 2 TCR procedures, whereas 1 received 3 TCR procedures. The mean ± SD (range) age was 7.5 ± 2.9 (2.2-12.7) years at the first TCR procedure (n = 27) and the mean (range) was 10.9 (10.1-11.7) years at the second TCR (n = 5); in addition, 1 patient underwent a third TCR procedure at age 15.9 years. There were no identified risk factors associated with the TCS. The first TCR procedure was performed due to worsened lower-extremity (LE) motor symptoms in 1 patient, worsened LE sensory symptoms in 3 patients, and worsened VUDS findings in 26 patients. After the procedure, LE motor symptoms improved in 1 patient (100%), LE sensory symptoms improved in 2 patients (66.7%), and VUDS findings improved in 18 patients (66.7%). Preoperative VUDS revealed urological deterioration characterized by a high-pressure bladder, reduced bladder capacity, increased detrusor overactivity (DO), and vesicoureteral reflux. Postoperative VUDS showed improvements in bladder function, including decreased bladder pressure and DO, increased bladder capacity, and compliance. None of the patients underwent augmentation cystoplasty or had renal dysfunction.</p><p><strong>Conclusions: </strong>Routine VUDS can detect urological deterioration, which can be a significant indicator for early diagnosis of TCS. Performing TCR at an early stage is beneficial, not only to protect renal function but also to improve VUDS findings and lower urinary tract function in patients with MMC. It is important to explore a standardized approach for the diagnosis and treatment of TCS.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk factors for abusive head trauma in the pediatric population. 儿童头部外伤的风险因素。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.3171/2024.8.PEDS24205
Kaho Adachi, Adith Srivatsa, Allison Raymundo, Daksh Bhargava, Ankit I Mehta

Objective: Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05).

Results: The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001).

Conclusions: Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

目的:在美国,虐待性头部创伤(AHT)是导致 5 岁以下儿童因身体虐待而死亡的主要原因。虐待性头部外伤患者的死亡率为 25%,如果缺乏干预,儿童虐待的复发率将上升至 35%。因此,识别虐待儿童行为至关重要,但对于语言发育尚未成熟的婴幼儿来说尤其具有挑战性。目前的虐童指南并没有充分考虑到低龄儿童的特殊需求。本研究旨在评估此类人群中与虐待相关的临床因素:从 2017 年到 2019 年,对国家创伤数据库中 3 岁以下的急性头部创伤患者进行了查询。根据人口统计学、合并症和格拉斯哥昏迷量表(GCS)评分,将疑似经历过虐待儿童的患者(疑似虐待儿童[SCA]组)与未疑似经历过虐待儿童的患者(非SCA组)进行倾向评分匹配。采用配对学生 t 检验和卡方检验来比较两组住院结果的差异。多变量回归分析用于确定与 SCA 相关的因素(P < 0.05):作者在 SCA 组和非 SCA 组分别发现了 10,844 名和 27,912 名患者。回归分析结果显示,SCA 组患者的早产率较高(OR 2.30,p < 0.001),GCS 评分 < 13(OR 1.79,p < 0.001),先天性疾病(OR 1.56,p < 0.001),使用公共保险的比例较高(68.38% vs 52.88% p < 0.001)。黑人和西班牙裔患者更有可能属于 SCA 组(OR 分别为 1.56,p < 0.001 和 OR 1.35,p < 0.001)。倾向得分匹配后,SCA 患者的住院时间更长(3.17 天 vs 1.34 天,p < 0.001),死亡率更高(4.89% vs 3.58%,p < 0.001):SCA组的急性颅脑损伤与早产、先天性疾病、低GCS评分和使用公共保险有关。因此,在对婴幼儿进行潜在虐待评估时,现行指南应考虑临床病史和保险类型,以更好地反映高危患者群体。黑人和西班牙裔患者中可能存在过度识别虐待儿童的情况,因此有必要开展进一步研究。
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引用次数: 0
Outcomes and complications of vertical parasagittal hemispherotomy in children: a nationwide population-based study. 儿童垂直矢状旁半球切除术的结果和并发症:一项基于全国人口的研究。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.3171/2024.9.PEDS24281
Vincent Zheng, Henri Lehtinen, Atte Karppinen, Eija Gaily, Heta Leinonen, Päivi Koroknay-Pál, Aki Laakso, Eeva-Liisa Metsähonkala

Objective: The goal of this study was to assess the complications associated with vertical parasagittal hemispherotomy (VPH), the impact of incomplete disconnection on long-term seizure freedom, and how VPH impacts cognitive development.

Methods: A retrospective evaluation was performed in all patients who had undergone VPH during 1991-2022 at the authors' institution. Two-year follow-up data were available for 45 patients, and there were 6-month data for 3 more. All available postoperative MRI studies (31/48, 64.6%) were reviewed. Before 2010, postoperative MRI was only performed if seizures recurred.

Results: Primary VPH led to Engel class I in 73% of patients. Acquired etiologies had a higher rate of Engel I compared to developmental and progressive etiologies (96% vs 46% and 44%, p < 0.001). Nearly half of patients (45%) showed improved cognitive trajectories as opposed to their preoperative ones, whereas in 45% trajectories remained unchanged. Additionally, 5 patients (10%) exhibited new major deficits or accelerated cognitive deterioration after VPH. Surgical complications occurred in 14 patients (29%) after the first VPH; 4 cases were classified as transient, resolving during follow-up without surgical intervention. Nontransient complications included 8 cases of hydrocephalus requiring surgical treatment, 1 shunted subdural hygroma, and 1 case of CSF leakage from the wound. Diabetes insipidus occurred in 6 patients, with all resolving spontaneously. Residual connections were present in 16 patients, primarily in the temporomesial region. Seven patients remained seizure free despite visible residual connections.

Conclusions: VPH is a highly effective treatment for drug-resistant hemispheric epilepsy, resulting in durable seizure freedom and often favorable cognitive outcomes. Diabetes insipidus in addition to hydrocephalus is a common complication after VPH. Incomplete disconnection does not necessarily preclude seizure freedom.

研究目的本研究旨在评估垂直矢状旁半球切开术(VPH)的相关并发症、不完全断开对长期癫痫发作自由度的影响以及 VPH 对认知发育的影响:作者所在机构对1991-2022年间接受VPH手术的所有患者进行了回顾性评估。45名患者获得了两年的随访数据,另有3名患者获得了6个月的随访数据。对所有可用的术后磁共振成像研究(31/48,64.6%)进行了审查。2010年之前,只有在癫痫复发时才进行术后磁共振成像检查:结果:原发性 VPH 导致 73% 的患者达到恩格尔 I 级。与发育性和进行性病因相比,获得性病因的恩格尔I级比例更高(96% vs 46%和44%,P < 0.001)。近一半患者(45%)的认知轨迹比术前有所改善,而 45% 的患者的认知轨迹保持不变。此外,5 名患者(10%)在 VPH 术后出现了新的重大缺陷或认知功能加速退化。14 名患者(29%)在首次 VPH 后出现了手术并发症,其中 4 例被归类为一过性并发症,在随访期间无需手术干预即可缓解。非短暂性并发症包括 8 例需要手术治疗的脑积水、1 例分流性硬膜下血肿和 1 例伤口 CSF 渗漏。6 名患者出现了糖尿病性尿崩症,但都自行缓解。16 名患者存在残余连接,主要在颞侧区域。尽管存在明显的残余连接,但仍有 7 名患者没有癫痫发作:结论:VPH 是治疗耐药半球癫痫的一种高效疗法,可使患者持久摆脱癫痫发作,并通常获得良好的认知结果。除脑积水外,糖尿病性尿崩症也是 VPH 术后常见的并发症。不完全断开并不一定排除癫痫发作。
{"title":"Outcomes and complications of vertical parasagittal hemispherotomy in children: a nationwide population-based study.","authors":"Vincent Zheng, Henri Lehtinen, Atte Karppinen, Eija Gaily, Heta Leinonen, Päivi Koroknay-Pál, Aki Laakso, Eeva-Liisa Metsähonkala","doi":"10.3171/2024.9.PEDS24281","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24281","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to assess the complications associated with vertical parasagittal hemispherotomy (VPH), the impact of incomplete disconnection on long-term seizure freedom, and how VPH impacts cognitive development.</p><p><strong>Methods: </strong>A retrospective evaluation was performed in all patients who had undergone VPH during 1991-2022 at the authors' institution. Two-year follow-up data were available for 45 patients, and there were 6-month data for 3 more. All available postoperative MRI studies (31/48, 64.6%) were reviewed. Before 2010, postoperative MRI was only performed if seizures recurred.</p><p><strong>Results: </strong>Primary VPH led to Engel class I in 73% of patients. Acquired etiologies had a higher rate of Engel I compared to developmental and progressive etiologies (96% vs 46% and 44%, p < 0.001). Nearly half of patients (45%) showed improved cognitive trajectories as opposed to their preoperative ones, whereas in 45% trajectories remained unchanged. Additionally, 5 patients (10%) exhibited new major deficits or accelerated cognitive deterioration after VPH. Surgical complications occurred in 14 patients (29%) after the first VPH; 4 cases were classified as transient, resolving during follow-up without surgical intervention. Nontransient complications included 8 cases of hydrocephalus requiring surgical treatment, 1 shunted subdural hygroma, and 1 case of CSF leakage from the wound. Diabetes insipidus occurred in 6 patients, with all resolving spontaneously. Residual connections were present in 16 patients, primarily in the temporomesial region. Seven patients remained seizure free despite visible residual connections.</p><p><strong>Conclusions: </strong>VPH is a highly effective treatment for drug-resistant hemispheric epilepsy, resulting in durable seizure freedom and often favorable cognitive outcomes. Diabetes insipidus in addition to hydrocephalus is a common complication after VPH. Incomplete disconnection does not necessarily preclude seizure freedom.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Individual- and community-level correlates of pediatric central nervous system tumor disparities in the US. 美国儿科中枢神经系统肿瘤差异在个人和社区层面的相关性。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.3171/2024.9.PEDS24180
Jeffrey C Rastatter, Daniel C Chelius, Tord D Alden, Michael DeCuypere, Jill N D'Souza, Anthony M Sheyn, David J Fei-Zhang

Objective: The aim of this study was, through comprehensive, multilevel models of social determinants of health (SDoH) factors, including the Yost Index socioeconomic status (SES) score, to determine whether community- or individual-level SDoH factors quantifiably influence pediatric CNS tumor disparities more in care and prognosis across the US.

Methods: The authors performed a retrospective cohort study assessing specialized Surveillance, Epidemiology, and End Results data of pediatric patients (≤ 19 years old) with nonmalignant and malignant tumors of the CNS from 2010 to 2018. A census-level Yost Index SES score and rurality/urbanicity measures were incorporated with individual characteristics of age, sex, and race/ethnicity. Chi-square analyses for clinical and demographic descriptions, multivariate Cox proportional hazards logistic regressions for survival, and multivariate logistic regressions for resection, radiation treatment, treatment delay, and advanced staging on preliminary presentation were performed.

Results: Across 18,236 patients, age-adjusted analyses showed substantially increased mortality risk among 6 of 11 subtypes (highest hazard ratio [HR] 1.91, 95% CI 1.59-2.28, p < 0.001 for glioma NOS), decreased odds of first-line therapy among 7 of 18 subtypes (lowest OR 0.36, 95% CI 0.11-0.97, p = 0.043 for resection of choroid plexus papilloma), increased odds of treatment delay among 6 of 11 subtypes (highest OR 2.47, 95% CI 1.01-6.49, p = 0.047 for germinoma), increased odds of advanced staging on preliminary presentation among 3 of 10 malignant subtypes (highest OR 2.56, 95% CI 1.27-5.52, p = 0.008 for malignant ependymomas), and increased odds of receipt of radiation therapy among 3 of 10 malignant subtypes (highest OR 2.30, 95% CI 1.87-2.84, p < 0.001) observed across many disease subtypes contributed by certain individual- and community-level SDoH factors.

Conclusions: Through comprehensive analyses combining individual- and community-level SDoH factors, this study identified detrimental interrelated SDoH associations with poorer care and prognosis of pediatric patients with CNS tumors, delineating how both levels differentially contribute to observed disparities across different subtypes.

研究目的本研究旨在通过包括约斯特指数社会经济地位(SES)评分在内的健康社会决定因素(SDoH)的综合多层次模型,确定社区或个人层面的SDoH因素是否会对全美儿科中枢神经系统肿瘤在治疗和预后方面的差异产生量化影响:作者进行了一项回顾性队列研究,评估了2010年至2018年中枢神经系统非恶性和恶性肿瘤儿科患者(≤19岁)的专业监测、流行病学和最终结果数据。人口普查水平的约斯特指数 SES 评分和乡村/城市化度量与年龄、性别和种族/人种等个体特征相结合。对临床和人口学描述进行了卡方分析,对生存率进行了多变量 Cox 比例危险 logistic 回归,对切除术、放射治疗、治疗延迟和初步表现的晚期分期进行了多变量 logistic 回归:在18236名患者中,年龄调整后的分析显示,11个亚型中有6个亚型的死亡风险大幅增加(最高危险比[HR] 1.91,95% CI 1.59-2.28,胶质瘤NOS的P < 0.001),18个亚型中有7个亚型的一线治疗几率下降(最低OR 0.36,95% CI 0.11-0.97,脉络丛乳头状瘤切除术的 P = 0.043),11 个亚型中有 6 个亚型的治疗延迟几率增加(生殖细胞瘤的最高 OR 2.47,95% CI 1.01-6.49,P = 0.在10种恶性肿瘤亚型中,有3种亚型初步诊断时分期较晚的几率增加(恶性上皮瘤的最高OR值为2.56,95% CI为1.27-5.52,p = 0.008);在10种恶性肿瘤亚型中,有3种亚型接受放射治疗的几率增加(最高OR值为2.30,95% CI为1.87-2.84,p < 0.001):通过结合个人和社区层面的 SDoH 因素进行综合分析,本研究发现了相互关联的 SDoH 与中枢神经系统肿瘤儿科患者较差的护理和预后之间的不利关联,并阐明了这两个层面如何在不同亚型中对所观察到的差异起到不同的作用。
{"title":"Individual- and community-level correlates of pediatric central nervous system tumor disparities in the US.","authors":"Jeffrey C Rastatter, Daniel C Chelius, Tord D Alden, Michael DeCuypere, Jill N D'Souza, Anthony M Sheyn, David J Fei-Zhang","doi":"10.3171/2024.9.PEDS24180","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS24180","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was, through comprehensive, multilevel models of social determinants of health (SDoH) factors, including the Yost Index socioeconomic status (SES) score, to determine whether community- or individual-level SDoH factors quantifiably influence pediatric CNS tumor disparities more in care and prognosis across the US.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study assessing specialized Surveillance, Epidemiology, and End Results data of pediatric patients (≤ 19 years old) with nonmalignant and malignant tumors of the CNS from 2010 to 2018. A census-level Yost Index SES score and rurality/urbanicity measures were incorporated with individual characteristics of age, sex, and race/ethnicity. Chi-square analyses for clinical and demographic descriptions, multivariate Cox proportional hazards logistic regressions for survival, and multivariate logistic regressions for resection, radiation treatment, treatment delay, and advanced staging on preliminary presentation were performed.</p><p><strong>Results: </strong>Across 18,236 patients, age-adjusted analyses showed substantially increased mortality risk among 6 of 11 subtypes (highest hazard ratio [HR] 1.91, 95% CI 1.59-2.28, p < 0.001 for glioma NOS), decreased odds of first-line therapy among 7 of 18 subtypes (lowest OR 0.36, 95% CI 0.11-0.97, p = 0.043 for resection of choroid plexus papilloma), increased odds of treatment delay among 6 of 11 subtypes (highest OR 2.47, 95% CI 1.01-6.49, p = 0.047 for germinoma), increased odds of advanced staging on preliminary presentation among 3 of 10 malignant subtypes (highest OR 2.56, 95% CI 1.27-5.52, p = 0.008 for malignant ependymomas), and increased odds of receipt of radiation therapy among 3 of 10 malignant subtypes (highest OR 2.30, 95% CI 1.87-2.84, p < 0.001) observed across many disease subtypes contributed by certain individual- and community-level SDoH factors.</p><p><strong>Conclusions: </strong>Through comprehensive analyses combining individual- and community-level SDoH factors, this study identified detrimental interrelated SDoH associations with poorer care and prognosis of pediatric patients with CNS tumors, delineating how both levels differentially contribute to observed disparities across different subtypes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preoperative interhemispheric coherence as a potential predictive marker for seizure outcome after total corpus callosotomy in nonlesional generalized epilepsy: a scalp EEG study. 术前大脑半球间连贯性作为非失神性全身性癫痫全胼胝体切开术后癫痫发作结果的潜在预测指标:一项头皮脑电图研究。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.3171/2024.7.PEDS24246
Vich Yindeedej, Takehiro Uda, Shugo Nishijima, Takeshi Inoue, Ichiro Kuki, Masataka Fukuoka, Megumi Nukui, Shin Okazaki, Noritsugu Kunihiro, Ryoko Umaba, Takeo Goto

Objective: Corpus callosotomy (CC) is one of the palliative epilepsy surgical procedures available for nonlesional generalized epilepsy, but it is more invasive than other palliative surgical procedures. The main challenge is proper selection of suitable patients for CC. Coherence analysis is a method for evaluating brain connectivity, but the correlation between preoperative coherence and surgical outcomes has not previously been clarified. The authors aimed to evaluate correlations between preoperative interhemispheric coherence and surgical outcome in patients with nonlesional generalized epilepsy.

Methods: This retrospective study investigated patients with nonlesional generalized epilepsy who underwent total CC. The authors collected data for patients with good seizure outcome (Oguni classification A or B) and bad seizure outcome (Oguni classification D). For coherence analysis, the authors selected a period without interictal discharges. Preoperative interhemispheric coherence values from 8 pairs of symmetrically opposite scalp electrodes were computed across 5 frequency bands. Then, the authors evaluated correlations between coherence and surgical outcomes.

Results: Forty patients were included (19 males and 21 females). The mean (range) age at the time of surgery was 5.1 (1-18) years. Seizure outcomes were good in 15 patients and bad in the other 25 patients. Age at onset of epilepsy, duration of epilepsy before surgery, age at time of surgery, and presence of epileptic spasm did not differ significantly between patients with good and bad seizure outcomes (p = 0.36, p = 0.14, p = 0.10, and p = 0.20, respectively). Significant correlations were identified between higher Fp1-Fp2 interhemispheric coherence values in the delta, theta, and alpha frequency bands and bad surgical outcomes (p = 0.0397, p = 0.0322, and p = 0.0476, respectively). The receiver operating characteristic curves of the Fp1-Fp2 coherence values in these frequency bands showed areas under the curve of 67%, 69%, and 67%, respectively. The optimal cutoff values for Fp1-Fp2 interhemispheric coherence to predict surgical outcomes were 55.6 for delta (66.7% sensitivity and 72.0% specificity), 55.9 for theta (60.0% sensitivity and 76.0% specificity), and 50.3 for alpha (53.3% sensitivity and 84.0% specificity).

Conclusions: This is the first study to identify potential predictive factors for surgical outcomes based on preoperative interhemispheric coherence in nonlesional generalized epilepsy. Higher coherence between Fp1-Fp2 in the delta, theta, and alpha frequencies correlated with bad seizure outcome after CC.

目的:胼胝体切开术(CC)是治疗非局限性全身性癫痫的姑息性癫痫外科手术之一,但它比其他姑息性外科手术更具创伤性。其主要挑战在于如何正确选择适合接受 CC 的患者。相干性分析是一种评估大脑连通性的方法,但术前相干性与手术结果之间的相关性此前尚未明确。作者旨在评估非失神性全身性癫痫患者术前大脑半球间连贯性与手术结果之间的相关性:这项回顾性研究调查了接受全CC手术的非失神性全身性癫痫患者。作者收集了发作结果良好(Oguni 分级 A 或 B)和发作结果不良(Oguni 分级 D)患者的数据。为了进行相干性分析,作者选择了没有发作间期放电的时期。作者计算了 8 对对称相对的头皮电极在 5 个频段上的术前半球间相干值。然后,作者评估了相干性与手术结果之间的相关性:共纳入 40 名患者(19 名男性和 21 名女性)。手术时的平均年龄(范围)为 5.1(1-18)岁。15名患者的癫痫发作结果良好,另外25名患者的发作结果较差。癫痫发病年龄、术前癫痫持续时间、手术时年龄和是否存在癫痫痉挛在发作结果良好和不良的患者之间没有显著差异(分别为 p = 0.36、p = 0.14、p = 0.10 和 p = 0.20)。在 delta、theta 和 alpha 频段较高的 Fp1-Fp2 半球间一致性值与不良手术结果之间存在显著相关性(分别为 p = 0.0397、p = 0.0322 和 p = 0.0476)。这些频段的 Fp1-Fp2 相干值的接收器操作特征曲线显示曲线下面积分别为 67%、69% 和 67%。Fp1-Fp2半球间相干性预测手术结果的最佳临界值为:delta为55.6(敏感性为66.7%,特异性为72.0%),θ为55.9(敏感性为60.0%,特异性为76.0%),α为50.3(敏感性为53.3%,特异性为84.0%):这是第一项根据非失神性全身性癫痫患者术前大脑半球间相干性确定手术结果潜在预测因素的研究。Fp1-Fp2在δ、θ和α频率上更高的相干性与CC术后的不良发作结果相关。
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引用次数: 0
Letter to the Editor. Growing body of literature on the increase in sinogenic and otogenic intracranial infections. 致编辑的信。有关窦源性和耳源性颅内感染增加的文献越来越多。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.3171/2024.8.PEDS24407
David S Hersh, Megan G Anderson, Jonathan A Pindrik
{"title":"Letter to the Editor. Growing body of literature on the increase in sinogenic and otogenic intracranial infections.","authors":"David S Hersh, Megan G Anderson, Jonathan A Pindrik","doi":"10.3171/2024.8.PEDS24407","DOIUrl":"https://doi.org/10.3171/2024.8.PEDS24407","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Erratum. Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study. 勘误。儿科开放性颅骨骨折的现代治疗:一项多中心儿科创伤中心研究。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-18 DOI: 10.3171/2024.9.PEDS20486a
Gerald Gollin
{"title":"Erratum. Contemporary management of pediatric open skull fractures: a multicenter pediatric trauma center study.","authors":"Gerald Gollin","doi":"10.3171/2024.9.PEDS20486a","DOIUrl":"https://doi.org/10.3171/2024.9.PEDS20486a","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The clinical significance of lack of hindbrain herniation in fetal myelomeningocele/myeloschisis patients. 胎儿脊髓膜膨出症/脊髓空洞症患者缺乏后脑疝的临床意义。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-10-18 DOI: 10.3171/2024.6.PEDS24170
Tracy M Flanders, Maria A Punchak, Edward R Oliver, Sierra D Land, Sabrina J Flohr, Tom A Reynolds, Katie M Schmidt, Danielle D Ertz, Julie S Moldenhauer, N Scott Adzick, Gregory G Heuer

Objective: Hindbrain herniation (HH) is a clinical prerequisite for prenatal repair of myelomeningocele/myeloschisis; however, a subset of patients lack HH on initial fetal imaging and may ultimately progress to exhibit herniation on subsequent prenatal or postnatal imaging. The authors sought to explore the cohort of patients without HH at the time of initial fetal consultation for myelomeningocele/myeloschisis repair to define their clinical characteristics and outcome.

Methods: From July 2016 to July 2022, patients evaluated at the Children's Hospital of Philadelphia Center for Fetal Diagnosis and Treatment for myelomeningocele/myeloschisis were classified into two cohorts: those with and those without HH. The diagnosis of HH was obtained from prenatal and postnatal MRI. The osseous lesion level, prenatal sac volume, and prenatal ventricular size was obtained from fetal ultrasound. The fronto-occipital horn ratio was measured on the first postnatal ultrasound. Ambulation status was obtained from postnatal evaluation in the spina bifida clinic.

Results: A total of 176 patients with prenatal HH had postnatal follow-up, of whom 95 (54%) had HH resolution and 81 (46%) had herniation persistence. Of 73 patients without prenatal HH, 9 (12%) had herniation on subsequent prenatal imaging while 64 (88%) had no herniation on prenatal imaging. Of these 64 patients, 11 (17%) had postnatal HH, 32 (50%) had no postnatal herniation, and 21 (33%) were lost to follow-up or the pregnancy was terminated. For patients without HH throughout, the sac volume was larger (9 cm3) than those who had herniation progression or initial herniation; however, the rate of talipes was not significantly different among the groups. The majority of patients were also ambulators (with assistive devices or independent), and the atrial diameter was also < 10 mm for most patients. Overall, 53% of those with initial HH compared with 35% with progression of herniation required CSF diversion, while only 25% of those without herniation required diversion.

Conclusions: This study demonstrates the natural history of HH in patients with a prenatal diagnosis of myelomeningocele/myeloschisis. The majority of patients without any herniation had larger sac sizes but not higher rates of talipes and smaller ventricles and were ambulatory. These findings improve the ability to guide families during prenatal consultation.

目的:后脑疝(HH)是产前修复脊髓膜膨出症/髓鞘裂的临床先决条件;然而,一部分患者在最初的胎儿影像学检查中没有发现后脑疝,最终可能在随后的产前或产后影像学检查中表现出后脑疝。作者试图探究在进行脊髓膜膨出症/脊髓空洞症修复术的初次胎儿会诊时没有HH的患者群体,以明确他们的临床特征和结局:从2016年7月至2022年7月,在费城儿童医院胎儿诊断和治疗中心接受评估的骨髓膜缺如/骨髓裂患者被分为两个队列:HH患者和无HH患者。HH的诊断是通过产前和产后磁共振成像获得的。骨性病变水平、产前胎囊体积和产前脑室大小由胎儿超声检查获得。出生后第一次超声波检查测量了前枕角比率。脊柱裂门诊的产后评估结果显示了患者的行走状况:结果:共有176名产前HH患者接受了产后随访,其中95人(54%)的HH得到缓解,81人(46%)的疝持续存在。在73名没有产前HH的患者中,9人(12%)在随后的产前成像中出现了疝,而64人(88%)在产前成像中没有出现疝。在这 64 例患者中,11 例(17%)产后出现 HH,32 例(50%)产后无疝,21 例(33%)失去随访机会或终止妊娠。自始至终未患 HH 的患者的妊娠囊体积(9 立方厘米)大于疝出进展或初次疝出的患者;但是,各组患者的滑囊率没有显著差异。大多数患者还可以行走(使用辅助设备或独立行走),大多数患者的心房直径也小于 10 毫米。总体而言,53%的初次HH患者和35%的疝气进展患者需要进行脑脊液转流,而只有25%的无疝气患者需要进行脑脊液转流:本研究展示了产前诊断为髓母细胞鞘膜积液/髓鞘膜炎的患者的HH自然病史。大多数没有任何疝出的患者的疝囊尺寸较大,但距骨和脑室较小的比例并不高,而且可以行走。这些发现提高了在产前咨询中指导家属的能力。
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引用次数: 0
期刊
Journal of neurosurgery. Pediatrics
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