Pub Date : 2024-07-19Print Date: 2024-10-01DOI: 10.3171/2024.6.PEDS2458
Jeffrey J Quezada, Marvin D Nelson, J Gordon McComb
Objective: The nomenclature characterizing posterior fossa (PF) extraventricular (EV) CSF collections in radiological reports can be quite variable, leading to uncertainty about the subsequent clinical course that may result in multiple follow-up imaging studies that may not be needed and occasionally to operative intervention that is not warranted. The important factor is the mass effect of the PF EV CSF collection on adjacent structures, the presence of hydrocephalus, and the likelihood of the CSF collection increasing in size over time.
Methods: The authors respectively reviewed the imaging database at Children's Hospital Los Angeles to identify all radiological reports from 2000 to 2015 indicating the presence of an EV CSF collection in the PF that was characterized as containing an arachnoid cyst, being cystic, or being an abnormal CSF collection.
Results: Of the 332 reports in 65 patients, the PF EV CSF collection was described as an arachnoid cyst or cystic in 306 with 20 different terms being used. In those patients who underwent multiple imaging studies, the PF EV CSF collection was often described differently in each report. Of this group, 47 (72%) patients did not undergo PF surgery. Eighteen (28%) patients did undergo PF surgery, of whom 14 had both hydrocephalus and brainstem displacement, 2 had brainstem displacement but no hydrocephalus, and 2 had neither brainstem displacement nor hydrocephalus and in retrospect did not benefit from PF surgery.
Conclusions: The terminology in radiology reports describing EV PF CSF collections is variable, is inconsistent, and does not correlate well with clinical management or the need for PF surgery. Significant brainstem displacement and hydrocephalus in the presence of EV PF CSF collection is highly correlated with the need for PF surgery. The incidence of a PF EV CSF collection increasing to become symptomatic becomes more remote the older the patient is at the time of diagnosis as compared with those that occur mainly in infancy. There are true EV CSF cysts in the PF, but the ones that are of consequence are those that exert pressure on the brainstem, obstruct CSF flow, or both. Calling any increased amount of CSF in the PF a "cyst" or "cystic" can cause uncertainty, leading to one or more subsequent imaging studies or, in rare cases, unwarranted operative intervention.
目的:放射学报告中描述后窝(PF)室外(EV)CSF 集结的术语可能存在很大差异,从而导致后续临床病程的不确定性,这可能会导致不必要的多次随访影像学检查,有时还会导致不必要的手术干预。重要的因素是 PF EV CSF 聚集对邻近结构的质量影响、是否存在脑积水以及 CSF 聚集随时间推移增大的可能性:作者分别查阅了洛杉矶儿童医院的影像数据库,以确定2000年至2015年期间所有表明PF中存在EV CSF集结的放射学报告,这些报告的特点是包含蛛网膜囊肿、囊性或异常CSF集结:在65名患者的332份报告中,有306份报告将PF EV CSF集结物描述为蛛网膜囊肿或囊性,其中使用了20种不同的术语。在接受过多次影像学检查的患者中,每份报告中对 PF EV CSF 集聚物的描述往往不同。在这组患者中,有 47 例(72%)没有接受 PF 手术。18例(28%)患者接受了PF手术,其中14例既有脑积水又有脑干移位,2例有脑干移位但无脑积水,2例既无脑干移位也无脑积水,回想起来并没有从PF手术中获益:结论:放射学报告中描述EV PF CSF积液的术语多种多样,不尽一致,与临床治疗或PF手术的必要性也没有很好的相关性。EV PF CSF 聚集时出现的脑干明显移位和脑积水与 PF 手术的必要性高度相关。与主要发生在婴儿期的 EV 脑脊液囊肿相比,诊断时患者年龄越大,其 EV 脑脊液囊肿增大并出现症状的发生率越低。PF 中确实存在 EV CSF 囊肿,但对脑干造成压力、阻碍 CSF 流动或两者兼而有之的囊肿才是有影响的囊肿。将 PF 中任何增多的 CSF 称为 "囊肿 "或 "囊性 "都会引起不确定性,导致后续的一项或多项影像学检查,或在极少数情况下进行不必要的手术干预。
{"title":"When is the radiology report of posterior fossa containing cyst/cystic-like CSF collection of clinical or surgical significance?","authors":"Jeffrey J Quezada, Marvin D Nelson, J Gordon McComb","doi":"10.3171/2024.6.PEDS2458","DOIUrl":"10.3171/2024.6.PEDS2458","url":null,"abstract":"<p><strong>Objective: </strong>The nomenclature characterizing posterior fossa (PF) extraventricular (EV) CSF collections in radiological reports can be quite variable, leading to uncertainty about the subsequent clinical course that may result in multiple follow-up imaging studies that may not be needed and occasionally to operative intervention that is not warranted. The important factor is the mass effect of the PF EV CSF collection on adjacent structures, the presence of hydrocephalus, and the likelihood of the CSF collection increasing in size over time.</p><p><strong>Methods: </strong>The authors respectively reviewed the imaging database at Children's Hospital Los Angeles to identify all radiological reports from 2000 to 2015 indicating the presence of an EV CSF collection in the PF that was characterized as containing an arachnoid cyst, being cystic, or being an abnormal CSF collection.</p><p><strong>Results: </strong>Of the 332 reports in 65 patients, the PF EV CSF collection was described as an arachnoid cyst or cystic in 306 with 20 different terms being used. In those patients who underwent multiple imaging studies, the PF EV CSF collection was often described differently in each report. Of this group, 47 (72%) patients did not undergo PF surgery. Eighteen (28%) patients did undergo PF surgery, of whom 14 had both hydrocephalus and brainstem displacement, 2 had brainstem displacement but no hydrocephalus, and 2 had neither brainstem displacement nor hydrocephalus and in retrospect did not benefit from PF surgery.</p><p><strong>Conclusions: </strong>The terminology in radiology reports describing EV PF CSF collections is variable, is inconsistent, and does not correlate well with clinical management or the need for PF surgery. Significant brainstem displacement and hydrocephalus in the presence of EV PF CSF collection is highly correlated with the need for PF surgery. The incidence of a PF EV CSF collection increasing to become symptomatic becomes more remote the older the patient is at the time of diagnosis as compared with those that occur mainly in infancy. There are true EV CSF cysts in the PF, but the ones that are of consequence are those that exert pressure on the brainstem, obstruct CSF flow, or both. Calling any increased amount of CSF in the PF a \"cyst\" or \"cystic\" can cause uncertainty, leading to one or more subsequent imaging studies or, in rare cases, unwarranted operative intervention.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727311","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}
Pub Date : 2024-07-12Print Date: 2024-10-01DOI: 10.3171/2024.5.PEDS24105
Matthew Jarrell, Caroline Caudill, Faizal Haji, Tofey Leon, Curtis J Rozzelle, Mary Halsey Maddox, Brandon G Rocque
Objective: The objective was to identify clinical and radiological factors associated with sleep-disordered breathing (SDB) in children with Chiari type I malformation (CIM) and to evaluate the efficacy of foramen magnum decompression (FMD) in resolving SDB.
Methods: A retrospective chart review was conducted for all children evaluated for CIM at a single institution from 2002 to 2022, identifying all children who had undergone nocturnal polysomnography (PSG). Apnea-hypopnea index (AHI) score, sleep apnea type (obstructive, central, mixed, and unspecified), clinical manifestations, and radiological measurements were recorded. SDB was considered present when officially diagnosed in the PSG report. Logistic regression was performed to identify factors correlating with the presence of SDB. For children with SDB who underwent FMD, the Wilcoxon signed-rank test was used to assess AHI improvement.
Results: Of the 997 children referred for CIM, 310 completed PSG. SDB was diagnosed in 147 patients (overall prevalence 14.7%, 95% CI 12.7%-17.1%; prevalence among children with PSG 47.4%, 95% CI 41.9%-53%). Specific SDB diagnosis consisted of 33% of patients with central sleep apnea, 27% with obstructive sleep apnea, 9% mixed, and 31% unspecified. Lower cranial nerve (CN) dysfunction (OR 3.891, p = 0.009), tonsillar position (OR 1.049, p = 0.017), Chiari type 1.5 malformation (OR 1.862, p = 0.044), and BMI (OR 1.039, p = 0.036) were significantly associated with presence of SDB. Of the 310 patients who underwent PSG, 47 were originally categorized as asymptomatic: 27 (57%) of these asymptomatic patients were diagnosed with SDB on PSG. Of children diagnosed with SDB, 34 completed PSG before and after FMD. Median AHI score decreased from 6.5 preoperatively to 1.8 postoperatively, with a median (IQR) difference of -2.3 (-11.9 to 0.1) (p = 0.001). Twelve (35%) had resolution of SDB.
Conclusions: The authors' findings suggest that the prevalence of SDB in children with CIM is high (15%-47%). Furthermore, lower CN dysfunction, Chiari type 1.5, lower tonsillar position, and higher BMI may be risk factors. Notably, SDB can be present even in the absence of clinical symptoms. This study also demonstrates that surgical intervention has the potential to reduce the severity of SDB. These results could help clinicians identify CIM patients at risk for SDB and those who may benefit from surgical decompression.
{"title":"Sleep-disordered breathing in children with Chiari type I malformation.","authors":"Matthew Jarrell, Caroline Caudill, Faizal Haji, Tofey Leon, Curtis J Rozzelle, Mary Halsey Maddox, Brandon G Rocque","doi":"10.3171/2024.5.PEDS24105","DOIUrl":"10.3171/2024.5.PEDS24105","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to identify clinical and radiological factors associated with sleep-disordered breathing (SDB) in children with Chiari type I malformation (CIM) and to evaluate the efficacy of foramen magnum decompression (FMD) in resolving SDB.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for all children evaluated for CIM at a single institution from 2002 to 2022, identifying all children who had undergone nocturnal polysomnography (PSG). Apnea-hypopnea index (AHI) score, sleep apnea type (obstructive, central, mixed, and unspecified), clinical manifestations, and radiological measurements were recorded. SDB was considered present when officially diagnosed in the PSG report. Logistic regression was performed to identify factors correlating with the presence of SDB. For children with SDB who underwent FMD, the Wilcoxon signed-rank test was used to assess AHI improvement.</p><p><strong>Results: </strong>Of the 997 children referred for CIM, 310 completed PSG. SDB was diagnosed in 147 patients (overall prevalence 14.7%, 95% CI 12.7%-17.1%; prevalence among children with PSG 47.4%, 95% CI 41.9%-53%). Specific SDB diagnosis consisted of 33% of patients with central sleep apnea, 27% with obstructive sleep apnea, 9% mixed, and 31% unspecified. Lower cranial nerve (CN) dysfunction (OR 3.891, p = 0.009), tonsillar position (OR 1.049, p = 0.017), Chiari type 1.5 malformation (OR 1.862, p = 0.044), and BMI (OR 1.039, p = 0.036) were significantly associated with presence of SDB. Of the 310 patients who underwent PSG, 47 were originally categorized as asymptomatic: 27 (57%) of these asymptomatic patients were diagnosed with SDB on PSG. Of children diagnosed with SDB, 34 completed PSG before and after FMD. Median AHI score decreased from 6.5 preoperatively to 1.8 postoperatively, with a median (IQR) difference of -2.3 (-11.9 to 0.1) (p = 0.001). Twelve (35%) had resolution of SDB.</p><p><strong>Conclusions: </strong>The authors' findings suggest that the prevalence of SDB in children with CIM is high (15%-47%). Furthermore, lower CN dysfunction, Chiari type 1.5, lower tonsillar position, and higher BMI may be risk factors. Notably, SDB can be present even in the absence of clinical symptoms. This study also demonstrates that surgical intervention has the potential to reduce the severity of SDB. These results could help clinicians identify CIM patients at risk for SDB and those who may benefit from surgical decompression.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141600217","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}
Pub Date : 2024-07-12Print Date: 2024-10-01DOI: 10.3171/2024.4.PEDS2481
Sina Sadeghzadeh, Thomas M Johnstone, Jurriaan M Peters, Brenda E Porter, S Katie Z Ihnen
Objective: The authors evaluated the impact of the timing of epilepsy surgery on postoperative neurocognitive outcomes in a cohort of children followed in the multiinstitutional Tuberous Sclerosis Complex (TSC) Autism Center of Excellence Research Network (TACERN) study.
Methods: Twenty-seven of 159 patients in the TACERN cohort had drug-refractory epilepsy and underwent surgery. Ages at surgery ranged from 15.86 to 154.14 weeks (median 91.93 weeks). Changes in patients' first preoperative (10-58 weeks) to last postoperative (155-188 weeks) scores on three neuropsychological tests-the Mullen Scales of Early Learning (MSEL), the Vineland Adaptive Behavior Scales, 2nd edition (VABS-2), and the Preschool Language Scales, 5th edition (PLS-5)-were calculated. Pearson correlation and multivariate linear regression models were used to correlate test outcomes separately with age at surgery and duration of epilepsy prior to surgery. Analyses were separately conducted for patients whose seizure burdens decreased postoperatively (n = 21) and those whose seizure burdens did not (n = 6). Regression analysis was specifically focused on the 21 patients who achieved successful seizure control.
Results: Age at surgery was significantly negatively correlated with the change in the combined verbal subtests of the MSEL (R = -0.45, p = 0.039) and predicted this score in a multivariate linear regression model (β = -0.09, p = 0.035). Similar trends were seen in the total language score of the PLS-5 (R = -0.4, p = 0.089; β = -0.12, p = 0.014) and in analyses examining the duration of epilepsy prior to surgery as the independent variable of interest. Associations between age at surgery and duration of epilepsy prior to surgery with changes in the verbal subscores of VABS-2 were more variable (R = -0.15, p = 0.52; β = -0.05, p = 0.482).
Conclusions: Earlier surgery and shorter epilepsy duration prior to surgery were associated with greater improvement in postoperative language in patients with TSC. Prospective or comparative effectiveness clinical trials are needed to further elucidate surgical timing impacts on neurocognitive outcomes.
{"title":"Association of earlier surgery with improved postoperative language development in children with tuberous sclerosis complex.","authors":"Sina Sadeghzadeh, Thomas M Johnstone, Jurriaan M Peters, Brenda E Porter, S Katie Z Ihnen","doi":"10.3171/2024.4.PEDS2481","DOIUrl":"10.3171/2024.4.PEDS2481","url":null,"abstract":"<p><strong>Objective: </strong>The authors evaluated the impact of the timing of epilepsy surgery on postoperative neurocognitive outcomes in a cohort of children followed in the multiinstitutional Tuberous Sclerosis Complex (TSC) Autism Center of Excellence Research Network (TACERN) study.</p><p><strong>Methods: </strong>Twenty-seven of 159 patients in the TACERN cohort had drug-refractory epilepsy and underwent surgery. Ages at surgery ranged from 15.86 to 154.14 weeks (median 91.93 weeks). Changes in patients' first preoperative (10-58 weeks) to last postoperative (155-188 weeks) scores on three neuropsychological tests-the Mullen Scales of Early Learning (MSEL), the Vineland Adaptive Behavior Scales, 2nd edition (VABS-2), and the Preschool Language Scales, 5th edition (PLS-5)-were calculated. Pearson correlation and multivariate linear regression models were used to correlate test outcomes separately with age at surgery and duration of epilepsy prior to surgery. Analyses were separately conducted for patients whose seizure burdens decreased postoperatively (n = 21) and those whose seizure burdens did not (n = 6). Regression analysis was specifically focused on the 21 patients who achieved successful seizure control.</p><p><strong>Results: </strong>Age at surgery was significantly negatively correlated with the change in the combined verbal subtests of the MSEL (R = -0.45, p = 0.039) and predicted this score in a multivariate linear regression model (β = -0.09, p = 0.035). Similar trends were seen in the total language score of the PLS-5 (R = -0.4, p = 0.089; β = -0.12, p = 0.014) and in analyses examining the duration of epilepsy prior to surgery as the independent variable of interest. Associations between age at surgery and duration of epilepsy prior to surgery with changes in the verbal subscores of VABS-2 were more variable (R = -0.15, p = 0.52; β = -0.05, p = 0.482).</p><p><strong>Conclusions: </strong>Earlier surgery and shorter epilepsy duration prior to surgery were associated with greater improvement in postoperative language in patients with TSC. Prospective or comparative effectiveness clinical trials are needed to further elucidate surgical timing impacts on neurocognitive outcomes.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141600216","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}
Pub Date : 2024-07-05Print Date: 2024-09-01DOI: 10.3171/2024.4.PEDS24168
Radek Frič, Eline Bryne, Bogna Warsza, Per Kristian Eide
Objective: Reduced intracranial compliance (ICC) may be an important factor in the pathophysiology of Chiari malformation type I (CM-I). However, direct measurement of ICC is controversial because of its invasiveness, particularly in children. Instead, ICC may be estimated from continuous measurements of intracranial pressure (ICP), where the metric mean wave amplitude (MWA) has been found to be more useful as a surrogate marker of ICC than mean ICP. This observational study investigated the distribution of MWA and mean ICP in symptomatic children with CM-I, as well as their association with clinical and radiological findings.
Methods: From a consecutive series of children treated for CM-I at a single institution between 2006 and 2023, the authors analyzed ICP scores in those who underwent an overnight preoperative ICP recording in which MWA was calculated. Clinical and radiological data were retrieved from the patient records.
Results: Thirty-seven children (mean age 12.4 ± 3.6 years) with symptomatic CM-I were identified. From the overnight ICP measurements, the average MWA was 5.2 ± 1.3 mm Hg: 56% of children had an abnormal MWA (> 5 mm Hg) and 33% had a borderline MWA (4-5 mm Hg). In contrast, the average mean ICP was 9.7 ± 4.1 mm Hg: 8% of children had an abnormal mean ICP (> 15 mm Hg) and 41% had a borderline mean ICP (10-15 mm Hg). Thus, more children were found to have an abnormal MWA than an abnormal mean ICP (p < 0.001). MWA was significantly higher in the subgroup of children with medullary compression in the foramen magnum, as seen on MRI, than in those without (5.6 ± 1.0 mm Hg vs 4.7 ± 1.4 mm Hg, p = 0.03), whereas a similar difference was not observed for mean ICP (9.9 ± 4.6 mm Hg vs 9.7 ± 3.7 mm Hg, p = 0.889).
Conclusions: In this cohort of symptomatic children with CM-I, MWA was more frequently abnormal than mean ICP, with a clinically significant discrepancy in half of the patients. Moreover, MWA was significantly higher in patients with medullary compression. Based on these findings, the authors' interpretation is that in children with CM-I, the ICC may be reduced, as indicated by increased MWA, even though the mean ICP is within normal thresholds.
目的:颅内顺应性(ICC)降低可能是奇拉氏畸形 I 型(CM-I)病理生理学的一个重要因素。然而,直接测量 ICC 因其侵入性而备受争议,尤其是对儿童而言。取而代之的是,可以通过连续测量颅内压(ICP)来估算 ICC,其中指标平均波幅(MWA)作为 ICC 的替代标记比平均 ICP 更有用。本观察性研究调查了有症状的 CM-I 儿童中 MWA 和平均 ICP 的分布情况,以及它们与临床和放射学检查结果的关联:作者分析了2006年至2023年间在一家医疗机构接受CM-I治疗的连续系列患儿的ICP评分,这些患儿在术前进行了ICP过夜记录,并在记录中计算了MWA。临床和放射学数据均来自患者病历:结果:共发现 37 名患有无症状 CM-I 的儿童(平均年龄为 12.4 ± 3.6 岁)。隔夜 ICP 测量结果显示,平均 MWA 为 5.2 ± 1.3 mm Hg:56%的儿童 MWA 异常(> 5 mm Hg),33%的儿童 MWA 处于边缘(4-5 mm Hg)。相比之下,ICP 的平均值为 9.7 ± 4.1 mm Hg:8%的儿童ICP平均值异常(> 15 mm Hg),41%的儿童ICP平均值处于边缘水平(10-15 mm Hg)。因此,发现 MWA 异常的儿童人数多于平均 ICP 异常的儿童人数(P < 0.001)。MWA在磁共振成像中显示为髓质压迫枕骨大孔的儿童亚组中明显高于没有压迫枕骨大孔的儿童亚组(5.6 ± 1.0 mm Hg vs 4.7 ± 1.4 mm Hg,p = 0.03),而在平均ICP方面没有观察到类似的差异(9.9 ± 4.6 mm Hg vs 9.7 ± 3.7 mm Hg,p = 0.889):在这批有症状的 CM-I 儿童中,MWA 比平均 ICP 更常出现异常,半数患者的差异具有临床意义。此外,髓质受压患者的 MWA 明显更高。基于这些发现,作者认为,对于 CM-I 儿童,即使平均 ICP 在正常阈值范围内,MWA 增加也表明 ICC 可能降低。
{"title":"Intracranial pulse pressure amplitude as an indicator of intracranial compliance: observations in symptomatic children with Chiari malformation type I.","authors":"Radek Frič, Eline Bryne, Bogna Warsza, Per Kristian Eide","doi":"10.3171/2024.4.PEDS24168","DOIUrl":"10.3171/2024.4.PEDS24168","url":null,"abstract":"<p><strong>Objective: </strong>Reduced intracranial compliance (ICC) may be an important factor in the pathophysiology of Chiari malformation type I (CM-I). However, direct measurement of ICC is controversial because of its invasiveness, particularly in children. Instead, ICC may be estimated from continuous measurements of intracranial pressure (ICP), where the metric mean wave amplitude (MWA) has been found to be more useful as a surrogate marker of ICC than mean ICP. This observational study investigated the distribution of MWA and mean ICP in symptomatic children with CM-I, as well as their association with clinical and radiological findings.</p><p><strong>Methods: </strong>From a consecutive series of children treated for CM-I at a single institution between 2006 and 2023, the authors analyzed ICP scores in those who underwent an overnight preoperative ICP recording in which MWA was calculated. Clinical and radiological data were retrieved from the patient records.</p><p><strong>Results: </strong>Thirty-seven children (mean age 12.4 ± 3.6 years) with symptomatic CM-I were identified. From the overnight ICP measurements, the average MWA was 5.2 ± 1.3 mm Hg: 56% of children had an abnormal MWA (> 5 mm Hg) and 33% had a borderline MWA (4-5 mm Hg). In contrast, the average mean ICP was 9.7 ± 4.1 mm Hg: 8% of children had an abnormal mean ICP (> 15 mm Hg) and 41% had a borderline mean ICP (10-15 mm Hg). Thus, more children were found to have an abnormal MWA than an abnormal mean ICP (p < 0.001). MWA was significantly higher in the subgroup of children with medullary compression in the foramen magnum, as seen on MRI, than in those without (5.6 ± 1.0 mm Hg vs 4.7 ± 1.4 mm Hg, p = 0.03), whereas a similar difference was not observed for mean ICP (9.9 ± 4.6 mm Hg vs 9.7 ± 3.7 mm Hg, p = 0.889).</p><p><strong>Conclusions: </strong>In this cohort of symptomatic children with CM-I, MWA was more frequently abnormal than mean ICP, with a clinically significant discrepancy in half of the patients. Moreover, MWA was significantly higher in patients with medullary compression. Based on these findings, the authors' interpretation is that in children with CM-I, the ICC may be reduced, as indicated by increased MWA, even though the mean ICP is within normal thresholds.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537964","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}
Pub Date : 2024-07-05Print Date: 2024-10-01DOI: 10.3171/2024.4.PEDS24102
Martin G Piazza, Vijay M Ravindra, Emma R Earl, Allison Ludwick, Gabriela Sarriera Valentin, Andrew T Dailey, John R W Kestle, Katie W Russell, Douglas L Brockmeyer, Rajiv R Iyer
Objective: The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice.
Methods: A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021. An SLIC score was calculated for each patient, and the subsequent recommendations were compared with actual treatment delivered. Percentage misclassification, sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated.
Results: Two hundred forty-three pediatric patients with trauma were included. Twenty-five patients (10.3%) underwent surgery and 218 were managed conservatively. The median SLIC score was 2 (interquartile range = 2). Sixteen patients (6.6%) had an SLIC score of 4, for which either conservative or surgical treatment is recommended; 27 children had an SLIC score ≥ 5, indicating a recommendation for surgical treatment; and 200 children had an SLIC score ≤ 3, indicating a recommendation for conservative treatment. Of the 243 patients, 227 received treatment consistent with SLIC score recommendations (p < 0.001). SLIC sensitivity in determining surgically treated patients was 79.2% and the specificity for accurately determining who underwent conservative treatment was 96.1%. The PPV was 70.3% and the NPV was 97.5%. There was a 5.7% misclassification rate (n = 13) using SLIC. Among patients for whom surgical treatment would be recommended by the SLIC, 29.6% (n = 8) did not undergo surgery; similarly, 2.5% (n = 5) of patients for whom conservative management would be recommended by the SLIC had surgery. The ROC curve for determining treatment received demonstrated excellent discriminative ability, with an AUC of 0.96 (OR 3.12, p < 0.001). Sensitivity decreased when the cohort was split by age (< 10 and ≥ 10 years old) to 0.5 and 0.82, respectively; specificity remained high at 0.98 and 0.94.
Conclusions: The SLIC scoring system recommended similar treatment when compared with the actual treatment delivered for traumatic subaxial cervical spine injuries in children, with a low misclassification rate and a specificity of 96%. These findings demonstrate that the SLIC can be useful in guiding treatment for pediatric patients with subaxial cervical spine injuries. Further investigation into the score in young children (< 10 years) using a multicenter cohort is warranted.
{"title":"Validation of the Subaxial Cervical Spine Injury Classification score in children: a single-institution experience at a level 1 pediatric trauma center.","authors":"Martin G Piazza, Vijay M Ravindra, Emma R Earl, Allison Ludwick, Gabriela Sarriera Valentin, Andrew T Dailey, John R W Kestle, Katie W Russell, Douglas L Brockmeyer, Rajiv R Iyer","doi":"10.3171/2024.4.PEDS24102","DOIUrl":"10.3171/2024.4.PEDS24102","url":null,"abstract":"<p><strong>Objective: </strong>The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice.</p><p><strong>Methods: </strong>A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021. An SLIC score was calculated for each patient, and the subsequent recommendations were compared with actual treatment delivered. Percentage misclassification, sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated.</p><p><strong>Results: </strong>Two hundred forty-three pediatric patients with trauma were included. Twenty-five patients (10.3%) underwent surgery and 218 were managed conservatively. The median SLIC score was 2 (interquartile range = 2). Sixteen patients (6.6%) had an SLIC score of 4, for which either conservative or surgical treatment is recommended; 27 children had an SLIC score ≥ 5, indicating a recommendation for surgical treatment; and 200 children had an SLIC score ≤ 3, indicating a recommendation for conservative treatment. Of the 243 patients, 227 received treatment consistent with SLIC score recommendations (p < 0.001). SLIC sensitivity in determining surgically treated patients was 79.2% and the specificity for accurately determining who underwent conservative treatment was 96.1%. The PPV was 70.3% and the NPV was 97.5%. There was a 5.7% misclassification rate (n = 13) using SLIC. Among patients for whom surgical treatment would be recommended by the SLIC, 29.6% (n = 8) did not undergo surgery; similarly, 2.5% (n = 5) of patients for whom conservative management would be recommended by the SLIC had surgery. The ROC curve for determining treatment received demonstrated excellent discriminative ability, with an AUC of 0.96 (OR 3.12, p < 0.001). Sensitivity decreased when the cohort was split by age (< 10 and ≥ 10 years old) to 0.5 and 0.82, respectively; specificity remained high at 0.98 and 0.94.</p><p><strong>Conclusions: </strong>The SLIC scoring system recommended similar treatment when compared with the actual treatment delivered for traumatic subaxial cervical spine injuries in children, with a low misclassification rate and a specificity of 96%. These findings demonstrate that the SLIC can be useful in guiding treatment for pediatric patients with subaxial cervical spine injuries. Further investigation into the score in young children (< 10 years) using a multicenter cohort is warranted.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537965","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}
Pub Date : 2024-07-05Print Date: 2024-10-01DOI: 10.3171/2024.5.PEDS2469
Vijay M Ravindra, Jay Riva-Cambrin, Hailey Jensen, William E Whitehead, Abhaya V Kulkarni, David D Limbrick, John C Wellons, Robert P Naftel, Curtis J Rozzelle, Brandon G Rocque, Ian F Pollack, Michael M McDowell, Mandeep S Tamber, Jason S Hauptman, Samuel R Browd, Jonathan Pindrik, Albert M Isaacs, Patrick J McDonald, Todd C Hankinson, Eric M Jackson, Jason Chu, Mark D Krieger, Tamara D Simon, Jennifer M Strahle, Richard Holubkov, Ron Reeder, John R W Kestle
Objective: When the peritoneal cavity cannot serve as the distal shunt terminus, nonperitoneal shunts, typically terminating in the atrium or pleural space, are used. The comparative effectiveness of these two terminus options has not been evaluated. The authors directly compared shunt survival and complication rates for ventriculoatrial (VA) and ventriculopleural (VPl) shunts in a pediatric cohort.
Methods: The Hydrocephalus Clinical Research Network Core Data Project was used to identify children ≤ 18 years of age who underwent either VA or VPl shunt insertion. The primary outcome was time to shunt failure. Secondary outcomes included distal site complications and frequency of shunt failure at 6, 12, and 24 months.
Results: The search criteria yielded 416 children from 14 centers with either a VA (n = 318) or VPl (n = 98) shunt, including those converted from ventriculoperitoneal shunts. Children with VA shunts had a lower median age at insertion (6.1 years vs 12.4 years, p < 0.001). Among those children with VA shunts, a hydrocephalus etiology of intraventricular hemorrhage (IVH) secondary to prematurity comprised a higher proportion (47.0% vs 31.2%) and myelomeningocele comprised a lower proportion (17.8% vs 27.3%) (p = 0.024) compared with those with VPl shunts. At 24 months, there was a higher cumulative number of revisions for VA shunts (48.6% vs 38.9%, p = 0.038). When stratified by patient age at shunt insertion, VA shunts in children < 6 years had the lowest shunt survival rate (p < 0.001, log-rank test). After controlling for age and etiology, multivariable analysis did not find that shunt type (VA vs VPl) was predictive of time to shunt failure. No differences were found in the cumulative frequency of complications (VA 6.0% vs VPl 9.2%, p = 0.257), but there was a higher rate of pneumothorax in the VPl cohort (3.1% vs 0%, p = 0.013).
Conclusions: Shunt survival was similar between VA and VPl shunts, although VA shunts are used more often, particularly in younger patients. Children < 6 years with VA shunts appeared to have the shortest shunt survival, which may be a result of the VA group having more cases of IVH secondary to prematurity; however, when age and etiology were included in a multivariable model, shunt location (atrium vs pleural space) was not associated with time to failure. The baseline differences between children treated with a VA versus a VPl shunt likely explain current practice patterns.
目的:当腹腔不能作为远端分流终点时,就会使用非腹腔分流,通常以心房或胸膜腔为终点。目前尚未对这两种终点选择的有效性进行比较评估。作者在儿科队列中直接比较了脑室-心房(VA)和脑室-胸膜(VPl)分流术的存活率和并发症发生率:方法:利用脑积水临床研究网络核心数据项目确定接受过VA或VPl分流术的18岁以下儿童。主要结果是分流失败的时间。次要结果包括远端部位并发症以及6、12和24个月时分流失败的频率:根据搜索标准,14个中心的416名患儿接受了VA(n = 318)或VPl(n = 98)分流术,其中包括从脑室腹腔分流术转化而来的患儿。使用 VA 分流的患儿插入时的中位年龄较低(6.1 岁对 12.4 岁,P < 0.001)。在接受VA分流术的患儿中,与接受VPl分流术的患儿相比,因早产而继发脑室内出血(IVH)的脑积水患儿比例较高(47.0% vs 31.2%),而髓鞘膜积液患儿比例较低(17.8% vs 27.3%)(P = 0.024)。在 24 个月时,VA 分流的累计翻修次数更高(48.6% 对 38.9%,p = 0.038)。如果根据患者插入分流管时的年龄进行分层,小于 6 岁儿童的 VA 分流存活率最低(p < 0.001,对数秩检验)。在对年龄和病因进行控制后,多变量分析并未发现分流类型(VA 与 VPl)可预测分流失败的时间。并发症的累积发生率没有差异(VA 6.0% vs VPl 9.2%,p = 0.257),但 VPl 组群的气胸发生率更高(3.1% vs 0%,p = 0.013):结论:尽管VA分流术和VPl分流术的存活率相似,但VA分流术的使用率更高,尤其是在年龄较小的患者中。使用VA分流术的6岁以下儿童的分流术存活时间最短,这可能是由于VA组因早产而继发IVH的病例较多;然而,将年龄和病因纳入多变量模型后,分流术位置(心房与胸膜腔)与失败时间无关。采用VA分流术与VPl分流术治疗的患儿之间的基线差异很可能解释了目前的治疗模式。
{"title":"Comparing ventriculoatrial and ventriculopleural shunts in pediatric hydrocephalus: a Hydrocephalus Clinical Research Network study.","authors":"Vijay M Ravindra, Jay Riva-Cambrin, Hailey Jensen, William E Whitehead, Abhaya V Kulkarni, David D Limbrick, John C Wellons, Robert P Naftel, Curtis J Rozzelle, Brandon G Rocque, Ian F Pollack, Michael M McDowell, Mandeep S Tamber, Jason S Hauptman, Samuel R Browd, Jonathan Pindrik, Albert M Isaacs, Patrick J McDonald, Todd C Hankinson, Eric M Jackson, Jason Chu, Mark D Krieger, Tamara D Simon, Jennifer M Strahle, Richard Holubkov, Ron Reeder, John R W Kestle","doi":"10.3171/2024.5.PEDS2469","DOIUrl":"10.3171/2024.5.PEDS2469","url":null,"abstract":"<p><strong>Objective: </strong>When the peritoneal cavity cannot serve as the distal shunt terminus, nonperitoneal shunts, typically terminating in the atrium or pleural space, are used. The comparative effectiveness of these two terminus options has not been evaluated. The authors directly compared shunt survival and complication rates for ventriculoatrial (VA) and ventriculopleural (VPl) shunts in a pediatric cohort.</p><p><strong>Methods: </strong>The Hydrocephalus Clinical Research Network Core Data Project was used to identify children ≤ 18 years of age who underwent either VA or VPl shunt insertion. The primary outcome was time to shunt failure. Secondary outcomes included distal site complications and frequency of shunt failure at 6, 12, and 24 months.</p><p><strong>Results: </strong>The search criteria yielded 416 children from 14 centers with either a VA (n = 318) or VPl (n = 98) shunt, including those converted from ventriculoperitoneal shunts. Children with VA shunts had a lower median age at insertion (6.1 years vs 12.4 years, p < 0.001). Among those children with VA shunts, a hydrocephalus etiology of intraventricular hemorrhage (IVH) secondary to prematurity comprised a higher proportion (47.0% vs 31.2%) and myelomeningocele comprised a lower proportion (17.8% vs 27.3%) (p = 0.024) compared with those with VPl shunts. At 24 months, there was a higher cumulative number of revisions for VA shunts (48.6% vs 38.9%, p = 0.038). When stratified by patient age at shunt insertion, VA shunts in children < 6 years had the lowest shunt survival rate (p < 0.001, log-rank test). After controlling for age and etiology, multivariable analysis did not find that shunt type (VA vs VPl) was predictive of time to shunt failure. No differences were found in the cumulative frequency of complications (VA 6.0% vs VPl 9.2%, p = 0.257), but there was a higher rate of pneumothorax in the VPl cohort (3.1% vs 0%, p = 0.013).</p><p><strong>Conclusions: </strong>Shunt survival was similar between VA and VPl shunts, although VA shunts are used more often, particularly in younger patients. Children < 6 years with VA shunts appeared to have the shortest shunt survival, which may be a result of the VA group having more cases of IVH secondary to prematurity; however, when age and etiology were included in a multivariable model, shunt location (atrium vs pleural space) was not associated with time to failure. The baseline differences between children treated with a VA versus a VPl shunt likely explain current practice patterns.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11244699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05Print Date: 2024-10-01DOI: 10.3171/2024.3.PEDS22376
Peter H Yang, Sasidhar Karuparti, Kaamya Varagur, Dimitrios Alexopoulos, Ron W Reeder, Rachel E Lean, Cynthia E Rogers, David D Limbrick, Christopher D Smyser, Jennifer M Strahle
Objective: The objective of this study was to evaluate whether volumetric measurements on early cranial ultrasound (CUS) in high-grade germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are associated with hydrocephalus and neurodevelopmental metrics.
Methods: A retrospective case series analysis of infants with high-grade GMH-IVH admitted to the St. Louis Children's Hospital neonatal intensive care unit between 2007 and 2015 who underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) at 2 years of corrected age was performed. GMH volume, periventricular hemorrhagic infarction volume, and frontotemporal horn ratio were obtained from direct review of neonatal CUS studies. Univariate and multivariable regression models were used to evaluate the association between hemorrhage volumes and hydrocephalus requiring permanent CSF diversion with ventricular shunt or endoscopic third ventriculostomy with or without choroid plexus cauterization and composite Bayley-III cognitive, language, and motor scores.
Results: Forty-three infants (29 males, mean gestational age 25 weeks) met the inclusion criteria. The mean age at time of the CUS with the largest hemorrhage volume or first diagnosis of highest grade was 6.2 days. Nineteen patients underwent treatment for hydrocephalus with permanent CSF diversion. In multivariable analyses, larger GMH volume was associated with worse estimated Bayley-III cognitive (left-sided GMH volume: p = 0.048, total GMH volume: p = 0.023) and motor (left-sided GMH volume: p = 0.010; total GMH volume: p = 0.014) scores. Larger periventricular hemorrhagic infarction volume was associated with worse estimated Bayley-III motor scores (each side p < 0.04). Larger left-sided (OR 2.55, 95% CI 1.10-5.88; p = 0.028) and total (OR 1.35, 95% CI 1.01-1.79; p = 0.041) GMH volumes correlated with hydrocephalus. There was no relationship between early ventricular volume and hydrocephalus or neurodevelopmental outcomes.
Conclusions: Location-specific hemorrhage volume on early CUS may be prognostic for neurodevelopmental and hydrocephalus outcomes in high-grade GMH-IVH.
研究目的本研究旨在评估高级别胚芽基质出血-脑室内出血(GMH-IVH)的早期头颅超声(CUS)容积测量值是否与脑积水和神经发育指标相关:方法: 对2007年至2015年期间入住圣路易斯儿童医院新生儿重症监护室的高位GMH-IVH婴儿进行了回顾性病例系列分析,这些婴儿在2岁矫正年龄时接受了贝利婴幼儿发育量表第3版(Bayley-III)的神经发育测试。GMH容积、脑室周围出血性梗死容积和额颞角比率是通过直接回顾新生儿CUS研究获得的。使用单变量和多变量回归模型评估出血量与需要通过脑室分流术或内镜下第三脑室造口术(带或不带脉络丛烧灼)进行永久性 CSF 分流的脑积水以及 Bayley-III 认知、语言和运动综合评分之间的关系:43名婴儿(29名男性,平均胎龄25周)符合纳入标准。CUS出血量最大或首次诊断为最高级别时的平均年龄为6.2天。19名患者接受了永久性脑脊液转移治疗。在多变量分析中,GMH体积越大,估计的Bayley-III认知(左侧GMH体积:p = 0.048,GMH总体积:p = 0.023)和运动(左侧GMH体积:p = 0.010;GMH总体积:p = 0.014)评分越差。脑室周围出血性梗死体积越大,估计的 Bayley-III 运动评分越差(每侧 p < 0.04)。较大的左侧(OR 2.55,95% CI 1.10-5.88;p = 0.028)和总(OR 1.35,95% CI 1.01-1.79;p = 0.041)GMH体积与脑积水相关。早期脑室容量与脑积水或神经发育结果之间没有关系:结论:早期CUS上特定位置的出血量可能是高位GMH-IVH患者神经发育和脑积水预后的预示因素。
{"title":"Association of germinal matrix hemorrhage volume with neurodevelopment and hydrocephalus.","authors":"Peter H Yang, Sasidhar Karuparti, Kaamya Varagur, Dimitrios Alexopoulos, Ron W Reeder, Rachel E Lean, Cynthia E Rogers, David D Limbrick, Christopher D Smyser, Jennifer M Strahle","doi":"10.3171/2024.3.PEDS22376","DOIUrl":"10.3171/2024.3.PEDS22376","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate whether volumetric measurements on early cranial ultrasound (CUS) in high-grade germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are associated with hydrocephalus and neurodevelopmental metrics.</p><p><strong>Methods: </strong>A retrospective case series analysis of infants with high-grade GMH-IVH admitted to the St. Louis Children's Hospital neonatal intensive care unit between 2007 and 2015 who underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) at 2 years of corrected age was performed. GMH volume, periventricular hemorrhagic infarction volume, and frontotemporal horn ratio were obtained from direct review of neonatal CUS studies. Univariate and multivariable regression models were used to evaluate the association between hemorrhage volumes and hydrocephalus requiring permanent CSF diversion with ventricular shunt or endoscopic third ventriculostomy with or without choroid plexus cauterization and composite Bayley-III cognitive, language, and motor scores.</p><p><strong>Results: </strong>Forty-three infants (29 males, mean gestational age 25 weeks) met the inclusion criteria. The mean age at time of the CUS with the largest hemorrhage volume or first diagnosis of highest grade was 6.2 days. Nineteen patients underwent treatment for hydrocephalus with permanent CSF diversion. In multivariable analyses, larger GMH volume was associated with worse estimated Bayley-III cognitive (left-sided GMH volume: p = 0.048, total GMH volume: p = 0.023) and motor (left-sided GMH volume: p = 0.010; total GMH volume: p = 0.014) scores. Larger periventricular hemorrhagic infarction volume was associated with worse estimated Bayley-III motor scores (each side p < 0.04). Larger left-sided (OR 2.55, 95% CI 1.10-5.88; p = 0.028) and total (OR 1.35, 95% CI 1.01-1.79; p = 0.041) GMH volumes correlated with hydrocephalus. There was no relationship between early ventricular volume and hydrocephalus or neurodevelopmental outcomes.</p><p><strong>Conclusions: </strong>Location-specific hemorrhage volume on early CUS may be prognostic for neurodevelopmental and hydrocephalus outcomes in high-grade GMH-IVH.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141537962","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}
Objective: An association between blunt head trauma and cerebral venous sinus thrombosis (CVST) has been recognized, but its symptoms are nonspecific and the duration of symptoms remains unclear. Anticoagulation therapy is not considered necessary in most cases of traumatic CVST; however, this is controversial. The aim of this study was to describe the clinical characteristics and outcomes of children with CVST after isolated head trauma.
Methods: The records of pediatric patients with isolated head trauma admitted for observation at 3 medical centers between January 2018 and May 2023 were reviewed retrospectively. CVST was diagnosed on MR venography (MRV). Clinical presentation, therapeutic management, and outcomes were evaluated in patients who had follow-up MRV.
Results: Of 260 pediatric patients with head trauma admitted to the 3 hospitals, 26 patients underwent MRV and 8 (30.8%) were diagnosed with CVST. One patient was treated with heparin, while the others received conservative treatment. All patients were discharged home asymptomatic. MRV performed during follow-up displayed complete recanalization in all cases, except for 1 case with partial recanalization. The median hospital stay was longer in patients with CVST than in those without CVST (9.5 vs 3.0 days, p = 0.001).
Conclusions: The length of stay of pediatric patients with traumatic CVST was prolonged compared with those without CVST, but most patients had good outcomes with spontaneous recanalization following conservative treatment.
{"title":"Clinical features of pediatric patients with cerebral venous sinus thrombosis after isolated head trauma.","authors":"Saki Kotani, Gaku Fujiwara, Keisuke Fuji, Toyonobu Maekawa, Shogo Ogita, Yudai Goto, Mamoru Murakami, Satoshi Kimura, Nobukuni Murakami, Naoya Hashimoto","doi":"10.3171/2024.4.PEDS24109","DOIUrl":"10.3171/2024.4.PEDS24109","url":null,"abstract":"<p><strong>Objective: </strong>An association between blunt head trauma and cerebral venous sinus thrombosis (CVST) has been recognized, but its symptoms are nonspecific and the duration of symptoms remains unclear. Anticoagulation therapy is not considered necessary in most cases of traumatic CVST; however, this is controversial. The aim of this study was to describe the clinical characteristics and outcomes of children with CVST after isolated head trauma.</p><p><strong>Methods: </strong>The records of pediatric patients with isolated head trauma admitted for observation at 3 medical centers between January 2018 and May 2023 were reviewed retrospectively. CVST was diagnosed on MR venography (MRV). Clinical presentation, therapeutic management, and outcomes were evaluated in patients who had follow-up MRV.</p><p><strong>Results: </strong>Of 260 pediatric patients with head trauma admitted to the 3 hospitals, 26 patients underwent MRV and 8 (30.8%) were diagnosed with CVST. One patient was treated with heparin, while the others received conservative treatment. All patients were discharged home asymptomatic. MRV performed during follow-up displayed complete recanalization in all cases, except for 1 case with partial recanalization. The median hospital stay was longer in patients with CVST than in those without CVST (9.5 vs 3.0 days, p = 0.001).</p><p><strong>Conclusions: </strong>The length of stay of pediatric patients with traumatic CVST was prolonged compared with those without CVST, but most patients had good outcomes with spontaneous recanalization following conservative treatment.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468726","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}
Pub Date : 2024-06-28Print Date: 2024-09-01DOI: 10.3171/2024.4.PEDS23475
Karim Mithani, Jennifer L Quon, Sara Breitbart, Patrick E Steadman, Ladina Greuter, Oliver L Richards, Ann K Schmitz, Hrishikesh Suresh, Noor Malik, Abdullah AlRamadan, George M Ibrahim, James T Rutka
Objective: Functional hemispherectomy is an effective surgical intervention for select patients with drug-resistant epilepsy. The last several decades have seen dramatic evolutions in preoperative evaluation, surgical techniques, and postoperative care. Here, the authors present a retrospective review of the medical records of 146 children who underwent hemispherectomy between 1987 and 2022 at The Hospital for Sick Children, providing a unique overview of the evolution of the procedure and patient outcomes over 35 years.
Methods: The medical records of all children who underwent hemispherectomy at The Hospital for Sick Children between 1987 and 2022 were reviewed. Demographic information, preoperative clinical features, short-term and long-term seizure outcomes, and details regarding postoperative complications were recorded.
Results: The seizure outcomes of 146 children were analyzed. There were 68 females and 78 males with a mean age of 5.08 years, 123 of whom demonstrated seizure freedom (Engel class IA) in the short-term postoperative follow-up period and 89 in the long term. The effectiveness of hemispherectomy in achieving long-term seizure control has improved over time (β = 0.06, p < 0.001). Factors associated with overall seizure freedom included younger age at the time of hemispherectomy and stroke as the etiology of seizures, as well as complete disconnection during the first surgery. Additionally, the etiologies of epilepsy for which hemispherectomy is performed have expanded over time, while complication rates have remained unchanged.
Conclusions: Hemispherectomy is an increasingly effective treatment for certain cases of drug-resistant epilepsy. The etiologies of epilepsy for which hemispherectomy is performed are broadening, with no change in its safety profile. Seizure outcomes are better when the etiology of epilepsy is an ischemic injury, and the most common complication after the procedure is hydrocephalus. These findings reinforce the ongoing use of hemispherectomy as a safe and effective treatment option for certain individuals with drug-resistant epilepsy, support its application to a broader range of etiologies, and highlight areas of future investigation.
{"title":"Hemispherectomy at The Hospital for Sick Children: expanded indications and lessons learned over 35 years.","authors":"Karim Mithani, Jennifer L Quon, Sara Breitbart, Patrick E Steadman, Ladina Greuter, Oliver L Richards, Ann K Schmitz, Hrishikesh Suresh, Noor Malik, Abdullah AlRamadan, George M Ibrahim, James T Rutka","doi":"10.3171/2024.4.PEDS23475","DOIUrl":"10.3171/2024.4.PEDS23475","url":null,"abstract":"<p><strong>Objective: </strong>Functional hemispherectomy is an effective surgical intervention for select patients with drug-resistant epilepsy. The last several decades have seen dramatic evolutions in preoperative evaluation, surgical techniques, and postoperative care. Here, the authors present a retrospective review of the medical records of 146 children who underwent hemispherectomy between 1987 and 2022 at The Hospital for Sick Children, providing a unique overview of the evolution of the procedure and patient outcomes over 35 years.</p><p><strong>Methods: </strong>The medical records of all children who underwent hemispherectomy at The Hospital for Sick Children between 1987 and 2022 were reviewed. Demographic information, preoperative clinical features, short-term and long-term seizure outcomes, and details regarding postoperative complications were recorded.</p><p><strong>Results: </strong>The seizure outcomes of 146 children were analyzed. There were 68 females and 78 males with a mean age of 5.08 years, 123 of whom demonstrated seizure freedom (Engel class IA) in the short-term postoperative follow-up period and 89 in the long term. The effectiveness of hemispherectomy in achieving long-term seizure control has improved over time (β = 0.06, p < 0.001). Factors associated with overall seizure freedom included younger age at the time of hemispherectomy and stroke as the etiology of seizures, as well as complete disconnection during the first surgery. Additionally, the etiologies of epilepsy for which hemispherectomy is performed have expanded over time, while complication rates have remained unchanged.</p><p><strong>Conclusions: </strong>Hemispherectomy is an increasingly effective treatment for certain cases of drug-resistant epilepsy. The etiologies of epilepsy for which hemispherectomy is performed are broadening, with no change in its safety profile. Seizure outcomes are better when the etiology of epilepsy is an ischemic injury, and the most common complication after the procedure is hydrocephalus. These findings reinforce the ongoing use of hemispherectomy as a safe and effective treatment option for certain individuals with drug-resistant epilepsy, support its application to a broader range of etiologies, and highlight areas of future investigation.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468727","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}
Pub Date : 2024-06-21Print Date: 2024-09-01DOI: 10.3171/2024.4.PEDS23486
Steven P Moura, Alexandra D Center, Manasa Kalluri, Jessica Blum, Ellen C Shaffrey, Samuel Lee, Jinggang J Ng, Bermans J Iskandar, Catharine B Garland, Daniel Y Cho
Objective: Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can address these sequelae, the postoperative outcomes, complications, and mortality risk of reduction cranioplasty are not well understood given the rarity of hydrocephalic macrocephaly. Therefore, the primary objective of this systematic review was to evaluate the surgical outcomes of reduction cranioplasty for the treatment of hydrocephalic macrocephaly.
Methods: A systematic review was performed using the PubMed, Scopus, and Web of Science databases while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened 350 studies; 27 studies reporting surgical outcomes on reduction cranioplasty for hydrocephalic macrocephaly met inclusion criteria. Data on study design, patient demographics, operative details, and surgical outcomes were collected.
Results: There were 65 reduction cranioplasties among the 27 included studies. Eighteen (66.7%) studies presented level V evidence, 7 (25.9%) presented level IV evidence, and 2 (7.4%) presented level III evidence. Following reduction cranioplasty, there was improvement in postoperative head positioning in 23 (85.2%) studies, improvement in postoperative cosmesis in 22 (81.5%) studies, and improvement in global postoperative neurological functioning in 20 (74.1%) studies. The median estimated blood loss was 633 mL (range 20-2600 mL). Shunt revisions were the most common complication, reported in 9 (47.4%) of the 19 studies assessing complications. Of the 65 patients, there was a mortality rate of 6.2% (n = 4).
Conclusions: The majority of the included studies reported improvement in head size, head positioning, cranial cosmesis, and global neurological functioning following reduction cranioplasty for hydrocephalic macrocephaly. However, the prevalence of lower-level evidence, risk of blood loss, complications, and mortality indicates the need for a serious discussion of surgical indication, an experienced team, and thorough perioperative planning to perform these complex surgeries.
{"title":"Reduction cranioplasty for hydrocephalic macrocephaly: a systematic review of surgical outcomes.","authors":"Steven P Moura, Alexandra D Center, Manasa Kalluri, Jessica Blum, Ellen C Shaffrey, Samuel Lee, Jinggang J Ng, Bermans J Iskandar, Catharine B Garland, Daniel Y Cho","doi":"10.3171/2024.4.PEDS23486","DOIUrl":"10.3171/2024.4.PEDS23486","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalic macrocephaly can result in poor psychosocial development, positioning difficulties, skin breakdown, and poor cosmesis. Although reduction cranioplasty can address these sequelae, the postoperative outcomes, complications, and mortality risk of reduction cranioplasty are not well understood given the rarity of hydrocephalic macrocephaly. Therefore, the primary objective of this systematic review was to evaluate the surgical outcomes of reduction cranioplasty for the treatment of hydrocephalic macrocephaly.</p><p><strong>Methods: </strong>A systematic review was performed using the PubMed, Scopus, and Web of Science databases while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers screened 350 studies; 27 studies reporting surgical outcomes on reduction cranioplasty for hydrocephalic macrocephaly met inclusion criteria. Data on study design, patient demographics, operative details, and surgical outcomes were collected.</p><p><strong>Results: </strong>There were 65 reduction cranioplasties among the 27 included studies. Eighteen (66.7%) studies presented level V evidence, 7 (25.9%) presented level IV evidence, and 2 (7.4%) presented level III evidence. Following reduction cranioplasty, there was improvement in postoperative head positioning in 23 (85.2%) studies, improvement in postoperative cosmesis in 22 (81.5%) studies, and improvement in global postoperative neurological functioning in 20 (74.1%) studies. The median estimated blood loss was 633 mL (range 20-2600 mL). Shunt revisions were the most common complication, reported in 9 (47.4%) of the 19 studies assessing complications. Of the 65 patients, there was a mortality rate of 6.2% (n = 4).</p><p><strong>Conclusions: </strong>The majority of the included studies reported improvement in head size, head positioning, cranial cosmesis, and global neurological functioning following reduction cranioplasty for hydrocephalic macrocephaly. However, the prevalence of lower-level evidence, risk of blood loss, complications, and mortality indicates the need for a serious discussion of surgical indication, an experienced team, and thorough perioperative planning to perform these complex surgeries.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437033","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}