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Intraoperative MRI in pediatric epilepsy and neuro-oncology: a systematic review and meta-analysis. 小儿癫痫和神经肿瘤学术中磁共振成像:系统回顾和荟萃分析。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-20 Print Date: 2024-12-01 DOI: 10.3171/2024.6.PEDS2414
Gideon Adegboyega, Sheikh Momin, Conor S Gillespie, Noor Ul Owase Jeelani, Sniya Sudhakar, Kshitij Mankad, Martin M Tisdall, Kristian Aquilina, Sebastian M Toescu

Objective: Intraoperative magnetic resonance imaging (iMRI) use is becoming increasingly widespread in neurosurgical practice, and most of the data reporting its use are in adult populations. There is less evidence on the use of iMRI in pediatric neurosurgery. The aim of this paper was to synthesize the available literature into a systematic review and meta-analysis to evaluate the evidence for iMRI in pediatric neurosurgery, with a particular focus on neuro-oncology and epilepsy surgery.

Methods: This review was registered on PROSPERO and conducted according to PRISMA guidelines. A comprehensive search strategy of Medline via Ovid and Embase was conducted with predetermined key terms. Studies in English reporting the outcomes of patients < 21 years of age who underwent neuro-oncological or epilepsy surgery with the use of iMRI were included in the study. The types of studies eligible for inclusion were observational case-control and cohort studies, randomized clinical trials, cross-sectional studies, editorials, case series, and commentaries. Articles were de-duplicated and abstracts independently screened for inclusion by two reviewers. Full texts were screened, and data on demographic characteristics, etiology, outcome (extent of resection for neuro-oncology and Engel class for epilepsy), and technical iMRI data were extracted.

Results: Thirty-five articles were included in the review, 25 of which were observational cohort studies. Four articles were suitable for meta-analysis. In total, 1217 patients underwent iMRI-guided neuro-oncology surgery in 26 studies, most commonly for gliomas (n = 443). A total of 148 patients underwent iMRI-guided epilepsy surgery in 9 studies, with focal cortical dysplasia being the most common diagnosis (n = 95). The mean ± SD operating time was 357 ± 94 minutes (12 studies), with a mean of 1.32 scans per patient. There was a mean re-entry rate into the operative field of 42% (across 20 studies). Complications were noted in 21% of epilepsy surgery patients and 11% of neuro-oncology surgery patients. Meta-analysis of 4 eligible studies revealed that iMRI was more likely to lead to better Engel outcomes in terms of seizure freedom (OR 3.84, 95% CI 1.38-10.68, p = 0.69) and complete tumor resection (OR 3.19, 95% CI 0.28-36.92, p = 0.06).

Conclusions: iMRI appears to be a useful adjunct in optimizing resective pediatric epilepsy and neuro-oncology surgery, with a low complication rate.

目的:术中磁共振成像(iMRI)在神经外科实践中的应用越来越广泛,而报告其应用的大多数数据都是针对成人群体的。有关 iMRI 在小儿神经外科中应用的证据较少。本文旨在对现有文献进行系统综述和荟萃分析,评估 iMRI 在小儿神经外科中的应用证据,尤其关注神经肿瘤学和癫痫外科:本综述在 PROSPERO 上注册,并按照 PRISMA 指南进行。采用预先确定的关键术语,通过 Ovid 和 Embase 对 Medline 进行了全面检索。研究纳入了使用 iMRI 对年龄小于 21 岁的神经肿瘤或癫痫手术患者的疗效进行报告的英文研究。符合纳入条件的研究类型包括观察性病例对照和队列研究、随机临床试验、横断面研究、社论、系列病例和评论。由两名审稿人对文章进行去重和摘要独立筛选。筛选全文,并提取人口统计学特征、病因学、结果(神经肿瘤学的切除范围和癫痫的恩格尔分级)和 iMRI 技术数据:35篇文章被纳入综述,其中25篇为观察性队列研究。4篇文章适合进行荟萃分析。在26项研究中,共有1217名患者接受了iMRI引导下的神经肿瘤手术,其中最常见的是胶质瘤手术(n = 443)。在9项研究中,共有148名患者接受了iMRI引导下的癫痫手术,最常见的诊断是局灶性皮质发育不良(n = 95)。手术时间的平均值(±SD)为 357±94 分钟(12 项研究),每位患者平均接受 1.32 次扫描。再次进入手术区域的平均比例为 42%(20 项研究)。21%的癫痫手术患者和11%的神经肿瘤手术患者出现并发症。对 4 项符合条件的研究进行的 Meta 分析显示,iMRI 更有可能在癫痫发作自由度(OR 3.84,95% CI 1.38-10.68,p = 0.69)和肿瘤完全切除(OR 3.19,95% CI 0.28-36.92,p = 0.06)方面带来更好的 Engel 结果。
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引用次数: 0
A comparative analysis of the Trauma and Injury Severity Score and the Injury Severity Score in predicting high-value care outcomes in children with traumatic brain injury. 创伤和损伤严重程度评分与损伤严重程度评分在预测脑外伤儿童高价值护理结果方面的比较分析。
IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.3171/2024.8.peds24309
Foad Kazemi,Jiaqi Liu,Isam W Nasr,Shenandoah Robinson,Alan R Cohen
OBJECTIVEPredicting high-value care outcomes is crucial in managing pediatric traumatic brain injuries (TBIs), where timely and accurate prognostication can significantly influence treatment decisions and resource allocation. This study aimed to enhance understanding of how well scoring systems such as the Trauma and Injury Severity Score (TRISS) can forecast high-value care outcomes. Furthermore, the authors compared the predictive power of TRISS with the routinely used Injury Severity Score (ISS).METHODSThe authors performed a retrospective review of their institutional database from June 2016 to June 2023 to identify cases of TBI based on a modified Centers for Disease Control and Prevention framework. Prolonged length of stay (LOS) was defined as a hospital stay falling into the upper quartile of the overall cohort. Discharge to an inpatient rehabilitation facility, acute care hospital, or foster care or death was defined as a nonroutine discharge disposition. Emergency department (ED) transfer to the intensive care unit (ICU) or operating room (OR) was defined as a proxy for severity of injuries. Multivariate logistic regression models were used to explore the association between ISS, TRISS, and high-value care outcomes. The DeLong test was used to assess the differences between the areas under the receiver operating characteristic curve (AUROCs).RESULTSThis study included 2705 patients with a mean age ± SD of 7.28 ± 5.46 years (63% male). In the overall cohort, 28% experienced prolonged LOS, 7% had a nonroutine discharge disposition from the hospital, and 23% were transferred to the ICU/OR from the ED. In multivariate regression models, both TRISS and ISS were correlated with higher odds of prolonged LOS, nonroutine discharge disposition, and transfer to the ICU/OR from the ED (all p < 0.001). TRISS had a significantly greater AUROC than ISS for nonroutine discharge disposition (0.883 vs 0.849, p < 0.001) and transfer to the ICU/OR (0.898 vs 0.887, p = 0.045), but this result was not significant for prolonged LOS (0.873 vs 0.880, p = 0.140).CONCLUSIONSTRISS and ISS are effective tools for predicting high-value care outcomes in pediatric TBI. Utilizing these resources can assist healthcare providers in making informed, risk-adjusted predictions.
目的预测高价值护理结果对于儿科创伤性脑损伤(TBIs)的管理至关重要,及时准确的预后可极大地影响治疗决策和资源分配。本研究旨在进一步了解创伤和损伤严重程度评分(TRISS)等评分系统对高价值护理结果的预测能力。此外,作者还将 TRISS 的预测能力与常规使用的损伤严重程度评分(ISS)进行了比较。方法作者对其机构数据库从 2016 年 6 月到 2023 年 6 月的数据进行了回顾性审查,以根据修改后的美国疾病控制和预防中心框架确定创伤和损伤病例。住院时间延长(LOS)被定义为住院时间处于总体队列的上四分位数。出院至住院康复机构、急症护理医院或寄养机构或死亡被定义为非例行出院处置。急诊科(ED)转入重症监护室(ICU)或手术室(OR)被定义为受伤严重程度的替代指标。多变量逻辑回归模型用于探讨 ISS、TRISS 和高价值护理结果之间的关联。结果本研究共纳入 2705 名患者,平均年龄(± SD)为 7.28±5.46 岁(63% 为男性)。在整个队列中,28%的患者经历了长期住院,7%的患者有非正常出院处置,23%的患者从急诊室转入重症监护室/手术室。在多变量回归模型中,TRISS 和 ISS 均与较高的 LOS 延长、非正常出院处置和从急诊室转入 ICU/OR 的几率相关(均 p <0.001)。在非正常出院处置(0.883 vs 0.849,p < 0.001)和转入 ICU/OR (0.898 vs 0.887,p = 0.045)方面,TRISS 的 AUROC 明显高于 ISS,但在延长 LOS(0.873 vs 0.880,p = 0.140)方面,这一结果并不显著。利用这些资源可以帮助医疗服务提供者做出明智的风险调整预测。
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引用次数: 0
Is initial unilateral revascularization acceptable in pediatric patients with bilateral moyamoya disease with mild contralateral hemodynamic disturbance? 对于患有双侧 moyamoya 病且对侧血流动力学有轻度障碍的儿科患者,是否可以接受最初的单侧血管再通术?
IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.3171/2024.7.peds23550
Masae Kuroha,Shoko Hara,Mai Fujioka,Motoki Inaji,Yoji Tanaka,Tadashi Nariai,Taketoshi Maehara
OBJECTIVEAlthough asymmetrical vascular involvement between hemispheres is common in pediatric patients with bilateral moyamoya disease, whether hemispheres with mild vascular changes and hemodynamic impairment require immediate surgical revascularization or whether they can be observed until disease progression remains unclear. The authors evaluated the long-term outcomes of their strategy to initially perform unilateral surgery and withhold surgery to the contralateral hemispheres with mild vascular changes and hemodynamic impairment.METHODSThe authors retrospectively evaluated Japanese pediatric patients (onset age ≤ 15 years) diagnosed with bilateral sporadic moyamoya disease who underwent unilateral revascularization. The authors investigated whether the patient underwent additional collateral surgery and the incidence of ischemic events during follow-up. They also compared visual assessments of arterial spin labeling (ASL) images obtained before initial surgery, before additional contralateral surgery, and at last follow-up.RESULTSOverall, 30/47 patients (63.8%) experienced progression of hemodynamic impairment in the contralateral hemisphere and underwent additional surgery. The age at initial surgery of the patients who needed additional contralateral surgery was significantly younger than that of the patients who did not require contralateral surgery (mean [SD] 7.0 [3.0] years vs 9.8 [2.6] years, p = 0.002). One patient (age 4 years) developed ischemic stroke before admission for preoperative evaluation 2 months after novel symptom onset, and another patient (age 6 years) experienced ischemic stroke in the contralateral hemisphere while discontinuing antiplatelet agents before surgery; both patients fully recovered from the neurological deficits. In contralateral hemispheres that required additional surgery, the ASL visual assessment scores significantly decreased before the additional contralateral surgery compared to those obtained before the initial surgery (p = 0.008).CONCLUSIONSIn pediatric patients with bilateral moyamoya disease, withholding surgery for hemispheres with mild vascular changes and hemodynamic impairment is generally safe. Younger patients were more likely to experience contralateral progression and require additional surgery, so close follow-up is needed. ASL imaging is useful for detecting and following the progression of hemodynamic impairment in conservatively treated hemispheres.
目的虽然在双侧莫亚莫亚病的儿科患者中,半球间不对称的血管受累很常见,但血管病变和血流动力学损伤轻微的半球是否需要立即进行血管重建手术,还是可以观察至疾病进展仍不清楚。方法作者回顾性评估了被诊断为双侧散发性 moyamoya 病并接受单侧血管再通手术的日本儿科患者(发病年龄小于 15 岁)。作者调查了患者是否接受了额外的侧支手术以及随访期间缺血事件的发生率。他们还比较了初次手术前、追加对侧手术前和最后一次随访时所获得的动脉自旋标记(ASL)图像的视觉评估。结果总体而言,30/47 例患者(63.8%)的对侧半球血流动力学损害有所进展,并接受了追加手术。需要对侧追加手术的患者初次手术时的年龄明显小于不需要对侧手术的患者(平均[标码] 7.0 [3.0] 岁 vs 9.8 [2.6] 岁,P = 0.002)。一名患者(4 岁)在新症状出现 2 个月后入院进行术前评估前发生缺血性中风,另一名患者(6 岁)在术前停用抗血小板药物时对侧半球发生缺血性中风,两名患者的神经功能缺损均已完全恢复。结论对于患有双侧 moyamoya 病的儿童患者,如果半球有轻微的血管病变和血流动力学损伤,暂缓手术一般是安全的。年龄较小的患者更有可能出现对侧病变进展并需要再次手术,因此需要密切随访。ASL 成像有助于检测和跟踪接受保守治疗的半球血液动力学损伤的进展情况。
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引用次数: 0
Comparative analysis of sport-related concussion: how do 8- to 12-year-old athletes differ from 13- to 17-year-old athletes? 运动相关脑震荡的比较分析:8 至 12 岁运动员与 13 至 17 岁运动员有何不同?
IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-13 DOI: 10.3171/2024.8.peds24295
Michael Zargari,Jacob Jo,Kristen Williams,Aaron M Yengo-Kahn,E Haley Vance,Christopher M Bonfield,Scott L Zuckerman,Douglas P Terry
OBJECTIVEDespite the growing literature on sport-related concussion (SRC) in high school and collegiate athletes, the understanding of how outcomes can vary in child athletes younger than 12 years of age remains limited. Therefore, the authors sought to compare injury characteristics and recovery in 8- to 12-year-old athletes with those of 13- to 17-year-old athletes following SRC.METHODSA single-institution retrospective cohort study was undertaken including 8- to 12-year-old and 13- to 17-year-old athletes seen at a regional SRC between November 2017 and January 2022. Demographic information, injury characteristics, Post-Concussion Symptom Scale (PCSS) scores, and recovery (i.e., return to learn [RTL], symptom resolution, and return to play [RTP]) were compared between 8- to 12-year-old and 13- to 17-year-old athletes using the Mann-Whitney U-test and chi-square test.RESULTSA total of 147 athletes (8- to 12-year-old athletes: n = 49; 13- to 17-year-old athletes: n = 98) were included. The mean ages for the younger and older groups were 10.9 ± 0.9 and 15.7 ± 1.3 years, respectively. Athletes aged 8-12 years and 13-17 years had similar median times to initial healthcare presentation (1 vs 2 days, p = 0.37). Athletes aged 8-12 years were more likely to present to the emergency department (ED) (44.9% vs 25.5%, p = 0.02) and receive head imaging (36.7% vs 19.4%, p = 0.02). Initial PCSS scores were similar between the groups (21.5 vs 22.0, p = 0.99). Athletes aged 8-12 years took longer to RTL (median 6.0 [IQR 4.0-13.0] days vs median 4.0 [IQR 2.0-8.0] days, p = 0.04). However, time to symptom resolution (median 16.0 [IQR 7.0-42.0] days vs median 13.5 [IQR 6.3-22.5] days, p = 0.34) and RTP (median 22.5 [IQR 10.0-54.8] days vs median 15.0 [IQR 10.0-24.0] days, p = 0.17) were not significantly different.CONCLUSIONSComparing 8- to 12-year-old with 13- to 17-year-old concussed athletes, the authors found that the initial PCSS score did not differ, although the younger group was more likely to present to the ED and receive head imaging. The 8- to 12-year-old athletes took more time to RTL, although no differences were found in time to symptom resolution or RTP.
目的尽管有关高中生和大学生运动员运动相关脑震荡(SRC)的文献越来越多,但人们对 12 岁以下儿童运动员脑震荡后果的了解仍然有限。因此,作者试图比较8至12岁运动员与13至17岁运动员在脑震荡后的损伤特征和恢复情况。研究方法2017年11月至2022年1月期间,在一家地区脑震荡中心就诊的8至12岁和13至17岁运动员被纳入了这项单一机构回顾性队列研究。采用曼-惠特尼U检验和卡方检验比较了8至12岁和13至17岁运动员的人口统计学信息、受伤特征、脑震荡后症状量表(PCSS)评分和恢复情况(即恢复学习[RTL]、症状缓解和恢复比赛[RTP])。结果共纳入147名运动员(8至12岁运动员:n = 49;13至17岁运动员:n = 98)。低龄组和高龄组的平均年龄分别为(10.9 ± 0.9)岁和(15.7 ± 1.3)岁。8-12 岁和 13-17 岁运动员初次就医的中位时间相似(1 天 vs 2 天,p = 0.37)。8-12 岁的运动员更有可能到急诊科(ED)就诊(44.9% 对 25.5%,p = 0.02)和接受头部成像检查(36.7% 对 19.4%,p = 0.02)。两组的 PCSS 初始评分相似(21.5 vs 22.0,p = 0.99)。年龄在 8-12 岁之间的运动员需要更长的时间来恢复运动能力(中位数 6.0 [IQR 4.0-13.0] 天 vs 中位数 4.0 [IQR 2.0-8.0] 天,p = 0.04)。然而,症状缓解时间(中位数 16.0 [IQR 7.0-42.0] 天 vs 中位数 13.5 [IQR 6.3-22.5] 天,p = 0.34)和 RTP(中位数 22.5 [IQR 10.0-54.8] 天 vs 中位数 15.0 [IQR 10.0-24.0] 天,p = 0.17)没有显著差异。结论作者将 8 至 12 岁的脑震荡运动员与 13 至 17 岁的脑震荡运动员进行比较后发现,虽然年龄较小的运动员更有可能到急诊室就诊并接受头部成像检查,但他们的 PCSS 初始评分并无差异。8 到 12 岁的运动员需要更多的时间来进行 RTL,但在症状缓解时间或 RTP 方面没有发现差异。
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引用次数: 0
Current trends, molecular insights, and future directions toward precision medicine in the management of pediatric cerebral arteriovenous malformations. 小儿脑动静脉畸形精准医疗管理的当前趋势、分子见解和未来方向。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS22354
H Westley Phillips, Regan M Shanahan, Clementina Aiyudu, Tracy A Miller, Hilary Y Liu, Stephanie Greene

Pediatric arteriovenous malformations (AVMs) are rare but carry a risk of devastating neurological morbidity and mortality. Rupture of a cerebral AVM is the most common cause of spontaneous intracranial hemorrhage in children, with an unruptured AVM having an approximate hemorrhage risk of 2%-4% per year. The complex etiology of pediatric AVMs persists as an impediment to a comprehensive understanding of pathogenesis and subsequent targeted gene therapies. While AVMs secondary to vascular malformation syndromes have a clearer pathogenesis, a variety of gene mutations have been identified within sporadic AVM cases. The Ephrin B2/EphB4 (RASA-1, KRAS, and MEK) signaling axis, hemorrhagic telangiectasia, NOTCH, and TIE2 receptor complexes (PIK3CA and mTOR), in addition to other isolated gene variants, have been implicated in AVM pathogenesis. Furthering the understanding of the molecular mechanisms of AVM pathogenesis will lead to future novel therapies and treatment paradigms. Given the expected lifespan of a child, pediatric patients have an unacceptably high cumulative lifetime risk of hemorrhage. AVM treatment strategies are dependent on AVM grade, provider preference, and institutional resources. While open microsurgery is the mainstay of treatment for some AVMs, radiosurgery for definitive treatment and adjunctive endovascular embolization are also used extensively. There is increasing evidence indicating that all three modalities play important and potentially synergistic roles in the armamentarium for pediatric AVM treatment. This review serves to report current understanding in the genetic and molecular mechanisms of pediatric AVMs, review clinical diagnostic and classification criteria, and detail treatment options and subsequent outcomes of pediatric AVM patients.

小儿动静脉畸形(AVM)虽然罕见,但却有可能导致毁灭性的神经系统发病和死亡。脑动静脉畸形破裂是导致儿童自发性颅内出血的最常见原因,未破裂的动静脉畸形每年约有 2%-4% 的出血风险。小儿动静脉畸形的病因复杂,一直阻碍着人们对其发病机制的全面了解和后续的靶向基因疗法。虽然继发于血管畸形综合征的 AVM 的发病机制较为明确,但在散发性 AVM 病例中也发现了多种基因突变。Ephrin B2/EphB4(RASA-1、KRAS 和 MEK)信号轴、出血性毛细血管扩张症、NOTCH 和 TIE2 受体复合物(PIK3CA 和 mTOR)以及其他孤立的基因变异都与 AVM 的发病机制有关。进一步了解 AVM 发病的分子机制将有助于开发新的疗法和治疗模式。考虑到儿童的预期寿命,儿科患者终生累积出血风险之高令人难以接受。动静脉畸形的治疗策略取决于动静脉畸形的等级、提供者的偏好和机构资源。虽然开放显微外科手术是治疗某些动静脉畸形的主要方法,但放射外科手术和辅助性血管内栓塞也被广泛用于最终治疗。越来越多的证据表明,这三种治疗方式在小儿视网膜血管瘤的治疗中发挥着重要且可能协同增效的作用。本综述旨在报告目前对小儿动静脉畸形遗传和分子机制的认识,回顾临床诊断和分类标准,并详细介绍小儿动静脉畸形患者的治疗方案和后续疗效。
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引用次数: 0
Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time. 绘制小儿神经外科地图:地理、性别和长期趋势。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-06 Print Date: 2024-12-01 DOI: 10.3171/2024.5.PEDS24167
Logan Muzyka, Sangami Pugazenthi, Michael R Kann, Jennifer M Strahle

Objective: Recently there has been an increase in pediatric neurosurgical fellowship graduates. It is important to understand the current pediatric neurosurgical workforce to help with prospective strategic workforce planning. The authors sought to determine 1) the geographic distribution and regional retention after training and 2) academic and leadership metrics by geographic location, era of training, and gender for practicing pediatric neurosurgeons in the United States.

Methods: Current practicing pediatric neurosurgeons were identified through American Board of Pediatric Neurological Surgery (ABPNS) certification status and the American Association of Neurological Surgeons directory. NIH RePORTER, Web of Science, and departmental and hospital networking websites were used to collect data on demographics, training, leadership, NIH involvement, and academic metrics.

Results: A total of 298 ABPNS-certified pediatric neurosurgeons were identified as currently practicing in the United States. Of these pediatric neurosurgeons, 26.2% were women, 74.5% were academic, and 11.7% have received current or past NIH funding. There were significant differences in the concentration of pediatric neurosurgeons per general population based on region. A total of 117 (39.3%) pediatric neurosurgeons held leadership positions; 4 (1.3%) served as neurosurgery department chairs, 67 (22.5%) served as chief of pediatric neurosurgery (9 of whom were women), 12 (4.0%) served as residency program directors, and 32 (10.7%) served as pediatric fellowship directors. Women were more likely to currently practice in the same region in which they trained for medical school (p = 0.050), have a lower academic rank (p = 0.004), and have a lower h-index (p < 0.001). Pediatric neurosurgeons practicing in the Northeast were more likely to have completed residency (p = 0.022) and medical school (p = 0.002) in the same region as their current practice.

Conclusions: There are differences in the concentration of pediatric neurosurgeons based on region. In pediatric neurosurgery, women hold fewer leadership positions, have lower academic ranks, and are less academically impactful as measured by the h-index. As the demand for pediatric neurosurgeons evolves, thoughtful monitoring of the distribution and composition of the neurosurgical workforce can help ensure equitable access to care across the country.

目的:最近,小儿神经外科研究员毕业生人数有所增加。了解当前的小儿神经外科人才队伍非常重要,有助于未来的人才战略规划。作者试图确定:1)培训后的地理分布和地区保留情况;2)按地理位置、培训年代和性别划分的美国儿科神经外科执业医师的学术和领导力指标:方法:通过美国小儿神经外科委员会(ABPNS)的认证状态和美国神经外科医师协会的目录确定了目前执业的小儿神经外科医师。利用 NIH RePORTER、Web of Science 以及科室和医院网络网站收集有关人口统计学、培训、领导力、NIH 参与情况和学术指标的数据:结果:共发现 298 名经 ABPNS 认证的儿科神经外科医生目前在美国执业。在这些儿科神经外科医生中,26.2%为女性,74.5%为学者,11.7%目前或过去曾获得美国国立卫生研究院的资助。根据地区的不同,儿科神经外科医生在总人口中的集中度也存在明显差异。共有 117 名(39.3%)小儿神经外科医生担任领导职务;其中 4 名(1.3%)担任神经外科系主任,67 名(22.5%)担任小儿神经外科主任(其中 9 名为女性),12 名(4.0%)担任住院医师培训项目主任,32 名(10.7%)担任小儿奖学金主任。女性目前更有可能在其接受医学院培训的同一地区执业(p = 0.050)、学术排名较低(p = 0.004)、h 指数较低(p < 0.001)。在东北部执业的儿科神经外科医生更有可能在与目前执业地区相同的地区完成住院医师培训(p = 0.022)和医学院学习(p = 0.002):结论:儿科神经外科医生的集中程度因地区而异。在小儿神经外科中,女性担任领导职务的人数较少,学术级别较低,而且根据 h 指数衡量,女性的学术影响力较低。随着对小儿神经外科医生需求的不断变化,对神经外科医生队伍的分布和构成进行周到的监测有助于确保全国范围内医疗服务的公平性。
{"title":"Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time.","authors":"Logan Muzyka, Sangami Pugazenthi, Michael R Kann, Jennifer M Strahle","doi":"10.3171/2024.5.PEDS24167","DOIUrl":"10.3171/2024.5.PEDS24167","url":null,"abstract":"<p><strong>Objective: </strong>Recently there has been an increase in pediatric neurosurgical fellowship graduates. It is important to understand the current pediatric neurosurgical workforce to help with prospective strategic workforce planning. The authors sought to determine 1) the geographic distribution and regional retention after training and 2) academic and leadership metrics by geographic location, era of training, and gender for practicing pediatric neurosurgeons in the United States.</p><p><strong>Methods: </strong>Current practicing pediatric neurosurgeons were identified through American Board of Pediatric Neurological Surgery (ABPNS) certification status and the American Association of Neurological Surgeons directory. NIH RePORTER, Web of Science, and departmental and hospital networking websites were used to collect data on demographics, training, leadership, NIH involvement, and academic metrics.</p><p><strong>Results: </strong>A total of 298 ABPNS-certified pediatric neurosurgeons were identified as currently practicing in the United States. Of these pediatric neurosurgeons, 26.2% were women, 74.5% were academic, and 11.7% have received current or past NIH funding. There were significant differences in the concentration of pediatric neurosurgeons per general population based on region. A total of 117 (39.3%) pediatric neurosurgeons held leadership positions; 4 (1.3%) served as neurosurgery department chairs, 67 (22.5%) served as chief of pediatric neurosurgery (9 of whom were women), 12 (4.0%) served as residency program directors, and 32 (10.7%) served as pediatric fellowship directors. Women were more likely to currently practice in the same region in which they trained for medical school (p = 0.050), have a lower academic rank (p = 0.004), and have a lower h-index (p < 0.001). Pediatric neurosurgeons practicing in the Northeast were more likely to have completed residency (p = 0.022) and medical school (p = 0.002) in the same region as their current practice.</p><p><strong>Conclusions: </strong>There are differences in the concentration of pediatric neurosurgeons based on region. In pediatric neurosurgery, women hold fewer leadership positions, have lower academic ranks, and are less academically impactful as measured by the h-index. As the demand for pediatric neurosurgeons evolves, thoughtful monitoring of the distribution and composition of the neurosurgical workforce can help ensure equitable access to care across the country.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"649-658"},"PeriodicalIF":2.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond traditional predictors: the impact of the pulsatility index and cortical subarachnoid space diameter on endoscopic third ventriculostomy success. 超越传统预测指标:搏动指数和皮质蛛网膜下腔直径对内窥镜第三脑室造口术成功率的影响。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS23560
Adrina Habibzadeh, Sina Zoghi, Ali Ansari, Sepehr Khademolhosseini, Mohammad Sadegh Masoudi, Afrooz Feili, Omid Yousefi, Reza Taheri

Objective: Determining the long-term success of endoscopic third ventriculostomy (ETV) remains challenging. This study aimed to investigate the impact of clinical and radiological factors on ETV success in pediatric patients with hydrocephalus.

Methods: The study included patients < 18 years old with hydrocephalus who underwent ETV between March 2014 and May 2021. Data including patient age, gender, history of previous shunt surgery, previous external ventricular drain placement, intraventricular hemorrhage history, and postoperative meningitis were extracted from medical records. Imaging features such as aqueductal stenosis, third ventricle floor bowing, displaced lamina terminalis, pulsatility index (PI), and maximum diameter of the cortical subarachnoid space (CSAS) were recorded for each patient using preoperative CT scans. Two independent neurosurgeons measured the CSAS maximum diameter and the PI. CSAS measurements were obtained on axial slices of the preoperative CT scans, whereas the PI was based on intraoperative third ventricle pulsatility. Patients were followed up for 1 year after surgery, with failure defined as the need for ventriculoperitoneal shunt (VPS) placement or death attributable to hydrocephalus.

Results: Ninety-eight children with a mean age of 16.39 ± 19.07 months underwent ETV for hydrocephalus. No deaths were recorded, but over 6 months and 1 year of follow-up, 12.2% and 22.4% of patients, respectively, experienced documented ETV failure requiring VPS placement. At the 6-month follow-up, a smaller maximum diameter of the CSAS was significantly associated with ETV failure; multivariate analysis revealed that CSAS maximum diameter was a predictor of 6-month ETV failure. At the 1-year follow-up, a lower PI was significantly associated with ETV failure, and multivariate analysis confirmed the PI as a significant predictor of ETV failure within 1 year after surgery. CSAS and PI measurements were repeated to assess interrater reliability: the intraclass correlation coefficients were 0.897 and 0.669 for CSAS and PI, respectively.

Conclusions: This study found that the CSAS maximum diameter and the PI are predictors of ETV failure at 6 months and 1 year, respectively. These findings highlight the importance of considering specific factors such as the CSAS and PI when assessing the likelihood of ETV success in pediatric patients with hydrocephalus. Further research and consideration of these factors may help optimize patient selection and improve outcomes for those undergoing ETV as a treatment for hydrocephalus.

目的:确定内镜下第三脑室造口术(ETV)的长期成功率仍具有挑战性。本研究旨在探讨儿科脑积水患者的临床和放射学因素对 ETV 成功率的影响:研究纳入了 2014 年 3 月至 2021 年 5 月间接受 ETV 的年龄小于 18 岁的脑积水患者。从病历中提取的数据包括患者的年龄、性别、既往分流手术史、既往脑室外引流管置入史、脑室内出血史和术后脑膜炎史。利用术前 CT 扫描记录了每位患者的影像学特征,如导水管狭窄、第三脑室底弓形、末端层移位、搏动指数(PI)和皮质蛛网膜下腔最大直径(CSAS)。两名独立的神经外科医生测量了 CSAS 的最大直径和 PI。CSAS 测量是通过术前 CT 扫描的轴向切片获得的,而 PI 则是根据术中第三脑室搏动率计算的。术后对患者进行为期一年的随访,失败的定义是需要进行脑室腹腔分流术(VPS)或因脑积水导致死亡:98名平均年龄为(16.39±19.07)个月的儿童接受了脑积水ETV治疗。没有死亡记录,但在6个月和1年的随访中,分别有12.2%和22.4%的患者出现有记录的ETV失败,需要植入VPS。在6个月的随访中,CSAS最大直径较小与ETV失败显著相关;多变量分析显示,CSAS最大直径是6个月ETV失败的预测因素。随访一年时,较低的 PI 与 ETV 失败显著相关,多变量分析证实 PI 是术后一年内 ETV 失败的重要预测因素。对 CSAS 和 PI 进行了重复测量,以评估相互间的可靠性:CSAS 和 PI 的类内相关系数分别为 0.897 和 0.669:本研究发现,CSAS 最大直径和 PI 分别可预测 6 个月和 1 年后 ETV 的失败。这些发现强调了在评估小儿脑积水患者 ETV 成功的可能性时考虑 CSAS 和 PI 等特定因素的重要性。对这些因素的进一步研究和考虑可能有助于优化患者选择,改善接受 ETV 治疗脑积水患者的预后。
{"title":"Beyond traditional predictors: the impact of the pulsatility index and cortical subarachnoid space diameter on endoscopic third ventriculostomy success.","authors":"Adrina Habibzadeh, Sina Zoghi, Ali Ansari, Sepehr Khademolhosseini, Mohammad Sadegh Masoudi, Afrooz Feili, Omid Yousefi, Reza Taheri","doi":"10.3171/2024.6.PEDS23560","DOIUrl":"10.3171/2024.6.PEDS23560","url":null,"abstract":"<p><strong>Objective: </strong>Determining the long-term success of endoscopic third ventriculostomy (ETV) remains challenging. This study aimed to investigate the impact of clinical and radiological factors on ETV success in pediatric patients with hydrocephalus.</p><p><strong>Methods: </strong>The study included patients < 18 years old with hydrocephalus who underwent ETV between March 2014 and May 2021. Data including patient age, gender, history of previous shunt surgery, previous external ventricular drain placement, intraventricular hemorrhage history, and postoperative meningitis were extracted from medical records. Imaging features such as aqueductal stenosis, third ventricle floor bowing, displaced lamina terminalis, pulsatility index (PI), and maximum diameter of the cortical subarachnoid space (CSAS) were recorded for each patient using preoperative CT scans. Two independent neurosurgeons measured the CSAS maximum diameter and the PI. CSAS measurements were obtained on axial slices of the preoperative CT scans, whereas the PI was based on intraoperative third ventricle pulsatility. Patients were followed up for 1 year after surgery, with failure defined as the need for ventriculoperitoneal shunt (VPS) placement or death attributable to hydrocephalus.</p><p><strong>Results: </strong>Ninety-eight children with a mean age of 16.39 ± 19.07 months underwent ETV for hydrocephalus. No deaths were recorded, but over 6 months and 1 year of follow-up, 12.2% and 22.4% of patients, respectively, experienced documented ETV failure requiring VPS placement. At the 6-month follow-up, a smaller maximum diameter of the CSAS was significantly associated with ETV failure; multivariate analysis revealed that CSAS maximum diameter was a predictor of 6-month ETV failure. At the 1-year follow-up, a lower PI was significantly associated with ETV failure, and multivariate analysis confirmed the PI as a significant predictor of ETV failure within 1 year after surgery. CSAS and PI measurements were repeated to assess interrater reliability: the intraclass correlation coefficients were 0.897 and 0.669 for CSAS and PI, respectively.</p><p><strong>Conclusions: </strong>This study found that the CSAS maximum diameter and the PI are predictors of ETV failure at 6 months and 1 year, respectively. These findings highlight the importance of considering specific factors such as the CSAS and PI when assessing the likelihood of ETV success in pediatric patients with hydrocephalus. Further research and consideration of these factors may help optimize patient selection and improve outcomes for those undergoing ETV as a treatment for hydrocephalus.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"432-437"},"PeriodicalIF":2.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A survey of the members of the American Society of Pediatric Neurosurgeons and factors associated with well-being. 对美国儿科神经外科医师学会成员的调查以及与幸福相关的因素。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-30 Print Date: 2024-11-01 DOI: 10.3171/2024.8.PEDS24225
Avery Roe, Ann Marie Flannery, Kimberly Hamilton, Paul Kanev, Lori A McBride, Chima Oluigbo, Jeffrey S Raskin, Zulma Tovar-Spinoza, Albert Tu, Howard L Weiner, Bradley Weprin, Chiu-Hsieh Hsu, Gerald A Grant, Anthony M Avellino

Objective: The goal of this study was to survey the members of the American Society of Pediatric Neurosurgeons (ASPN) to assess the prevalence and associated risks of burnout among pediatric neurosurgeons. The authors aimed to identify the factors that most significantly contributed to this risk to provide a baseline group of characteristics to improve physician well-being.

Methods: Institutional Review Board approval from the University of Arizona was obtained, and the 7-question and 9-question Mayo Physician Well-Being Index (WBI) was distributed to members of the ASPN (n = 275). This index screens for many different aspects of distress for physicians, including burnout risk, stress, depression, fatigue, suicidal ideation, and low career satisfaction.

Results: An analysis of 111 pediatric neurosurgeons (111/275 [40% response rate]) was completed. Respondent ages were distributed, with those aged 56-60 years representing the highest proportion (20%). University practice represented a majority (72%). One-third (32%) of respondents reported practicing greater than 25 years, and most physicians in the survey were married (76%). One-third of surgeons spend 61-70 hours working per week (33%), and a plurality are on call between 6 and 10 days per month (42%). Most surgeons reported treating fewer than 200 cases per year (37% reported 100-150 cases; 23%, 151-200). Most pediatric neurosurgeons (63%) stated their annual salary was sufficient. Analysis of each WBI question was performed to identify which factors specifically contributed to the risk of burnout. An overwhelming majority of respondents reported that they make significant efforts to do at least one thing each week that brings them joy (97%), and they either agree or strongly agree that they perform meaningful work (98% of all participants, 97% of females, and 98% of men, p = 0.010). Nearly half of all respondents (49%) reported feelings of burnout and a majority of them were female (67% of women and 42% of men, p = 0.021). Time, environment, case volumes, and quality-of-life concerns are all factors that significantly contribute to the overall risk of burnout and well-being.

Conclusions: This survey study of the ASPN membership revealed a 49% rate of burnout with females at higher risk (67%). Factors associated with burnout were salary, more than 10 days on call per month, electronic medical record stressors, and work-life incongruity. The aforementioned notwithstanding, respondents believe pediatric neurosurgery is a meaningful career. This study provides evidence supporting a moral imperative toward recognition of burnout symptoms and a pivot point toward implementing change.

研究目的本研究的目的是对美国儿科神经外科医师学会(ASPN)的成员进行调查,以评估儿科神经外科医师职业倦怠的发生率和相关风险。作者的目的是找出导致这种风险的最主要因素,从而为改善医生福利提供一组基线特征:方法:作者获得了亚利桑那大学机构审查委员会的批准,并向ASPN成员(n = 275)分发了包含7个问题和9个问题的梅奥医生幸福指数(WBI)。该指数可筛查医生的许多不同方面的困扰,包括职业倦怠风险、压力、抑郁、疲劳、自杀倾向和职业满意度低:对 111 名儿科神经外科医生(111/275 [40%回复率])进行了分析。受访者年龄分布广泛,其中 56-60 岁的比例最高(20%)。在大学执业的占大多数(72%)。三分之一(32%)的受访者称执业时间超过 25 年,调查中大多数医生已婚(76%)。三分之一的外科医生每周工作 61-70 小时(33%),大多数医生每月待命 6-10 天(42%)。大多数外科医生称每年治疗的病例少于 200 例(37% 称 100-150 例;23% 称 151-200 例)。大多数儿科神经外科医生(63%)表示他们的年薪足够。我们对 WBI 的每个问题都进行了分析,以确定哪些因素是导致职业倦怠风险的具体原因。绝大多数受访者表示,他们每周至少努力做一件能给自己带来快乐的事情(97%),而且他们同意或非常同意自己从事的是有意义的工作(所有参与者的98%、女性的97%和男性的98%,P = 0.010)。近一半的受访者(49%)表示有职业倦怠的感觉,其中大部分是女性(67% 的女性和 42% 的男性,p = 0.021)。时间、环境、病例量和生活质量问题都是导致职业倦怠和幸福感总体风险的重要因素:这项针对 ASPN 成员的调查研究显示,职业倦怠率为 49%,其中女性的风险更高(67%)。与职业倦怠相关的因素包括工资、每月出诊超过 10 天、电子病历压力以及工作与生活不协调。尽管存在上述问题,但受访者认为小儿神经外科是一个有意义的职业。本研究提供的证据支持了认识职业倦怠症状的道德必要性以及实施变革的支点。
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引用次数: 0
Challenges in endoscopic third ventriculostomy for patients with achondroplasia: a focus on third ventricle floor anatomy. 为软骨发育不全患者实施内窥镜第三脑室造口术的挑战:聚焦第三脑室底解剖学。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-30 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS2472
Ji Yul Shin, A Hyeon Kim, Jung Min Ko, Tae-Joon Cho, Seung-Ki Kim, Ji Hoon Phi

Objective: Hydrocephalus is one of the neurological risks occurring in patients with achondroplasia. Ventriculoperitoneal shunt (VPS) insertion is the most common treatment. However, reports of successful endoscopic third ventriculostomy (ETV) suggest that ETV may be a good alternative to VPS insertion in achondroplasia. However, it has been stated that ETV in achondroplasia patients is technically demanding to perform. The current study examined the anatomical variations of the third ventricle and the brainstem in achondroplasia patients and correlated the findings with the difficulty of performing ETV.

Methods: A retrospective analysis of 51 patients with achondroplasia and 138 hydrocephalus patients without achondroplasia (48 patients had tumor-related hydrocephalus and 90 patients had hydrocephalus of nontumorous origin) who have visited the authors' institution since 2012 was performed. Preoperative T2-weighted sagittal MR images were used to measure α (steepness of the third ventricle floor), β (endoscopic angle of incidence), d1 (vertical distance between the dorsum sellae and basilar bifurcation), and d2 (horizontal distance between the dorsum sellae and basilar artery). Each value was compared using the Tukey multicomparison test.

Results: Achondroplasia patients showed significantly smaller α (p < 0.001) and β (p < 0.001) angles, while there were no significant differences between the control groups (p = 0.947 for α, p = 0.836 for β). The d1 value was significantly larger in achondroplasia patients (p < 0.001), and d2 was smaller (p < 0.001). The control groups showed similar d1 and d2 values (p = 0.415 for d1, p = 0.154 for d2). Smaller α and β values meant that in achondroplasia patients the third ventricle floor stood more vertically than in other patients with hydrocephalus, and the endoscopic contact angles were small, increasing the risk of ventriculostomy devices slipping down into the infundibular recess. Additionally, a large d1 meant that the basilar artery was shifted upward and a small d2 indicated that the basilar artery was located closer to the dorsum sellae, potentially increasing the risk of basilar artery damage.

Conclusions: Achondroplasia patients' skull and brain anatomies were significantly different from those of other hydrocephalus patients, with steeper third ventricle floors and basilar arteries closer to the dorsum sellae. Because these anatomical differences lead to difficulties in performing ETVs in achondroplasia patients, such differences should be considered when ETV is planned for the patients.

目的:脑积水是软骨发育不全患者的神经系统风险之一。脑室腹腔分流术(VPS)是最常见的治疗方法。然而,有关内窥镜第三脑室造口术(ETV)成功的报道表明,ETV可能是软骨发育不全患者进行脑室腹腔分流术的良好替代方法。然而,有学者指出,对软骨发育不全患者实施 ETV 在技术上要求较高。本研究对软骨发育不全患者第三脑室和脑干的解剖变异进行了研究,并将研究结果与实施 ETV 的难度相关联:对自2012年以来在作者所在机构就诊的51名软骨发育不全患者和138名无软骨发育不全的脑积水患者(48名患者为肿瘤相关性脑积水,90名患者为非肿瘤性脑积水)进行了回顾性分析。术前T2加权矢状位磁共振图像用于测量α(第三脑室底的陡度)、β(内镜入射角)、d1(背侧与基底动脉分叉之间的垂直距离)和d2(背侧与基底动脉之间的水平距离)。采用 Tukey 多重比较检验对每个值进行比较:结果:软骨发育不全患者的α角(p < 0.001)和β角(p < 0.001)明显较小,而对照组之间无明显差异(α角p = 0.947,β角p = 0.836)。软骨发育不全患者的 d1 值明显较大(p < 0.001),而 d2 则较小(p < 0.001)。对照组的 d1 和 d2 值相似(d1 的 p = 0.415,d2 的 p = 0.154)。α和β值较小意味着软骨发育不全患者的第三脑室底比其他脑积水患者更垂直,内镜接触角较小,增加了脑室造口术装置滑落到脑底凹陷的风险。此外,d1大意味着基底动脉上移,d2小表明基底动脉更靠近背侧,可能增加基底动脉损伤的风险:结论:软骨发育不全患者的头骨和大脑解剖结构与其他脑积水患者明显不同,第三脑室底更陡峭,基底动脉更靠近背侧。由于这些解剖差异导致软骨发育不全患者在进行脑电图检查时遇到困难,因此在为患者计划脑电图检查时应考虑到这些差异。
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引用次数: 0
Management and outcomes of foramen magnum stenosis in children with achondroplasia at a single center over 15 years. 15 年来,单个中心对软骨发育不全儿童枕骨大孔狭窄的处理和结果。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-30 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS23586
Ulrika Sandvik, Edvin Ringvall, Katrin Klangemo, Sigrun Hallgrimsdottir, Alexandra Gkourogianni, Lars Ottosson, Jan Svoboda, Ola Nilsson

Objective: Achondroplasia is associated with foramen magnum stenosis (FMS), which can lead to sudden unexpected death in infants. There is no wide consensus regarding the best management of FMS. This study aimed to analyze the prevalence of FMS in a cohort of children with achondroplasia and to evaluate screening and neurosurgical interventions of FMS regarding its effects and complications.

Methods: The authors conducted a retrospective cohort study including all children with achondroplasia assessed or treated at Karolinska University Hospital between September 2005 and June 2020. The severity of FMS was graded using the MRI Achondroplasia Foramen Magnum Score (AFMS). The AFMS was correlated with neurological examinations and polysomnography (PSG) results.

Results: Severe FMS (AFMS 3-4) was present in 35% of the 51 children included in the study. As many as 65% of the children in the cohort underwent foramen magnum decompression (FMD). Neurological examination had a high specificity (94%) but a low sensitivity (28%) for severe FMS. Signs of central apnea on PSG did not correlate with severity of FMS (p = 0.735). Surgery improved FMS (p < 0.001) with a nonsignificant trend of decreased central apnea (p = 0.070), but carried a 9% risk of severe surgery- and anesthesia-related complications.

Conclusions: This study confirmed previous reports that severe FMS is common in children with achondroplasia, that neurological symptoms may be absent even in severe FMS, and that FMD improves FMS and may improve central apnea. The finding that neurological examination had a low sensitivity for severe FMS supports the recommendation that all children with achondroplasia should undergo early MRI.

目的:软骨发育不全与枕骨大孔狭窄(FMS)有关,可导致婴儿意外猝死。关于 FMS 的最佳治疗方法,目前尚未达成广泛共识。本研究旨在分析FMS在一组软骨发育不全患儿中的发病率,并评估FMS的筛查和神经外科干预对其影响和并发症的影响:作者进行了一项回顾性队列研究,研究对象包括2005年9月至2020年6月期间在卡罗林斯卡大学医院接受评估或治疗的所有软骨发育不全儿童。FMS的严重程度通过核磁共振成像软骨发育不全椎间孔评分(AFMS)进行分级。AFMS与神经系统检查和多导睡眠图(PSG)结果相关:结果:在 51 名参与研究的儿童中,35% 患有严重的 FMS(AFMS 3-4)。多达65%的患儿接受了枕骨大孔减压术(FMD)。神经系统检查对重度 FMS 的特异性较高(94%),但敏感性较低(28%)。PSG 显示的中枢性呼吸暂停与 FMS 的严重程度无关(p = 0.735)。手术可改善 FMS(p < 0.001),中枢性呼吸暂停减少的趋势不明显(p = 0.070),但出现严重手术和麻醉相关并发症的风险为 9%:本研究证实了之前的报道,即严重的 FMS 常见于软骨发育不全的儿童,即使是严重的 FMS 也可能没有神经系统症状,而 FMD 可改善 FMS 并可改善中枢性呼吸暂停。神经系统检查对重度 FMS 的敏感性较低,这一发现支持了所有软骨发育不全患儿都应尽早接受磁共振成像检查的建议。
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Journal of neurosurgery. Pediatrics
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