Pub Date : 2024-10-04Print Date: 2024-12-01DOI: 10.3171/2024.9.PEDS24277
Parker D Smith, Mina Guirguis, Michael Farid, Kwadwo Darko, Shubhang Bhalla, Jason Wang, Umaru Barrie, Brett Whittemore
Objective: The objective of this study was to characterize pediatric patients with tight filum terminale (TFT) or fatty filum terminale (FFT) who experienced retethering after transection of the filum, and to determine the risk factors for retethering.
Methods: A systematic review was conducted on May 31, 2023, using PubMed, Google Scholar, SCOPUS, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies detailing retethering following transection for TFT or FFT. Studies were then screened using the Newcastle-Ottawa Scale for risk of bias assessment.
Results: Eleven articles met the inclusion criteria with an overall cohort of 1167 patients evaluated for retethering following transection for TFT or FFT. The combined retethering rate across all retrospective studies was 3.4% (95% CI 1.6%-5.2%). A random-effects model was used to estimate the prevalence of presenting symptoms, with the most common being lower-extremity weakness in the overall cohort (54.5%, 95% CI 32.6%-76.4%) and bowel or bladder dysfunction in the retethered cohort (57.9%, 95% CI 41.1%-74.8%). Patients who experienced retethering had a similar estimated prevalence of low-lying conus (71.1%, 95% CI 45.1%-97.1%) compared with the overall cohort (51.1%, 95% CI 39.3%-63.0%). The most common complication following surgery for the overall cohort was a wound complication (2.7%, 95% CI 0.8%-4.6%). Postoperative CSF leakage (OR 13.8, 95% CI 3.9-49.4) was a strong predictor of retethering. Sensory changes at initial presentation were also found to be a predictor of retethering (OR 2.9, 95% CI 1.3-6.5). Low-lying conus was not predictive of retethering.
Conclusions: Preoperative sensory changes and postsurgical CSF leakage were associated with an increased retethering rate following transection of the filum in cases of tethered cord syndrome secondary to fatty filum terminale.
研究目的本研究的目的是描述在横切细丝后出现再系带的儿童紧密细丝(TFT)或脂肪细丝(FFT)患者的特征,并确定再系带的风险因素:2023年5月31日,根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南,使用PubMed、谷歌学术、SCOPUS和Web of Science数据库进行了系统综述,以确定详细描述TFT或FFT横断后再系带的研究。然后使用纽卡斯尔-渥太华量表对研究进行筛选,以评估偏倚风险:结果:11 篇文章符合纳入标准,共有 1167 名患者在因 TFT 或 FFT 而横断后接受了再系带评估。所有回顾性研究的综合再系带率为3.4%(95% CI为1.6%-5.2%)。随机效应模型用于估算出现症状的发生率,其中最常见的症状是总体队列中的下肢乏力(54.5%,95% CI 32.6%-76.4%),以及系带复位队列中的肠道或膀胱功能障碍(57.9%,95% CI 41.1%-74.8%)。与总体队列(51.1%,95% CI 39.3%-63.0%)相比,经历过系带复位的患者低位圆锥体的估计发生率(71.1%,95% CI 45.1%-97.1%)相似。总体队列中最常见的术后并发症是伤口并发症(2.7%,95% CI 0.8%-4.6%)。术后脑脊液渗漏(OR 13.8,95% CI 3.9-49.4)是预测再系的一个重要因素。初次发病时的感觉改变也是预测再系的一个因素(OR 2.9,95% CI 1.3-6.5)。结论:术前感觉变化和术后感觉变化是预测再系迹的重要因素:结论:术前感觉改变和术后脑脊液渗漏与继发于脂肪性末端丝的系索综合征病例横断丝后的系留率增加有关。
{"title":"Predictors of postsurgical retethering in pediatric fatty or tight filum terminale: a systematic review and meta-analysis of 1167 patients.","authors":"Parker D Smith, Mina Guirguis, Michael Farid, Kwadwo Darko, Shubhang Bhalla, Jason Wang, Umaru Barrie, Brett Whittemore","doi":"10.3171/2024.9.PEDS24277","DOIUrl":"10.3171/2024.9.PEDS24277","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to characterize pediatric patients with tight filum terminale (TFT) or fatty filum terminale (FFT) who experienced retethering after transection of the filum, and to determine the risk factors for retethering.</p><p><strong>Methods: </strong>A systematic review was conducted on May 31, 2023, using PubMed, Google Scholar, SCOPUS, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies detailing retethering following transection for TFT or FFT. Studies were then screened using the Newcastle-Ottawa Scale for risk of bias assessment.</p><p><strong>Results: </strong>Eleven articles met the inclusion criteria with an overall cohort of 1167 patients evaluated for retethering following transection for TFT or FFT. The combined retethering rate across all retrospective studies was 3.4% (95% CI 1.6%-5.2%). A random-effects model was used to estimate the prevalence of presenting symptoms, with the most common being lower-extremity weakness in the overall cohort (54.5%, 95% CI 32.6%-76.4%) and bowel or bladder dysfunction in the retethered cohort (57.9%, 95% CI 41.1%-74.8%). Patients who experienced retethering had a similar estimated prevalence of low-lying conus (71.1%, 95% CI 45.1%-97.1%) compared with the overall cohort (51.1%, 95% CI 39.3%-63.0%). The most common complication following surgery for the overall cohort was a wound complication (2.7%, 95% CI 0.8%-4.6%). Postoperative CSF leakage (OR 13.8, 95% CI 3.9-49.4) was a strong predictor of retethering. Sensory changes at initial presentation were also found to be a predictor of retethering (OR 2.9, 95% CI 1.3-6.5). Low-lying conus was not predictive of retethering.</p><p><strong>Conclusions: </strong>Preoperative sensory changes and postsurgical CSF leakage were associated with an increased retethering rate following transection of the filum in cases of tethered cord syndrome secondary to fatty filum terminale.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"610-618"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375503","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 : 2024-10-04Print Date: 2024-12-01DOI: 10.3171/2024.7.PEDS24159
Maria A Punchak, Stephen Miranda, Canada Montgomery, Ena Agbodza, Daksh Chauhan, Amy Houtrow, Kathryn Smith, Andrew B Foy, Jeffrey R Leonard, Heidi Castillo, Jonathan Castillo, Rhonda G Cady, Robin M Bowman, Kurt A Freeman, Brandon G Rocque, Tracy M Flanders, Gregory G Heuer
Objective: Myelomeningocele (MMC) is a lifelong condition requiring complex multidisciplinary management. Using the National Spina Bifida Patient Registry (NSBPR), the authors tested the association between sociodemographic variables and odds of undergoing neurosurgical procedures.
Methods: The authors extracted sociodemographic, clinical, and neurosurgical procedure data on participants with MMC aged ≥ 1 year who visited an NSBPR clinic between 2009 and 2020. The zip code of the participant's residence at the time of the last spina bifida clinic visit was linked to the Distressed Communities Index (DCI) tier. Multivariate models were built to identify factors associated with undergoing CSF diversion, shunt revision, tethered cord release (TCR), and Chiari decompression.
Results: There were 7924 participants with a median visit age of 13 years (IQR 7-20 years); 49.1% were male, 30.2% were non-Hispanic Black or Hispanic, 54.5% had public/supplemental insurance, and 16.9% were from distressed communities. CSF diversion, shunt revision, TCR, and Chiari decompression were performed in 81.8%, 47.7%, 22.9%, and 8.7% of participants, respectively. In multivariate analyses controlling for age, sex, insurance, DCI tier, lesion level, and surgical closure timing, Hispanic individuals were less likely than their non-Hispanic White counterparts to undergo shunt revision (p = 0.013). Non-Hispanic Black and Hispanic individuals were less likely to undergo TCR (p < 0.001 each) or Chiari decompression (p < 0.001 each). Compared with privately insured individuals, publicly insured individuals were more likely to undergo CSF diversion (p = 0.031). Those in distressed communities had increased odds of undergoing CSF diversion (p = 0.004) than those in prosperous communities.
Conclusions: Among individuals with MMC participating in the NSBPR, there were differences in receiving neurosurgical procedures by race/ethnicity, insurance type, and DCI tier. Additional prospective studies are necessary to elucidate the reasons for these variations and their impact on long-term outcomes for this patient population in order to created targeted interventions.
{"title":"Association between social determinants of health and select neurosurgical procedures in the National Spina Bifida Patient Registry.","authors":"Maria A Punchak, Stephen Miranda, Canada Montgomery, Ena Agbodza, Daksh Chauhan, Amy Houtrow, Kathryn Smith, Andrew B Foy, Jeffrey R Leonard, Heidi Castillo, Jonathan Castillo, Rhonda G Cady, Robin M Bowman, Kurt A Freeman, Brandon G Rocque, Tracy M Flanders, Gregory G Heuer","doi":"10.3171/2024.7.PEDS24159","DOIUrl":"10.3171/2024.7.PEDS24159","url":null,"abstract":"<p><strong>Objective: </strong>Myelomeningocele (MMC) is a lifelong condition requiring complex multidisciplinary management. Using the National Spina Bifida Patient Registry (NSBPR), the authors tested the association between sociodemographic variables and odds of undergoing neurosurgical procedures.</p><p><strong>Methods: </strong>The authors extracted sociodemographic, clinical, and neurosurgical procedure data on participants with MMC aged ≥ 1 year who visited an NSBPR clinic between 2009 and 2020. The zip code of the participant's residence at the time of the last spina bifida clinic visit was linked to the Distressed Communities Index (DCI) tier. Multivariate models were built to identify factors associated with undergoing CSF diversion, shunt revision, tethered cord release (TCR), and Chiari decompression.</p><p><strong>Results: </strong>There were 7924 participants with a median visit age of 13 years (IQR 7-20 years); 49.1% were male, 30.2% were non-Hispanic Black or Hispanic, 54.5% had public/supplemental insurance, and 16.9% were from distressed communities. CSF diversion, shunt revision, TCR, and Chiari decompression were performed in 81.8%, 47.7%, 22.9%, and 8.7% of participants, respectively. In multivariate analyses controlling for age, sex, insurance, DCI tier, lesion level, and surgical closure timing, Hispanic individuals were less likely than their non-Hispanic White counterparts to undergo shunt revision (p = 0.013). Non-Hispanic Black and Hispanic individuals were less likely to undergo TCR (p < 0.001 each) or Chiari decompression (p < 0.001 each). Compared with privately insured individuals, publicly insured individuals were more likely to undergo CSF diversion (p = 0.031). Those in distressed communities had increased odds of undergoing CSF diversion (p = 0.004) than those in prosperous communities.</p><p><strong>Conclusions: </strong>Among individuals with MMC participating in the NSBPR, there were differences in receiving neurosurgical procedures by race/ethnicity, insurance type, and DCI tier. Additional prospective studies are necessary to elucidate the reasons for these variations and their impact on long-term outcomes for this patient population in order to created targeted interventions.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"601-609"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375501","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 : 2024-09-27Print Date: 2024-12-01DOI: 10.3171/2024.7.PEDS24231
Deepak Khatri, Richard Zampolin, Adisson Fortunel, Seon-Kyu Lee
Objective: Currently available data regarding unruptured intracranial aneurysms (UIAs) in sickle cell disease (SCD) are largely based on adult patients; this has made it challenging to reach a consensus on treatment decisions and follow-up strategies for pediatric SCD patients with UIAs.
Methods: A retrospective review of 296 SCD patients (aged 18 years or younger) who underwent MRA from January 2008 to September 2022 was performed. The vessel of origin and characteristics of the UIAs, including maximum diameter, laterality, and number, were evaluated. Demographic data, as well as history of vaso-occlusive crisis and moyamoya syndrome, were recorded. Interval change in size or morphology, as well as a new aneurysm development, were reviewed on follow-up MRA.
Results: Forty-nine aneurysms were identified in 32/296 (10.81%) patients, and they all had saccular morphology. In total, 30/49 (61.22%) aneurysms were in the anterior circulation. The ophthalmic segment of the internal carotid artery and the posterior cerebral artery were the most common locations (n = 12 [24.49%] each). Multiple aneurysms were seen in 11/32 patients (34.37%). Most of the African American patients had multiple aneurysms (n = 25/28 [89.3%]). Most aneurysms (n = 43 [87.75%]) were 3 mm or less in diameter. No significant difference in aneurysm size was noticed between aneurysms located in anterior or posterior circulation (p = 0.22). Similarly, age, sex, ethnicity, genotype, or aneurysm multiplicity were not associated with size. Follow-up MRA was available for 24/32 patients (75%). All except 2 aneurysms (n = 2/38 [5.3%]) were stable in size and morphology on follow-up. Interval progression in aneurysm size was noticed in 2 patients with multiple intracranial aneurysms (n = 2/11 [18.2%]).
Conclusions: In pediatric SCD patients, the incidence of UIAs was higher than previously reported. Those aneurysms demonstrated a tendency for multiplicity, an atypical anatomical distribution compared with that of adult brain aneurysms, bilateral involvement, and higher prevalence in African Americans. Although most of the aneurysms were stable, some showed interval growth in size.
{"title":"Unruptured intracranial aneurysms in pediatric sickle cell disease: clinical and MR imaging follow-up of 296 patients.","authors":"Deepak Khatri, Richard Zampolin, Adisson Fortunel, Seon-Kyu Lee","doi":"10.3171/2024.7.PEDS24231","DOIUrl":"10.3171/2024.7.PEDS24231","url":null,"abstract":"<p><strong>Objective: </strong>Currently available data regarding unruptured intracranial aneurysms (UIAs) in sickle cell disease (SCD) are largely based on adult patients; this has made it challenging to reach a consensus on treatment decisions and follow-up strategies for pediatric SCD patients with UIAs.</p><p><strong>Methods: </strong>A retrospective review of 296 SCD patients (aged 18 years or younger) who underwent MRA from January 2008 to September 2022 was performed. The vessel of origin and characteristics of the UIAs, including maximum diameter, laterality, and number, were evaluated. Demographic data, as well as history of vaso-occlusive crisis and moyamoya syndrome, were recorded. Interval change in size or morphology, as well as a new aneurysm development, were reviewed on follow-up MRA.</p><p><strong>Results: </strong>Forty-nine aneurysms were identified in 32/296 (10.81%) patients, and they all had saccular morphology. In total, 30/49 (61.22%) aneurysms were in the anterior circulation. The ophthalmic segment of the internal carotid artery and the posterior cerebral artery were the most common locations (n = 12 [24.49%] each). Multiple aneurysms were seen in 11/32 patients (34.37%). Most of the African American patients had multiple aneurysms (n = 25/28 [89.3%]). Most aneurysms (n = 43 [87.75%]) were 3 mm or less in diameter. No significant difference in aneurysm size was noticed between aneurysms located in anterior or posterior circulation (p = 0.22). Similarly, age, sex, ethnicity, genotype, or aneurysm multiplicity were not associated with size. Follow-up MRA was available for 24/32 patients (75%). All except 2 aneurysms (n = 2/38 [5.3%]) were stable in size and morphology on follow-up. Interval progression in aneurysm size was noticed in 2 patients with multiple intracranial aneurysms (n = 2/11 [18.2%]).</p><p><strong>Conclusions: </strong>In pediatric SCD patients, the incidence of UIAs was higher than previously reported. Those aneurysms demonstrated a tendency for multiplicity, an atypical anatomical distribution compared with that of adult brain aneurysms, bilateral involvement, and higher prevalence in African Americans. Although most of the aneurysms were stable, some showed interval growth in size.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"585-590"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348496","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 : 2024-09-27DOI: 10.3171/2024.7.PEDS24353
Fardad T Afshari
{"title":"Letter to the Editor. Pediatric traumatic venous sinus thrombosis: anticoagulation dilemma.","authors":"Fardad T Afshari","doi":"10.3171/2024.7.PEDS24353","DOIUrl":"10.3171/2024.7.PEDS24353","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"673-674"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348495","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 : 2024-09-27Print Date: 2024-12-01DOI: 10.3171/2024.7.PEDS2429
Tamar Brooks, Dexiang Gao, Kathleen Dorris, Karlie Boone, David M Mirsky, Susan Staulcup, Eric Prince, Marina Moskalenko, Elizabeth Ignowski, Narine Wandrey, Kareem Fakhoury, Todd C Hankinson, Sarah A Milgrom
Objective: In a cohort of patients who were treated with resection and adjuvant radiotherapy (RT) for adamantinomatous craniopharyngioma (ACP), the authors aimed to determine whether gross tumor volume (GTV) at the initiation of RT was associated with the risk of progressive disease (PD) following treatment.
Methods: Pediatric and adolescent patients who received surgery and RT for ACP at a single institution from 1998 to 2021 were identified. Univariable Cox regression analyses (UVAs) were performed to assess the association between pre-RT GTV and PD after RT. Multivariable analyses (MVAs) were used to control for potential confounders. Two different endpoints were used to define PD. The first definition was based on radiographic tumor growth, with or without progression of clinical symptoms. The second definition was the requirement for an additional tumor-directed intervention following the completion of RT.
Results: Forty-eight patients were eligible for inclusion. The median age at diagnosis was 7.9 years (range 2.1-17.4 years). All patients were treated with surgery and RT with a median dose of 52.2 Gy (range 45-55.8 Gy) and median GTV of 9.86 cm3 (range 0.7-117.7 cm3). After a median follow-up of 66.4 months, 8 patients experienced PD based on both definitions. The 5-year event-free survival rate was 85.4% (95% CI 74.1%-98.3%). On both UVA and MVA, GTV was significantly associated with an increased likelihood of PD (UVA: HR 1.02, 95% CI 1.00-1.04, p = 0.02; MVA: HR 1.10, 95% CI 1.02-1.19, p = 0.01). However, after exclusion of a single outlier with a GTV of 117.7 cm3 prior to RT (remainder of the cohort: range 0.7-37.3 cm3), a second analysis identified no significant association between GTV and PD (UVA: HR 1.03, 95% CI 0.96-1.10, p = 0.4; MVA: HR 1.06, 95% CI 0.96-1.17, p = 0.24).
Conclusions: The authors conclude that for most children and adolescents with ACP, the GTV at the initiation of RT is not associated with the risk of PD. This finding may influence surgical practice, because it suggests that aggressive tumor debulking for the purpose of improving the efficacy of RT may not be necessary. In the case of giant tumors, however, novel strategies may be needed for tumor control.
{"title":"Does pre-irradiation gross tumor volume predict the risk of progression after radiation therapy in pediatric patients with adamantinomatous craniopharyngioma?","authors":"Tamar Brooks, Dexiang Gao, Kathleen Dorris, Karlie Boone, David M Mirsky, Susan Staulcup, Eric Prince, Marina Moskalenko, Elizabeth Ignowski, Narine Wandrey, Kareem Fakhoury, Todd C Hankinson, Sarah A Milgrom","doi":"10.3171/2024.7.PEDS2429","DOIUrl":"10.3171/2024.7.PEDS2429","url":null,"abstract":"<p><strong>Objective: </strong>In a cohort of patients who were treated with resection and adjuvant radiotherapy (RT) for adamantinomatous craniopharyngioma (ACP), the authors aimed to determine whether gross tumor volume (GTV) at the initiation of RT was associated with the risk of progressive disease (PD) following treatment.</p><p><strong>Methods: </strong>Pediatric and adolescent patients who received surgery and RT for ACP at a single institution from 1998 to 2021 were identified. Univariable Cox regression analyses (UVAs) were performed to assess the association between pre-RT GTV and PD after RT. Multivariable analyses (MVAs) were used to control for potential confounders. Two different endpoints were used to define PD. The first definition was based on radiographic tumor growth, with or without progression of clinical symptoms. The second definition was the requirement for an additional tumor-directed intervention following the completion of RT.</p><p><strong>Results: </strong>Forty-eight patients were eligible for inclusion. The median age at diagnosis was 7.9 years (range 2.1-17.4 years). All patients were treated with surgery and RT with a median dose of 52.2 Gy (range 45-55.8 Gy) and median GTV of 9.86 cm3 (range 0.7-117.7 cm3). After a median follow-up of 66.4 months, 8 patients experienced PD based on both definitions. The 5-year event-free survival rate was 85.4% (95% CI 74.1%-98.3%). On both UVA and MVA, GTV was significantly associated with an increased likelihood of PD (UVA: HR 1.02, 95% CI 1.00-1.04, p = 0.02; MVA: HR 1.10, 95% CI 1.02-1.19, p = 0.01). However, after exclusion of a single outlier with a GTV of 117.7 cm3 prior to RT (remainder of the cohort: range 0.7-37.3 cm3), a second analysis identified no significant association between GTV and PD (UVA: HR 1.03, 95% CI 0.96-1.10, p = 0.4; MVA: HR 1.06, 95% CI 0.96-1.17, p = 0.24).</p><p><strong>Conclusions: </strong>The authors conclude that for most children and adolescents with ACP, the GTV at the initiation of RT is not associated with the risk of PD. This finding may influence surgical practice, because it suggests that aggressive tumor debulking for the purpose of improving the efficacy of RT may not be necessary. In the case of giant tumors, however, novel strategies may be needed for tumor control.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"642-648"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348493","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 : 2024-09-27DOI: 10.3171/2024.7.PEDS24376
Leonardo B Oliveira, Raphael Bertani, Leonardo C Welling, Fernando Campos Gomes Pinto, Fernando Hakim, Eberval G Figueiredo
{"title":"Letter to the Editor. Pediatric hydrocephalus shunt: atrium or pleura?","authors":"Leonardo B Oliveira, Raphael Bertani, Leonardo C Welling, Fernando Campos Gomes Pinto, Fernando Hakim, Eberval G Figueiredo","doi":"10.3171/2024.7.PEDS24376","DOIUrl":"10.3171/2024.7.PEDS24376","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"672-673"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348494","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 : 2024-09-20DOI: 10.3171/2024.6.PEDS24300
Antonia M Sames, Arman Sawhney, Travis R Quinoa, Nina E Glass
{"title":"Letter to the Editor. Re-examining the influence of age and surgical intervention on pediatric intracranial gunshot wounds.","authors":"Antonia M Sames, Arman Sawhney, Travis R Quinoa, Nina E Glass","doi":"10.3171/2024.6.PEDS24300","DOIUrl":"10.3171/2024.6.PEDS24300","url":null,"abstract":"","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"671-672"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289491","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 : 2024-09-20Print Date: 2024-12-01DOI: 10.3171/2024.7.PEDS247
Thomas Johnstone, Maria Isabel Barros Guinle, Laura M Prolo, Gerald A Grant
Objective: Chiari malformation type I (CM-I) is defined by the herniation of the cerebellar tonsils into the spinal canal. When symptomatic, surgical decompression is recommended. Reported CM-I reoperation rates have ranged from 3% to 30%. However, the relationship between patient age at first surgical intervention and the likelihood of reoperation and postoperative complications remains poorly characterized. Therefore, this study aimed to determine whether patient age was associated with reoperation and complication rates.
Methods: Patients 0-21 years old with a diagnosis of CM-I and surgical decompression were queried from the 2007-2021 MarketScan databases. Patient sex, age at time of first procedure, comorbidities, 90-day postoperative complications, and reoperations were identified. Bootstrap-augmented binary classifiers were constructed to determine the optimal timing of first surgical decompression with respect to all-cause 90-day postoperative complications and reoperation. Multivariate logistic regression models were built to assess the relationship between age, sex, and comorbidities and the likelihood of reoperation and complications following surgical decompression.
Results: A total of 2675 patients were included for analysis of 90-day postoperative complications, and 1157 were included in the reoperation analysis cohort. A total of 524 patients (19.6%) experienced a complication within 90 days of surgical decompression, and 84 patients (7.3%) had reoperations. On multivariate regression, increased age was an independent predictor of a reduced likelihood of both reoperations (OR 0.94, 95% CI 0.90-0.98; p < 0.01) and 90-day postoperative complications (OR 0.96, 95% CI 0.94-0.98; p < 0.01). The optimal age cutoff to predict both complications and reoperations was 4 years. For patients ages 4 years and older, both the reoperation rate (5.5% vs 13.2%, p < 0.01) and 90-day postoperative complication rates (18.4% vs 27.7%; p < 0.01) were significantly less than those for children 3 years and younger.
Conclusions: In a national cohort of pediatric patients undergoing surgically managed CM-I, there was a significantly increased likelihood of reoperation and complications in patients ages 3 years and younger. Although CM-I decompression should not be postponed in the face of progressive neurological deficits, the authors' findings suggest that delaying surgery until after the age of 3 years, when medically feasible, may help mitigate adverse events.
{"title":"Age as a predictor of reoperations and complications in surgically managed pediatric Chiari malformation type I.","authors":"Thomas Johnstone, Maria Isabel Barros Guinle, Laura M Prolo, Gerald A Grant","doi":"10.3171/2024.7.PEDS247","DOIUrl":"10.3171/2024.7.PEDS247","url":null,"abstract":"<p><strong>Objective: </strong>Chiari malformation type I (CM-I) is defined by the herniation of the cerebellar tonsils into the spinal canal. When symptomatic, surgical decompression is recommended. Reported CM-I reoperation rates have ranged from 3% to 30%. However, the relationship between patient age at first surgical intervention and the likelihood of reoperation and postoperative complications remains poorly characterized. Therefore, this study aimed to determine whether patient age was associated with reoperation and complication rates.</p><p><strong>Methods: </strong>Patients 0-21 years old with a diagnosis of CM-I and surgical decompression were queried from the 2007-2021 MarketScan databases. Patient sex, age at time of first procedure, comorbidities, 90-day postoperative complications, and reoperations were identified. Bootstrap-augmented binary classifiers were constructed to determine the optimal timing of first surgical decompression with respect to all-cause 90-day postoperative complications and reoperation. Multivariate logistic regression models were built to assess the relationship between age, sex, and comorbidities and the likelihood of reoperation and complications following surgical decompression.</p><p><strong>Results: </strong>A total of 2675 patients were included for analysis of 90-day postoperative complications, and 1157 were included in the reoperation analysis cohort. A total of 524 patients (19.6%) experienced a complication within 90 days of surgical decompression, and 84 patients (7.3%) had reoperations. On multivariate regression, increased age was an independent predictor of a reduced likelihood of both reoperations (OR 0.94, 95% CI 0.90-0.98; p < 0.01) and 90-day postoperative complications (OR 0.96, 95% CI 0.94-0.98; p < 0.01). The optimal age cutoff to predict both complications and reoperations was 4 years. For patients ages 4 years and older, both the reoperation rate (5.5% vs 13.2%, p < 0.01) and 90-day postoperative complication rates (18.4% vs 27.7%; p < 0.01) were significantly less than those for children 3 years and younger.</p><p><strong>Conclusions: </strong>In a national cohort of pediatric patients undergoing surgically managed CM-I, there was a significantly increased likelihood of reoperation and complications in patients ages 3 years and younger. Although CM-I decompression should not be postponed in the face of progressive neurological deficits, the authors' findings suggest that delaying surgery until after the age of 3 years, when medically feasible, may help mitigate adverse events.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"619-627"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289487","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 : 2024-09-20Print Date: 2024-12-01DOI: 10.3171/2024.7.PEDS24156
Lelio Guida, Alissa Visentin, Sandro Benichi, Syril James, Giovanna Paternoster, Marie Bourgeois, Hélène Sauvé-Martin, Philippe Meyer, Juliette Montmayeur, Estelle Vergnaud, Volodia Dangouloff-Ros, Kevin Beccaria, Gilles Orliaguet, Thomas Blauwblomme
Objective: Guidelines for the management of pediatric severe traumatic brain injury (TBI) recommend external ventricular drainage for CSF drainage as a first-tier treatment in the intracranial pressure (ICP) pathway. However, ventriculostomy in children can sometimes be challenging because of the small size of the lateral ventricles. External lumbar drainage (ELD) may be a useful alternative; therefore, the authors analyzed the outcome of a cohort of pediatric patients who underwent ELD to manage intracranial hypertension (ICH).
Methods: This study retrospectively enrolled pediatric patients with ICH following severe TBI who underwent ELD. Radiological and clinical severity scores (Marshall classification, Rotterdam score, Injury Severity Score, and Pediatric Trauma Score) were noted. ICP and cerebral perfusion pressure (CPP) curves were analyzed 12 hours before and after the procedure. Any change in medical therapy was recorded, as well as the total volume and duration of drainage. Cerebellar tonsillar position according to the McRae line was noted before and after ELD. Glasgow Outcome Scale-Extended score at follow-up was also noted.
Results: Thirty patients were included, with a mean age of 8 ± 4.4 years, and a median admission Glasgow Coma Scale score of 7 ± 4 (range 3-13). ELD was performed after a median delay of 1 day (range 0-7 days), mean drainage volume/day was 296 ± 129 ml, and median duration of drainage was 7 ± 5 (range 2-12) days. Forty-three percent of the patients underwent ELD as a part of the first-tier therapy. ICP decreased after ELD (mean difference 13.4 ± 6.2 mm Hg, p < 0.001), whereas CPP increased (mean difference 10.6 ± 6.4 mm Hg, p < 0.001). Fifty-three percent of the cohort did not need any further second-tier therapy after ELD. The study found 1 case of drain revision and 3 cases of cerebellar tonsil herniation.
Conclusions: These preliminary data suggest ELD is a valuable option to treat ICH in severely head-injured children, limiting the use of second-tier treatments. This pilot study should lay the foundation for a multicenter prospective trial.
{"title":"External lumbar drainage for the management of refractory intracranial hypertension in pediatric severe traumatic brain injury: a retrospective single-center case series.","authors":"Lelio Guida, Alissa Visentin, Sandro Benichi, Syril James, Giovanna Paternoster, Marie Bourgeois, Hélène Sauvé-Martin, Philippe Meyer, Juliette Montmayeur, Estelle Vergnaud, Volodia Dangouloff-Ros, Kevin Beccaria, Gilles Orliaguet, Thomas Blauwblomme","doi":"10.3171/2024.7.PEDS24156","DOIUrl":"10.3171/2024.7.PEDS24156","url":null,"abstract":"<p><strong>Objective: </strong>Guidelines for the management of pediatric severe traumatic brain injury (TBI) recommend external ventricular drainage for CSF drainage as a first-tier treatment in the intracranial pressure (ICP) pathway. However, ventriculostomy in children can sometimes be challenging because of the small size of the lateral ventricles. External lumbar drainage (ELD) may be a useful alternative; therefore, the authors analyzed the outcome of a cohort of pediatric patients who underwent ELD to manage intracranial hypertension (ICH).</p><p><strong>Methods: </strong>This study retrospectively enrolled pediatric patients with ICH following severe TBI who underwent ELD. Radiological and clinical severity scores (Marshall classification, Rotterdam score, Injury Severity Score, and Pediatric Trauma Score) were noted. ICP and cerebral perfusion pressure (CPP) curves were analyzed 12 hours before and after the procedure. Any change in medical therapy was recorded, as well as the total volume and duration of drainage. Cerebellar tonsillar position according to the McRae line was noted before and after ELD. Glasgow Outcome Scale-Extended score at follow-up was also noted.</p><p><strong>Results: </strong>Thirty patients were included, with a mean age of 8 ± 4.4 years, and a median admission Glasgow Coma Scale score of 7 ± 4 (range 3-13). ELD was performed after a median delay of 1 day (range 0-7 days), mean drainage volume/day was 296 ± 129 ml, and median duration of drainage was 7 ± 5 (range 2-12) days. Forty-three percent of the patients underwent ELD as a part of the first-tier therapy. ICP decreased after ELD (mean difference 13.4 ± 6.2 mm Hg, p < 0.001), whereas CPP increased (mean difference 10.6 ± 6.4 mm Hg, p < 0.001). Fifty-three percent of the cohort did not need any further second-tier therapy after ELD. The study found 1 case of drain revision and 3 cases of cerebellar tonsil herniation.</p><p><strong>Conclusions: </strong>These preliminary data suggest ELD is a valuable option to treat ICH in severely head-injured children, limiting the use of second-tier treatments. This pilot study should lay the foundation for a multicenter prospective trial.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"566-573"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289489","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 : 2024-09-20Print Date: 2024-12-01DOI: 10.3171/2024.6.PEDS23360
Megan V Ryan, Lindsey M Freeman, Sophia Blasco, Kim Sawyer, Sarah Graber, Suhong Tong, Joyce Oleszek, Corbett Wilkinson
Objective: The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions.
Methods: The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling).
Results: One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts.
Conclusions: Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.
{"title":"Complications of intrathecal baclofen therapy in children and young adults.","authors":"Megan V Ryan, Lindsey M Freeman, Sophia Blasco, Kim Sawyer, Sarah Graber, Suhong Tong, Joyce Oleszek, Corbett Wilkinson","doi":"10.3171/2024.6.PEDS23360","DOIUrl":"10.3171/2024.6.PEDS23360","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling).</p><p><strong>Results: </strong>One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts.</p><p><strong>Conclusions: </strong>Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"659-670"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289488","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}