Journal of neurosurgery. Pediatrics最新文献

Objective: Neurosurgeon scientists play a unique role in advancing neuroscience research. While previous publications have explored trends in federal and foundation funding among neurosurgeons, funding is often dominated by neurosurgical oncologists and functional neurosurgeons. Less is known about the research efforts of pediatric neurosurgeons. The aim of this study was to survey the members of the American Society of Pediatric Neurosurgeons (ASPN) to provide an overview of past research experience, current involvement, funding, and research priorities among pediatric neurosurgeons, and to gather insights that could shape future efforts to advance pediatric neurosurgical research.

Methods: A survey was developed using the REDCap platform and distributed to all ASPN members via email. Survey questions used branching logic and were organized into 5 sections: 1) demographics, 2) research experience during training, 3) research experience as an attending physician, 4) research priorities, and 5) multicenter consortiums.

Results: One hundred thirty-nine respondents completed more than half of the survey, for an overall response rate of 52.1%. Most respondents (96.4%) participated in research during their training, but only 38.1% had received a grant during training. In contrast, 83.9% of respondents were actively engaged in research as an attending physician, and 48.7% reported active funding (60.7% federal, 41.8% from foundations, and 42.9% internal). Furthermore, 74.8% of respondents reported being a member of a multicenter research consortium, and 82.4% agreed that multicenter research is important. Seventy percent of respondents agreed that the ASPN should facilitate multicenter consortium-based pediatric neurosurgical research, offering free-text responses with the following suggestions: 1) set aside time at the annual meeting to discuss multicenter research (22.9%); 2) encourage collaboration and facilitate networking (42.9%); 3) provide centralized core services such as a data coordinator and biostatistician (12.9%); and 4) provide training, education, and mentoring (7.1%).

Conclusions: The survey provided a cross-sectional analysis of the pediatric neurosurgical research landscape, highlighting the current state of research experience, funding, and the perspectives of pediatric neurosurgeons regarding research priorities. Despite the challenges, there is clear recognition of the importance of multicenter research collaboration. These findings reinforce the ongoing necessity of organized initiatives to support pediatric neurosurgical research and offer actionable insights into how organized pediatric neurosurgery can contribute to this critical endeavor.

Objective: Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia.

Methods: A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children's Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05.

Results: Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up.

Conclusions: SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.

Objective: The relationship between Chiari malformation type I (CMI) and tethered cord syndrome (TCS) is not well understood. The aim of this study was to examine conus position and rates of TCS and tethered cord release (TCR) in pediatric patients with CMI at a tertiary hospital.

Methods: The medical records of children with a diagnosis of CMI based on MRI of the lumbar spine from 2010 to 2023 were retrospectively reviewed. Conus position on MRI, tonsil position below the foramen magnum, presence of fatty filum or filum terminale lipoma, and rates of CMI decompression and TCR were recorded. Age- and sex-matched controls were randomly selected from a cohort of patients who obtained an MRI of the spine for any reason. Conus position was coded and then compared using the Student t-test. Categorical variables were compared using the chi-square test.

Results: A total of 657 pediatric patients with CMI were included. The mean ± SD tonsil position was 11.7 ± 5.6 mm below the foramen magnum, and 44.7% of patients underwent CMI decompression. The conus terminated at or above the L2-3 disc space in 97% of CMI patients. There was no statistical difference in conus position between CMI patients and controls (p = 0.09). Nine patients (1.4%) in the CMI cohort had symptomatic TCS and underwent TCR. This proportion was not statistically different compared to the control group: 11 patients (1.7%) had symptomatic TCS and underwent TCR (p = 0.1).

Conclusions: Most patients with CMI had a normal conus position (97%), and conus position was not different between CMI and control patients. The number of patients with symptomatic TCS was not statistically different between CMI and control patients.

Objective: The posterior fossa is the most common location for primary brain tumors in pediatric patients, and these infratentorial lesions are the leading cause of solid-tumor mortality. Resection remains a cornerstone of managing many of these tumors. However, the overall rate of perioperative complications in pediatric patients who have undergone posterior fossa tumor resection and the associated risk factors have not been explored. Therefore, the authors of this paper aimed to explore the association between clinical characteristics and the likelihood of complications with the intention of guiding patient counseling and directing areas for quality improvement to expand value-based care.

Methods: This is a retrospective cohort study utilizing the National Surgical Quality Improvement Program Pediatric data from 2012 to 2022 to track 30-day perioperative complications in patients 18 years of age or younger who underwent posterior fossa tumor resection. The primary outcome was postsurgical complications within 30 days. A generalized additive model was used to evaluate the relationship of clinical (e.g., age, pulmonary or cardiac conditions) and surgical (e.g., CSF diversion, operating time) factors with 30-day complications.

Results: Approximately 1 in 3 pediatric patients (1314/4044) experienced a perioperative complication within 30 days of posterior fossa tumor resection. The most common complications were bleeding or a need for transfusion (15.0%) and unplanned reoperation (14.6%). The rate of unplanned, related readmissions within 30 days was 8.5%. Variables significantly associated with greater odds of complications included an American Society of Anesthesiologists status of IV or V, emergent or urgent surgery, malignant tumor, sepsis/septic shock/systemic inflammatory response syndrome, structural CNS abnormality, steroid use, the need for ventricular catheter or CSF diversion, a history of pulmonary conditions, and a history of nutritional support. The probability of complications was highest in patients younger than 1 year of age relative to that in older patients. Longer operation times were also associated with an increased probability of perioperative complications.

Conclusions: While high, the perioperative complication rate of 33% is comparable to previously reported rates for pediatric intracranial tumor resection in smaller sample sizes. The study results suggest that several clinical and surgical factors are associated with a greater risk of perioperative complications in children undergoing posterior fossa tumor resection. Understanding the impact that this has on surgical morbidity can inform risk stratification and presurgical counseling for patients and their families.

Objective: This study investigates the potential of artificial intelligence (AI), specifically ChatGPT 4o, to revolutionize the readability of patient education materials in pediatric neurosurgery. The American Medical Association and the National Institutes of Health recommend that educational materials be written at a 3rd- to 7th-grade reading level for accessibility. However, existing resources often exceed this range, hindering comprehension for many patients.

Methods: This study analyzed 38 patient education materials on hydrocephalus, spina bifida, tethered cord syndrome, cerebral palsy, Chiari malformation, and craniosynostosis from 7 top-ranked US children's hospitals. The Flesch-Kincaid grade level calculator was used to assess readability before and after AI modification.

Results: ChatGPT effectively reduced the mean reading level from 10.60 (SD 0.57) to 6.18 (SD 0.28; p < 0.05), achieving the target 6th-grade level across all conditions.

Conclusions: Despite some limitations in maintaining word count and precise grade-level control, the results demonstrate the promising potential of AI in significantly enhancing the accessibility of pediatric neurosurgical education materials, which may lead to more inclusive patient communication and understanding.

Objective: Limited health literacy (HL) is associated with worse clinical outcomes across medical specialties. The association between limited HL and neurosurgical outcomes remains largely unknown. In this systematic review, the authors synthesized the existing literature on the association between limited patient and/or caregiver HL and neurosurgical outcomes.

Methods: A systematic search was conducted in PubMed, Embase, CINAHL, and JBI EBP from inception to February 12, 2025, following PRISMA guidelines. Study quality was assessed using the Newcastle-Ottawa Scale. The study design, sample size, population of interest, neurosurgical diagnoses/procedures, HL assessment used, pertinent findings, and related demographic factors were collected.

Results: The search yielded 698 article titles and abstracts, of which 37 underwent full-text review and 6 met inclusion criteria for this systematic review. These 6 studies included 695 neurosurgical patients and/or caregivers and used various methods to assess HL. Neurosurgical outcomes were grouped into the following categories: 1) delivery and timing of neurosurgical care, 2) hospital admission and discharge, and 3) quality of life (QOL) and well-being. Study results were split evenly across these 3 categories, with 2 studies that explored the delivery and timing of neurosurgical care, 2 that examined hospital admission and discharge, and 2 that investigated QOL and well-being. Study designs included 2 prospective observational studies, 3 cross-sectional studies, and 1 qualitative study. Sample sizes ranged from 27 to 300 patients, including pediatric, adult, and mixed (pediatric and adult) populations, as well as caregivers of pediatric and adult patients. All 6 studies were conducted outside the United States. Limited HL was found to be associated with delays in neurosurgical care, increased rates of discharge against medical advice, decreased patient independence, and worse psychological well-being.

Conclusions: This systematic review highlights the paucity of studies on neurosurgical outcomes among patients and/or caregivers with limited HL, while suggesting that limited HL is associated with worse neurosurgical outcomes. In addition, the lack of studies conducted in the US indicates a geographic gap in the literature. The authors provide a call to action and concrete steps to address the critical need for further research on HL to achieve more equitable neurosurgical care.

Objective: Traumatic brain injury (TBI) is a leading cause of acquired neurological disability in children of both sexes. Therapies that improve neurological disability in animal TBI models have universally failed in humans. Successful transition to clinical application should increase if experimental TBI models use animals that are more similar to humans and collect clinically relevant biomarkers. Porcine models of human disease are strong predictors of clinical efficacy. However, studies using immature swine of both sexes and serial collection of biological samples after TBI are lacking. In the authors' rat model of pediatric TBI, docosahexaenoic acid (DHA) improved outcomes and decreased white matter injury, neuroinflammation, and oxidative stress. The authors conducted a proof-of-concept study to evaluate the feasibility of obtaining serial blood, cerebrospinal fluid (CSF), and urine samples from piglets of both sexes after TBI using fluid percussion injury (FPI), and to assess the utility of these samples for measuring clinically relevant biomarkers in a preclinical pediatric TBI model.

Methods: After pilot testing of a CSF reservoir in cadaver piglets, the authors conducted FPI followed by reservoir placement in live 4-week-old male and female piglets.

Results: The authors succeeded in obtaining all 3 types of samples and measuring biomarkers of white matter injury, neuroinflammation, and oxidative stress. When inserted to an optimal depth of 10 mm, CSF reservoir function was preserved for 3-7 days despite normal piglet activity. Surgery-related mortality (occurring within 1 hour) was 3/36 piglets. One piglet had a quickly resolved scalp infection. FPI increased serum neurofilament light (NfL), a marker of axonal injury, at postinjury day (PID) 1 and 7 in males, blunted by DHA, although the sample size was small. At PID 3, FPI increased CSF interleukin (IL)-4, -8, -12, and -18. DHA abrogated the FPI-induced increase in IL-8 in males. FPI increased IL-12 in DHA-treated females but not control (coconut oil-treated) females. Female sex was associated with increased levels of 10 of the 13 CSF cytokines even in the absence of FPI. At PID 1, the authors observed markedly decreased CSF total antioxidant capacity, a measure of oxidative stress, in all groups.

Conclusions: Modified piglet FPI allowed serial collection of CSF, urine, and blood samples during the 1st week after surgery. The authors anticipate that this model will be useful for preclinical pharmacokinetic and efficacy studies that require longer term survival and serial biofluid collection after TBI.

Objective: The authors' objective was to assess the impact of telehealth on pediatric neurosurgical care access for underserved and rural populations in West Virginia. The authors explored how telehealth utilization varied over time, the socioeconomic benefits it provided to families, and its effect on visit completion rates compared with in-person appointments.

Methods: Clinic visits from January 1, 2017, to May 31, 2023, at the sole pediatric neurosurgery clinic in West Virginia were retrospectively reviewed. The data included three types of outpatient visits: in-person, telemedicine satellite clinic, and MyChart video appointments. Initial statistical analysis focused on visit completion rates, distance traveled, and time and cost savings for families. Additional geospatial analysis used heat density mapping to recognize regional utilization patterns, and community-level socioeconomic variables were analyzed for correlation with visit type utilization.

Results: Telehealth usage (telemedicine and MyChart) increased significantly during and after the COVID-19 pandemic. MyChart visits demonstrated the highest completion rates postpandemic. Telehealth visits saved families substantial travel time and cost, especially for those living more than 100 miles from the clinic. Geospatial analysis revealed that telemedicine usage was clustered in specific Appalachian regions, and in-person visits were more common among patients from economically distressed communities. Correlation analysis showed that higher poverty and unemployment rates were associated with in-person visit reliance, while telehealth adoption was lower in these populations.

Conclusions: Telehealth significantly enhances access to pediatric neurosurgical care for rural and economically disadvantaged families, reducing travel-related burdens and increasing visit adherence. However, economically distressed communities in Appalachia are less likely to use telehealth, possibly due to digital access issues or skepticism about remote care. Addressing these barriers is crucial to ensure equitable healthcare access. Further research should investigate structural and personal obstacles to telehealth uptake to improve service delivery for at-risk populations, ultimately fostering more inclusive and accessible healthcare options in remote areas.