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Cerebroventricular deformation and vector mapping, a topographic visualizer for surgical interventions in pediatric hydrocephalus. 脑室变形和矢量绘图,小儿脑积水手术干预的地形可视化工具。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-23 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS24117
Kristen W Yeom, Michael Zhang, Edward H Lee, Allison K Duh, Shannon J Beres, Laura M Prolo, Robert M Lober, Heather E Moss, Michael E Moseley, Nils D Forkert, Matthias Wilms, Gerald A Grant

Objective: Hydrocephalus is a challenging neurosurgical condition due to nonspecific symptoms and complex brain-fluid pressure dynamics. Typically, the assessment of hydrocephalus in children requires radiographic or invasive pressure monitoring. There is usually a qualitative focus on the ventricular spaces even though stress and shear forces extend across the brain. Here, the authors present an MRI-based vector approach for voxelwise brain and ventricular deformation visualization and analysis.

Methods: Twenty pediatric patients (mean age 7.7 years, range 6 months-18 years; 14 males) with acute, newly diagnosed hydrocephalus requiring surgical intervention for symptomatic relief were randomly identified after retrospective chart review. Selection criteria included acquisition of both pre- and posttherapy paired 3D T1-weighted volumetric MRI (3D T1-MRI) performed on 3T MRI systems. Both pre- and posttherapy 3D T1-MRI pairs were aligned using image registration, and subsequently, voxelwise nonlinear transformations were performed to derive two exemplary visualizations of compliance: 1) a whole-brain vector map projecting the resulting deformation field on baseline axial imaging; and 2) a 3D heat map projecting the volumetric changes along ventricular boundaries and the brain periphery.

Results: The patients underwent the following interventions for treatment of hydrocephalus: endoscopic third ventriculostomy (n = 6); external ventricular drain placement and/or tumor resection (n = 10); or ventriculoperitoneal shunt placement (n = 4). The mean time between pre- and postoperative imaging was 36.5 days. Following intervention, the ventricular volumes decreased significantly (mean pre- and posttherapy volumes of 151.9 cm3 and 82.0 cm3, respectively; p < 0.001, paired t-test). The largest degree of deformation vector changes occurred along the lateral ventricular spaces, relative to the genu and splenium. There was a significant correlation between change in deformation vector magnitudes within the cortical layer and age (p = 0.011, Pearson), as well as between the ventricle size and age (p = 0.014, Pearson), suggesting higher compliance among infants and younger children.

Conclusions: This study highlights an approach for deformation analysis and vector mapping that may serve as a topographic visualizer for therapeutic interventions in patients with hydrocephalus. A future study that correlates the degree of cerebroventricular deformation or compliance with intracranial pressures could clarify the potential role of this technique in noninvasive pressure monitoring or in cases of noncompliant ventricles.

目的:脑积水是一种具有挑战性的神经外科疾病,因为它具有非特异性症状和复杂的脑液压力动态变化。通常情况下,评估儿童脑积水需要进行放射成像或有创压力监测。尽管应力和剪切力遍及整个大脑,但其定性重点通常是脑室空间。在此,作者介绍了一种基于核磁共振成像的矢量方法,用于体素脑和脑室变形的可视化和分析:经过回顾性病历审查,随机确定了 20 名新诊断为急性脑积水的儿科患者(平均年龄 7.7 岁,6 个月至 18 岁;14 名男性),这些患者需要通过手术治疗来缓解症状。选择标准包括在 3T 磁共振成像系统上采集治疗前和治疗后的成对三维 T1 加权容积磁共振成像(3D T1-MRI)。治疗前和治疗后的三维 T1-MRI 成对图像通过图像配准进行对齐,然后进行体素非线性变换,以获得两种可视化的顺应性示例:1)全脑矢量图,将由此产生的形变场投射到基线轴向成像上;2)三维热图,投射沿脑室边界和大脑外围的容积变化:患者接受了以下脑积水干预治疗:内镜下第三脑室造口术(6例);脑室外引流管置入术和/或肿瘤切除术(10例);或脑室腹腔分流术(4例)。术前和术后成像的平均间隔时间为 36.5 天。介入治疗后,脑室容积明显缩小(治疗前和治疗后的平均容积分别为 151.9 立方厘米和 82.0 立方厘米;P < 0.001,配对 t 检验)。相对于茎突和脾脏,侧脑室间隙的变形矢量变化程度最大。皮质层内的变形矢量大小变化与年龄(P = 0.011,Pearson)以及脑室大小与年龄(P = 0.014,Pearson)之间存在明显的相关性,这表明婴幼儿的顺应性更高:本研究强调了一种变形分析和矢量绘图方法,可作为地形图可视化工具对脑积水患者进行治疗干预。未来的研究如果能将脑室变形或顺应性程度与颅内压联系起来,就能明确该技术在无创压力监测或不顺应性脑室病例中的潜在作用。
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引用次数: 0
Thirty-day outcomes of surgery for hydrocephalus: metrics in a large cohort from the National Surgical Quality Improvement Program-Pediatric. 脑积水手术三十天后的疗效:国家外科质量改进计划-儿科大型队列中的指标。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-23 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS24183
Paulo Castro, Joseph Piatt

Objective: Hydrocephalus is a lifelong condition punctuated in most cases by unpredictable hospital admissions for surgical maintenance. It occupies more of the attention of the pediatric neurosurgeon than any other condition. Benchmarks for the measurement of outcomes are of interest to patients, their families, and the healthcare system. Compared to other metrics, 30-day outcomes require modest resources to collect, are conceptually transparent, and are responsive to process improvement.

Methods: The National Surgical Quality Improvement Program-Pediatric of the American College of Surgeons was queried for operations for hydrocephalus in the years 2013 through 2020. Demographic data and data regarding comorbidities were collected. Thirty-day rates of return to the operating room, of shunt infection, and of readmission to hospital were analyzed on a univariate basis and in multivariate models.

Results: There were 29,098 surgical procedures in the sample, including 10,135 shunt insertions, 16,420 shunt revisions, and 2543 endoscopic third ventriculostomies. The overall 30-day reoperation rate was 10.3%. The most powerful associations were with the nature of the index procedure and with a history of extreme prematurity. The 30-day shunt infection rate was 1.80%. The major associations were with young age, major cardiac risk factors, nutritional support, and ventilator dependence. The 30-day readmission rate was 17.2%. The nature of the index procedure, current malignancy, nutritional support, and recent steroid administration were major associations. Comorbidities negatively associated with these outcomes were highly prevalent.

Conclusions: Precise benchmarks for important 30-day outcomes have been calculated from a very large sample of operations for hydrocephalus in childhood.

目的:脑积水是一种终生疾病,在大多数情况下,患者会因难以预料的手术治疗而入院。与其他疾病相比,它更受儿科神经外科医生的关注。患者、患者家属和医疗保健系统都很关心衡量疗效的基准。与其他指标相比,30 天疗效的收集所需的资源不多,在概念上也比较透明,而且对流程改进反应迅速:方法:查询了美国外科学院国家外科质量改进计划-儿科 2013 年至 2020 年的脑积水手术情况。收集了人口统计学数据和合并症数据。在单变量和多变量模型中分析了三十天内返回手术室率、分流器感染率和再次入院率:结果:样本中有29098例手术,包括10135例分流插入术、16420例分流翻修术和2543例内镜下第三脑室造口术。30 天内的总体再手术率为 10.3%。最重要的关联因素是指数手术的性质和极度早产史。30 天分流感染率为 1.80%。主要与年龄小、主要心脏风险因素、营养支持和呼吸机依赖有关。30 天再入院率为 17.2%。指标手术的性质、目前的恶性肿瘤、营养支持和最近的类固醇用药是主要的关联因素。与这些结果呈负相关的合并症非常普遍:从儿童脑积水手术的大量样本中计算出了重要的 30 天结果的精确基准。
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引用次数: 0
Safety and accuracy of stereoelectroencephalography for pediatric and young adult patients with prior craniotomy. 对曾接受开颅手术的儿童和年轻成人患者进行立体脑电图检查的安全性和准确性。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-23 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS24198
Peter H Yang, Nathan Wulfekammer, Amanda V Jenson, Elliot G Neal, Stuart Tomko, John Zempel, Peter Brunner, Sean D McEvoy, Matthew D Smyth, Jarod L Roland

Objective: The authors assessed the safety and accuracy of stereoelectroencephalography (SEEG) electrode implantation in pediatric patients who had previously undergone craniotomy compared to those without prior cranial surgery.

Methods: The authors performed a retrospective analysis of patients under 25 years of age with medically refractory epilepsy at a single institution who underwent SEEG electrode placement between March 2016 and July 2023. Surgical history and demographic characteristics were collected from the electronic medical records. The coordinates of the anchor bolts and their respective SEEG electrode contacts were manually annotated using postoperative head CT scans. Bolt coordinates were used to calculate the initiated electrode trajectory set by the bolt by using the least-squares method to define a line along the bolt, projected along the length of the electrode. The shortest distance from each electrode contact to this line was calculated to obtain the error measurement. Statistical analysis was conducted using the Kolmogorov-Smirnov test to compare the distribution of errors between groups, the Student t-test was used for continuous variables, and the chi-square/Fisher's exact test was used for categorical variables.

Results: Fifty-eight patients underwent a total of 60 SEEG placements and met the inclusion criteria. Eighteen had a history of prior craniotomy and 40 without prior surgery, indicating entirely native cranial bone. Mean age, sex, and mean number of electrodes implanted per surgery were similar between groups. For the electrode contact furthest from the bolt, a mean (IQR) deviation of 1.32 (0.73-2.53) mm was noted for the prior craniotomy group and 1.08 (0.65-1.55) mm for the native bone group (p < 0.0001). A greater number of outliers for the contact furthest from the bolt, defined as > 6 mm from the initiated electrode trajectory, was seen in the prior craniotomy group (p < 0.0001). The complication rate was low and not statistically different between groups.

Conclusions: The authors' analysis draws attention to the effect of the intracranial biomechanical environment along the path of the electrode after traversing past the anchor bolt and found that prior craniotomy was associated with a higher number of contacts with a significant deviation from the initiated trajectory. Despite these deviations, we did not find a difference in the overall low complication rate in both groups. Therefore, the authors conclude that SEEG electrode placement is a safe option in pediatric patients even after prior craniotomy.

目的:作者评估了立体脑电图(SEEG)电极植入的安全性和准确性:作者评估了曾接受开颅手术的儿科患者与未接受开颅手术的患者相比,立体脑电图(SEEG)电极植入的安全性和准确性:作者对2016年3月至2023年7月期间在一家医疗机构接受SEEG电极植入术的25岁以下医学难治性癫痫患者进行了回顾性分析。从电子病历中收集了手术史和人口统计学特征。使用术后头部 CT 扫描手动标注锚栓坐标及其各自的 SEEG 电极接触点。螺栓坐标用于计算螺栓设定的初始电极轨迹,方法是使用最小二乘法沿螺栓定义一条线,并沿电极长度投影。计算每个电极触点到这条直线的最短距离,从而获得误差测量值。统计分析采用 Kolmogorov-Smirnov 检验比较组间误差分布,连续变量采用学生 t 检验,分类变量采用卡方/费舍尔精确检验:58 名患者共接受了 60 次 SEEG 放置,均符合纳入标准。其中 18 人曾接受过开颅手术,40 人未接受过手术,这表明他们的颅骨完全是原生的。两组患者的平均年龄、性别和每次手术植入电极的平均数量相似。对于离螺栓最远的电极接触点,开颅手术前组的平均(IQR)偏差为 1.32 (0.73-2.53) mm,而原生骨组的平均(IQR)偏差为 1.08 (0.65-1.55) mm(P < 0.0001)。先前开颅手术组中,距离螺栓最远的接触点(定义为距离初始电极轨迹 > 6 mm)的异常值数量较多(p < 0.0001)。并发症发生率较低,组间无统计学差异:作者的分析提醒人们注意电极穿过锚栓后颅内生物力学环境对电极轨迹的影响,并发现之前进行过开颅手术的患者接触次数较多,且明显偏离初始轨迹。尽管存在这些偏差,但我们并未发现两组在总体低并发症发生率方面存在差异。因此,作者认为 SEEG 电极置入术对儿科患者来说是一种安全的选择,即使之前进行过开颅手术。
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引用次数: 0
Ten-year statewide cross-sectional review of pediatric sinogenic intracranial abscess and empyema in Queensland, Australia: microbial profile before and after COVID-19. 澳大利亚昆士兰州小儿窦源性颅内脓肿和肺水肿十年全州横断面回顾:COVID-19 前后的微生物概况。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-16 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS24201
Michael J Stuart, Annabelle M Harbison, Norman Ma, Robert A J Campbell, Amelia J Jardim, David S Anderson, Teresa K Withers, Liam G Coulthard

Objective: Sinogenic intracranial infections in children, such as subdural empyema or intracranial abscess, are a rare disease process with significant associated morbidity. Recent literature has suggested that there may have been an increase in frequency of these infections following the COVID-19 pandemic, but the literature has been conflicting, perhaps related to the heterogenous management of COVID-19 lockdowns in various states and differences in data capture between methods. The collection of statewide Australian data overcomes these limitations by capturing a comprehensive sample though the public healthcare system of patients who were subject to a homogeneous statewide approach to public health policy during the COVID-19 pandemic (population 5.6 million, including 1.3 million children). The objective of this study was to present population-level data to address the question of whether the incidence of intracranial infections changed in pediatric patients before and after the COVID-19 pandemic.

Methods: The authors present a retrospective 10-year statewide description of sinogenic intracranial infections in Queensland, Australia. A comparison was made between the incidence and microbiological profile before and after the onset of COVID-19 lockdowns on March 22, 2020.

Results: Forty-four pediatric intracranial infections undergoing neurosurgical intervention were identified within the review period. After exclusion of postsurgical and cardioembolic causes, 33 sinogenic intracranial infections were included (16 before and 17 after 2020, with a mean annualized incidence of 0.25 vs 0.37 cases per 100,000 children, respectively; p > 0.05). The most frequent organisms identified were Streptococcus milleri (n = 19), polymicrobial (n = 4), and S. aureus (n = 3). No significant differences in antimicrobial profile, susceptibility, parenchymal involvement, or clinical outcome were identified between the pre- and post-COVID-19 groups.

Conclusions: No statistically significant differences in the epidemiology of pediatric intracranial infection have occurred in the state of Queensland, Australia, before and after March 22, 2020, and the COVID-19 pandemic.

目的:儿童颅内窦源性感染,如硬膜下积液或颅内脓肿,是一种罕见的疾病过程,相关发病率很高。最近的文献表明,在 COVID-19 大流行后,此类感染的发生率可能有所上升,但这些文献相互矛盾,这可能与各州对 COVID-19 封锁的不同管理方式以及不同数据采集方法之间的差异有关。澳大利亚全州数据的收集克服了这些局限性,因为它通过公共医疗保健系统采集了一个全面的样本,这些病人在 COVID-19 大流行期间接受了全州统一的公共卫生政策(人口 560 万,包括 130 万儿童)。本研究的目的是提供人群层面的数据,以解决 COVID-19 大流行前后儿科患者颅内感染发病率是否发生变化的问题:作者对澳大利亚昆士兰州窦源性颅内感染进行了为期 10 年的全州回顾性描述。对 2020 年 3 月 22 日 COVID-19 封锁开始前后的发病率和微生物概况进行了比较:结果:在审查期间发现了44例接受神经外科干预的小儿颅内感染。在排除手术后和心脏栓塞原因后,共纳入 33 例窦源性颅内感染(2020 年前 16 例,2020 年后 17 例,平均年发病率分别为每 10 万名儿童 0.25 例和 0.37 例;P > 0.05)。最常发现的微生物是毫雷链球菌(19 例)、多杀菌素(4 例)和金黄色葡萄球菌(3 例)。COVID-19前后两组在抗菌谱、药敏性、实质受累情况或临床结果方面均无明显差异:结论:在 2020 年 3 月 22 日和 COVID-19 大流行前后,澳大利亚昆士兰州的小儿颅内感染流行病学在统计学上没有明显差异。
{"title":"Ten-year statewide cross-sectional review of pediatric sinogenic intracranial abscess and empyema in Queensland, Australia: microbial profile before and after COVID-19.","authors":"Michael J Stuart, Annabelle M Harbison, Norman Ma, Robert A J Campbell, Amelia J Jardim, David S Anderson, Teresa K Withers, Liam G Coulthard","doi":"10.3171/2024.6.PEDS24201","DOIUrl":"10.3171/2024.6.PEDS24201","url":null,"abstract":"<p><strong>Objective: </strong>Sinogenic intracranial infections in children, such as subdural empyema or intracranial abscess, are a rare disease process with significant associated morbidity. Recent literature has suggested that there may have been an increase in frequency of these infections following the COVID-19 pandemic, but the literature has been conflicting, perhaps related to the heterogenous management of COVID-19 lockdowns in various states and differences in data capture between methods. The collection of statewide Australian data overcomes these limitations by capturing a comprehensive sample though the public healthcare system of patients who were subject to a homogeneous statewide approach to public health policy during the COVID-19 pandemic (population 5.6 million, including 1.3 million children). The objective of this study was to present population-level data to address the question of whether the incidence of intracranial infections changed in pediatric patients before and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>The authors present a retrospective 10-year statewide description of sinogenic intracranial infections in Queensland, Australia. A comparison was made between the incidence and microbiological profile before and after the onset of COVID-19 lockdowns on March 22, 2020.</p><p><strong>Results: </strong>Forty-four pediatric intracranial infections undergoing neurosurgical intervention were identified within the review period. After exclusion of postsurgical and cardioembolic causes, 33 sinogenic intracranial infections were included (16 before and 17 after 2020, with a mean annualized incidence of 0.25 vs 0.37 cases per 100,000 children, respectively; p > 0.05). The most frequent organisms identified were Streptococcus milleri (n = 19), polymicrobial (n = 4), and S. aureus (n = 3). No significant differences in antimicrobial profile, susceptibility, parenchymal involvement, or clinical outcome were identified between the pre- and post-COVID-19 groups.</p><p><strong>Conclusions: </strong>No statistically significant differences in the epidemiology of pediatric intracranial infection have occurred in the state of Queensland, Australia, before and after March 22, 2020, and the COVID-19 pandemic.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"489-494"},"PeriodicalIF":2.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141992348","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
Letter to the Editor. Unilateral hemilaminectomy for pediatric intradural tumors. 致编辑的信。小儿硬膜内肿瘤的单侧半椎板切除术。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-16 DOI: 10.3171/2024.7.PEDS24339
Naci Balak
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引用次数: 0
Longitudinal analysis of cranial growth using comprehensive craniometric measurements after fronto-orbital advancement in coronal craniosynostosis. 对冠状颅畸形患者进行前眶前移术后,利用综合头颅测量法对头颅生长情况进行纵向分析。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-16 Print Date: 2024-11-01 DOI: 10.3171/2024.6.PEDS24137
Sungmi Jeon, Se Yeon Lee, Albert K Oh, Taekeun Yoon, Jee Hyeok Chung, Sukwha Kim, Seung-Ki Kim, Ji Hoon Phi, Ji Yeoun Lee, Kyung Hyun Kim, Byung Jun Kim

Objective: The objective of this study was to investigate the longitudinal changes in cranial growth following fronto-orbital advancement (FOA) surgery in patients with unilateral and bilateral coronal craniosynostosis.

Methods: This retrospective review analyzed head circumference (HC) and CT data during preoperative (T0), immediate postoperative (T1), and final follow-up (T2) visits in 40 patients (23 female, 17 male) who underwent FOA using either the open approach or distraction osteogenesis (DO) between 1987 and 2018. The mean follow-up period was 90.62 months. The z-scores of HC, CT-based intracranial volume, anteroposterior diameter (APD), biparietal diameter (BPD), and cranial height (CH) were calculated using sex- and age-specific standards. Logistic regression analysis was performed.

Results: While the z-scores of HC, intracranial volume, and BPD remained within the normal range, the z-scores of APD fluctuated between -2 and -1, and the z-scores of CH were > 2, indicating a substantial elevation compared with norms from T0 to T2. Age at surgery significantly influenced the z-scores of HC, BPD, and CH at T2 (all p < 0.05). Delayed surgical timing was correlated with increased BPD and CH z-scores from T1 to T2 (p = 0.007 and 0.019, respectively). The DO for FOA resulted in elevated HC z-scores at T2 and increased APD from T0 to T1, followed by a significant APD relapse from T1 to T2.

Conclusions: These findings suggest that delayed surgical timing may support better cranial growth, as indicated by increased HC at long-term follow-up. However, delayed timing is also associated with worsening abnormally elevated CH. Despite the immediate APD expansion and long-term HC increase with DO, potential relapse warrants caution. While intentional overcorrection of APD is recommended, careful consideration of surgical timing and planning is essential.

研究目的本研究旨在探讨单侧和双侧冠状颅发育不良患者在接受眶前推进(FOA)手术后头颅生长的纵向变化:这项回顾性研究分析了1987年至2018年间采用开放式方法或牵张成骨术(DO)接受前眶推进术(FOA)的40名患者(23名女性,17名男性)在术前(T0)、术后即刻(T1)和最终随访(T2)期间的头围(HC)和CT数据。平均随访时间为 90.62 个月。采用性别和年龄特异性标准计算了HC、基于CT的颅内容积、前胸直径(APD)、双顶径(BPD)和颅高(CH)的z值。进行了逻辑回归分析:结果:虽然HC、颅内容积和BPD的z值保持在正常范围内,但APD的z值在-2和-1之间波动,CH的z值大于2,表明从T0到T2与正常值相比有大幅升高。手术年龄对 T2 期 HC、BPD 和 CH 的 z 值有明显影响(均 p <0.05)。从 T1 到 T2,手术时间延迟与 BPD 和 CH z 分数增加相关(p = 0.007 和 0.019)。FOA的DO导致T2的HC z-scores升高,从T0到T1的APD增加,随后从T1到T2的APD显著复发:这些研究结果表明,延迟手术时机可能有助于颅骨更好地生长,长期随访时HC的增加就表明了这一点。结论:这些研究结果表明,延迟手术时间可能有助于颅骨更好地生长,长期随访中HC的增加就表明了这一点。然而,延迟手术时间也与异常升高的CH恶化有关。尽管DO能立即扩大APD并增加长期HC,但潜在的复发仍值得警惕。虽然建议有意过度矫正 APD,但仔细考虑手术时机和计划至关重要。
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引用次数: 0
To shunt or not to shunt when closing myelomeningocele? A systematic review and meta-analysis of simultaneous versus delayed ventriculoperitoneal shunt placement in neonates undergoing myelomeningocele closure. 脊髓膜膨出闭合术中分流还是不分流?对接受脊髓膜膨出闭合术的新生儿同时进行脑室腹腔分流术与延迟进行脑室腹腔分流术的系统回顾和荟萃分析。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-09 Print Date: 2024-11-01 DOI: 10.3171/2024.5.PEDS23600
Okko Saarinen, Susanna Piironen, Tytti Pokka, Juha-Jaakko Sinikumpu, Willy Serlo, Niina Salokorpi, Oula Knuutinen

Objective: Approximately 70%-80% of children born with myelomeningocele develop hydrocephalus and need CSF diversion, commonly a ventriculoperitoneal shunt (VPS) placement. The optimal timing of surgery is not known, but many centers delay VPS placement and perform it in a separate surgery to avoid shunt complications, mainly shunt contamination and infection. This systematic review and meta-analysis aimed to compare shunt-related complications between populations with VPS surgery performed either simultaneously with myelomeningocele closure or with delay.

Methods: The authors searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases on December 15, 2022, and November 11, 2023, using a predefined search strategy. Randomized and nonrandomized trials of neonates undergoing postnatal myelomeningocele closure and VPS placement before the age of 29 days were included. Cases with prenatal myelomeningocele closure and hydrocephalus treatment other than a VPS were excluded. All studies were screened and assessed by two independent reviewers. The authors performed a meta-analysis pooling risk ratios (RRs) with a 95% CI using the random-effects model. The quality of studies was assessed using the Newcastle-Ottawa Scale.

Results: After screening and a full-text review of 2099 database search results, 12 studies with a total number of 4894 patients were included. All studies were nonrandomized studies. Only 2 studies were ranked as good quality on the Newcastle-Ottawa Scale. No statistically significant differences were found between simultaneous and delayed shunt insertion in terms of shunt infection (RR 0.77, 95% CI 0.41-1.42); shunt revision (RR 0.49, 95% CI 0.19-1.30); overall mortality (RR 0.87, 95% CI 0.09-8.57); wound CSF leak (RR 0.20, 95% CI 0.03-1.23); or myelomeningocele wound dehiscence (RR 0.52, 95% CI 0.07-3.71). In the subgroup analysis of studies conducted in high-income countries, simultaneous shunting was superior to delayed shunting concerning shunt infection (RR 0.49, 95% CI 0.31-0.78) and shunt revision (RR 0.30, 95% CI 0.09-0.95).

Conclusions: This systematic review and meta-analysis found no statistically significant differences in shunt-related complications between simultaneous and delayed VPS surgery in myelomeningocele-related hydrocephalus in neonates. The current literature does not support the common practice of delayed shunting or its alternative, simultaneous shunting.

目的:大约 70%-80% 的先天性脊髓脑膜膨出患儿会出现脑积水,需要进行 CSF 转移,通常是脑室腹腔分流术(VPS)。手术的最佳时机尚不清楚,但许多中心推迟了 VPS 置入时间,并在单独的手术中进行,以避免分流并发症,主要是分流管污染和感染。本系统综述和荟萃分析旨在比较VPS手术与骨髓腔闭合术同时进行或延迟进行的人群之间的分流相关并发症:作者于2022年12月15日和2023年11月11日使用预先确定的检索策略检索了MEDLINE(PubMed)、Scopus、Web of Science、Cochrane对照试验中央登记册和Cochrane系统性综述数据库。纳入的随机和非随机试验均涉及在新生儿出生后 29 天前接受脊髓脊膜膨出闭合术和 VPS 置入术的新生儿。排除了产前进行脊髓膜膨出闭合术和 VPS 以外的脑积水治疗的病例。所有研究均由两名独立评审员进行筛选和评估。作者采用随机效应模型对风险比(RRs)和 95% CI 进行了荟萃分析。研究质量采用纽卡斯尔-渥太华量表进行评估:在对 2099 项数据库搜索结果进行筛选和全文检索后,共纳入了 12 项研究,患者总人数为 4894 人。所有研究均为非随机研究。只有 2 项研究在纽卡斯尔-渥太华量表中被评为质量良好。在分流管感染(RR 0.77,95% CI 0.41-1.42)、分流管翻修(RR 0.49,95% CI 0.19-1.30)、总死亡率(RR 0.87,95% CI 0.09-8.57)、伤口 CSF 渗漏(RR 0.20,95% CI 0.03-1.23)或髓母细胞瘤伤口开裂(RR 0.52,95% CI 0.07-3.71)方面,同时插入分流管和延迟插入分流管没有统计学意义上的差异。在对高收入国家的研究进行的亚组分析中,在分流管感染(RR 0.49,95% CI 0.31-0.78)和分流管修正(RR 0.30,95% CI 0.09-0.95)方面,同步分流优于延迟分流:这项系统性回顾和荟萃分析发现,在新生儿脊髓膜膨出相关脑积水患者中,同时进行和延迟进行VPS手术在分流相关并发症方面没有明显的统计学差异。目前的文献并不支持延迟分流或同步分流的普遍做法。
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引用次数: 0
Intracranial ependymomas in pediatric patients: patterns of care, disparities, and survival outcomes from the National Cancer Database. 儿科颅内外胚乳瘤:来自全国癌症数据库的护理模式、差异和生存结果。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-09 Print Date: 2024-11-01 DOI: 10.3171/2024.5.PEDS2480
Pemla Jagtiani, Mert Karabacak, Chi Le, Zeynep Bahadir, Peter F Morgenstern, Konstantinos Margetis

Objective: This study aimed to extract and analyze comprehensive data from the National Cancer Database (NCDB) to gain insights into the epidemiological prevalence, treatment patterns, and survival outcomes associated with intracranial ependymomas in pediatric patients.

Methods: The authors examined data extracted from the NCDB spanning the years 2010 to 2017, with a specific emphasis on intracranial ependymomas in individuals aged 0-21 years. The study used logistic and Poisson regression, along with Kaplan-Meier survival estimates and Cox proportional hazards models, for analysis.

Results: Among 908 included pediatric patients, 495 (54.5%) were male, and 702 (80.6%) were White. Kaplan-Meier analysis determined overall survival (OS) rates of 97.1% (95% CI 96%-98.2%) at 1 year postdiagnosis, 89% (95% CI 86.9%-91.1%) at 3 years, 82.9% (95% CI 80.3%-85.7%) at 5 years, and 74.5% (95% CI 69.8%-79.4%) at 10 years. Grade 3 tumors predicted a more than fourfold higher mortality hazard (p < 0.001; reference = grade 2). Infratentorial localization was also associated with a 1.7-fold increase in mortality hazard (p = 0.002; reference = supratentorial). Larger maximum tumor size (> 5 cm) correlated with a lower mortality hazard (HR 0.64, p = 0.011; reference ≤ 5 cm). The vast majority of patients (85.9%, n = 780) underwent resection. Uninsured patients had over fourfold higher prolonged length of stay (LOS) odds than those privately insured (OR 4.645, p = 0.007). Radiotherapy was received by 76.1% of patients, and the highest rates of radiotherapy occurred among children aged 5-12 years (p < 0.001). Only 25.6% received chemotherapy at any point during their treatment. Peak chemotherapy use emerged within ages 0-4 years, reaching 33.6% in this age group. Kaplan-Meier analysis indicated chemotherapy was associated with significantly worse OS (p = 0.041).

Conclusions: This comprehensive analysis of the NCDB provides valuable insights into the epidemiology, treatment patterns, and survival outcomes of intracranial ependymomas in pediatric patients. Higher tumor grade, infratentorial localization, and chemotherapy use was associated with worse OS, while larger tumor size correlated with lower mortality hazard. Disparities in care were identified, with uninsured patients experiencing prolonged LOS. These findings underscore the need for tailored treatment strategies based on patient and tumor characteristics and highlight the importance of addressing socioeconomic barriers to optimize outcomes for children with ependymomas.

研究目的本研究旨在提取和分析美国国家癌症数据库(NCDB)中的综合数据,以深入了解与儿科患者颅内上皮瘤相关的流行病学发病率、治疗模式和生存结果:作者研究了从NCDB中提取的2010年至2017年的数据,重点研究了0-21岁个体的颅内附乳瘤。研究采用逻辑回归和泊松回归,以及卡普兰-梅耶生存估计和考克斯比例危险模型进行分析:在纳入的908名儿科患者中,495人(54.5%)为男性,702人(80.6%)为白人。卡普兰-梅耶尔分析确定,诊断后1年的总生存率(OS)为97.1%(95% CI 96%-98.2%),3年为89%(95% CI 86.9%-91.1%),5年为82.9%(95% CI 80.3%-85.7%),10年为74.5%(95% CI 69.8%-79.4%)。3级肿瘤预示的死亡风险高出4倍多(P < 0.001;参考值 = 2级)。脑室下定位也与死亡率增加1.7倍有关(p = 0.002;参考值 = 脑室上)。肿瘤最大尺寸越大(> 5 厘米),死亡率越低(HR 0.64,p = 0.011;参考值 ≤ 5 厘米)。绝大多数患者(85.9%,n = 780)接受了切除术。未参保患者延长住院时间(LOS)的几率是参保患者的四倍多(OR 4.645,P = 0.007)。76.1%的患者接受了放疗,5-12岁儿童接受放疗的比例最高(p < 0.001)。只有25.6%的患者在治疗过程中的任何阶段接受了化疗。化疗的高峰期出现在0-4岁年龄组,该年龄组的化疗率高达33.6%。Kaplan-Meier分析表明,化疗与较差的OS显著相关(p = 0.041):对 NCDB 的全面分析为了解儿童颅内外胚瘤瘤的流行病学、治疗模式和生存结果提供了宝贵的信息。较高的肿瘤分级、颅内下定位和化疗的使用与较差的OS相关,而较大的肿瘤体积与较低的死亡率相关。研究还发现了护理方面的差异,未参保患者的住院时间更长。这些发现强调了根据患者和肿瘤特征制定针对性治疗策略的必要性,并突出了消除社会经济障碍以优化儿童肾上腺瘤患者预后的重要性。
{"title":"Intracranial ependymomas in pediatric patients: patterns of care, disparities, and survival outcomes from the National Cancer Database.","authors":"Pemla Jagtiani, Mert Karabacak, Chi Le, Zeynep Bahadir, Peter F Morgenstern, Konstantinos Margetis","doi":"10.3171/2024.5.PEDS2480","DOIUrl":"10.3171/2024.5.PEDS2480","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to extract and analyze comprehensive data from the National Cancer Database (NCDB) to gain insights into the epidemiological prevalence, treatment patterns, and survival outcomes associated with intracranial ependymomas in pediatric patients.</p><p><strong>Methods: </strong>The authors examined data extracted from the NCDB spanning the years 2010 to 2017, with a specific emphasis on intracranial ependymomas in individuals aged 0-21 years. The study used logistic and Poisson regression, along with Kaplan-Meier survival estimates and Cox proportional hazards models, for analysis.</p><p><strong>Results: </strong>Among 908 included pediatric patients, 495 (54.5%) were male, and 702 (80.6%) were White. Kaplan-Meier analysis determined overall survival (OS) rates of 97.1% (95% CI 96%-98.2%) at 1 year postdiagnosis, 89% (95% CI 86.9%-91.1%) at 3 years, 82.9% (95% CI 80.3%-85.7%) at 5 years, and 74.5% (95% CI 69.8%-79.4%) at 10 years. Grade 3 tumors predicted a more than fourfold higher mortality hazard (p < 0.001; reference = grade 2). Infratentorial localization was also associated with a 1.7-fold increase in mortality hazard (p = 0.002; reference = supratentorial). Larger maximum tumor size (> 5 cm) correlated with a lower mortality hazard (HR 0.64, p = 0.011; reference ≤ 5 cm). The vast majority of patients (85.9%, n = 780) underwent resection. Uninsured patients had over fourfold higher prolonged length of stay (LOS) odds than those privately insured (OR 4.645, p = 0.007). Radiotherapy was received by 76.1% of patients, and the highest rates of radiotherapy occurred among children aged 5-12 years (p < 0.001). Only 25.6% received chemotherapy at any point during their treatment. Peak chemotherapy use emerged within ages 0-4 years, reaching 33.6% in this age group. Kaplan-Meier analysis indicated chemotherapy was associated with significantly worse OS (p = 0.041).</p><p><strong>Conclusions: </strong>This comprehensive analysis of the NCDB provides valuable insights into the epidemiology, treatment patterns, and survival outcomes of intracranial ependymomas in pediatric patients. Higher tumor grade, infratentorial localization, and chemotherapy use was associated with worse OS, while larger tumor size correlated with lower mortality hazard. Disparities in care were identified, with uninsured patients experiencing prolonged LOS. These findings underscore the need for tailored treatment strategies based on patient and tumor characteristics and highlight the importance of addressing socioeconomic barriers to optimize outcomes for children with ependymomas.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"495-508"},"PeriodicalIF":2.1,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912984","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
Intracranial complications secondary to acute bacterial sinusitis requiring neurosurgical intervention before and after the onset of the COVID-19 pandemic. 在 COVID-19 大流行之前和之后,继发于急性细菌性鼻窦炎并需要神经外科干预的颅内并发症。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-02 Print Date: 2024-11-01 DOI: 10.3171/2024.5.PEDS2433
Tracy M Flanders, Nankee K Kumar, Chao Zhao, Torsten A Joerger, Jimmy W Huh, Adva Buzi, Mark D Rizzi, Christine Settoon, Phillip B Storm, Gregory G Heuer, Benjamin C Kennedy, Alexander M Tucker, Peter J Madsen, Shih-Shan Lang

Objective: Intracranial complications of acute bacterial sinusitis are rare pathologies that occur in children, and are associated with significant neurological morbidity and mortality. There is a subjective concern among neurosurgeons that the incidence of this rare disease has increased since the onset of the novel COVID-19 pandemic. The primary objective of this study was to review the presentation and management of patients admitted at the authors' institution with intracranial extension of sinusitis, to better understand the local disease burden relative to the COVID-19 pandemic.

Methods: This is a single-center retrospective observational cohort study. The patients underwent neurosurgical intervention for intracranial extension of sinusitis between January 1, 2007, and March 1, 2023. The historical cohort was defined as those patients who presented prior to March 2020. Clinical covariates such as surgical and microbiological data were collected and analyzed.

Results: A total of 78 patients (55 historical, 23 new) were included; they had a median age of 11.7 years and a male predominance of 69.2%. There was a significant increase in the annual rate of neurosurgical intervention for suppurative intracranial extension of acute bacterial sinusitis after the onset of the COVID-19 pandemic, with an average of 4.2 cases per year prior to March 2020 compared to 7.7 cases per year after that date (p = 0.013). This increase was largely driven by the unprecedented case volume of 13 cases in 2022. Patients in the new cohort were older (p = 0.009) and more likely to have Pott's puffy tumor/frontal bone osteomyelitis (p = 0.003) at the time of presentation than patients in the historical cohort. Patients in the new cohort had lower rates of readmission within 30 days of discharge than those in the historical cohort (p = 0.047). In both cohorts, patients with seizure on presentation were more likely to have neurological sequelae at last follow-up (p = 0.004), which occurred at a median of 2.9 months after discharge.

Conclusions: Clinicians encountering pediatric patients presenting with persistent symptoms of acute bacterial sinusitis must have a high index of suspicion for suppurative intracranial extension. Prompt neuroimaging and subsequent neurosurgical intervention are critical to ensure timely diagnosis and treatment. The results in this study show a significant increase in the number of neurosurgical interventions for suppurative intracranial extension of sinusitis per year after the onset of the COVID-19 pandemic. Further research is needed to understand the underlying pathophysiology of this clinical phenomenon.

目的:急性细菌性鼻窦炎的颅内并发症是发生在儿童身上的罕见病症,与严重的神经系统发病率和死亡率相关。自新型 COVID-19 大流行以来,这种罕见疾病的发病率有所上升,这引起了神经外科医生的主观担忧。本研究的主要目的是回顾作者所在医院收治的颅内扩展性鼻窦炎患者的表现和治疗情况,以更好地了解与 COVID-19 大流行相关的当地疾病负担:这是一项单中心回顾性队列研究。2007年1月1日至2023年3月1日期间,患者因鼻窦炎颅内扩展接受了神经外科干预。历史队列是指 2020 年 3 月之前就诊的患者。对手术和微生物学数据等临床协变量进行了收集和分析:共纳入 78 名患者(55 名历史患者,23 名新患者);他们的中位年龄为 11.7 岁,男性占 69.2%。COVID-19 大流行后,因急性细菌性鼻窦炎颅内化脓性扩展而进行神经外科干预的年比率明显增加,2020 年 3 月前平均每年 4.2 例,而 2020 年 3 月后平均每年 7.7 例(P = 0.013)。这一增长的主要原因是 2022 年出现了前所未有的 13 例病例。与历史队列中的患者相比,新队列中的患者年龄更大(p = 0.009),发病时更有可能患有波特浮肿瘤/额骨骨髓炎(p = 0.003)。新队列患者在出院后 30 天内的再入院率低于历史队列患者(p = 0.047)。在两个队列中,癫痫发作患者在最后一次随访时更有可能出现神经系统后遗症(p = 0.004),中位随访时间为出院后 2.9 个月:结论:临床医生在遇到急性细菌性鼻窦炎症状持续存在的儿科患者时,必须高度怀疑颅内化脓性扩展。及时进行神经影像学检查和随后的神经外科干预对于确保及时诊断和治疗至关重要。本研究结果显示,在 COVID-19 大流行后,每年因鼻窦炎颅内化脓性扩展而进行神经外科干预的人数显著增加。要了解这一临床现象的潜在病理生理学,还需要进一步的研究。
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引用次数: 0
Presentation, management, and outcomes of pediatric hydrocephalus in Africa: a systematic review and meta-analysis of 12,355 patients. 非洲小儿脑积水的表现、管理和预后:对 12,355 名患者的系统回顾和荟萃分析。
IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-02 Print Date: 2024-10-01 DOI: 10.3171/2024.5.PEDS23595
Kwadwo Darko, Mina Guirguis, Shravya Kakulamarri, Michael Farid, Pooja Venkatesh, Emmanuel Kwadwo Osei Adjei, Nancy Abu-Bonsrah, Umaru Barrie, Brett Whittemore, Salah G Aoun, Bruno P Braga, Mabel Banson, Teddy Totimeh

Objective: The prevalence, management, and outcomes of hydrocephalus remain underexplored in Africa. This study aimed to analyze demographic and clinical features, evaluate treatment strategies, and assess neurological outcomes of pediatric hydrocephalus in Africa.

Methods: A systematic review of the literature using the PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles describing pediatric patients in Africa with hydrocephalus.

Results: Seventy-four retrospective and prospective studies and 33 case reports involving 12,355 patients were included. In 54 retrospective articles reporting patient demographics, 53.8% (3926/7297) were male with a mean age of 12.3 months. Nineteen studies reported macrocephaly (80.2%, 1639/2043) as the most common presentation. The etiology of hydrocephalus was reported as postinfectious (41.0%, 2303/5614) across 27 articles and congenital (48.6%, 1246/2563) in 10 articles. Eleven articles reported 46.7% (609/1305) of patients had communicating hydrocephalus while 53.3% (696/1305) had obstructive hydrocephalus. Diagnostic imaging included CT (76.1%, 2435/3202; n = 29 articles), ultrasonography (72.9%, 2043/2801; n = 15 articles), and MRI (44.8%, 549/1225; n = 11 articles). In 51 articles, 83.1% (7365/8865) of patients had ventriculoperitoneal shunting (VPS) while 33 articles described 54.1% (2795/5169) receiving endoscopic third ventriculostomy (ETV) for hydrocephalus surgical management. Postoperative complications included sepsis (6.9%, 29/421; n = 4 articles), surgical site infections (5.1%, 11/218; n = 4 articles), and CSF leaks (2.0%, 15/748; n = 8 articles). Shunt-related complications included infections (4.3%, 117/2717; n = 21 articles) and blockages (4.1%, 34/829; n = 6 studies). In 15 articles, 9.0% (301/3358) of patients with shunts had revisions. The mean follow-up duration was 18.9 ± 16.7 months with an overall mortality rate of 7.4% (397/5383; n = 29 articles). In the analysis of comparative studies, the 160 patients undergoing ETV demonstrated significantly higher odds of a successful operation (OR 1.54, 95% CI 0.51-4.69; p = 0.03) and neurological improvement at last follow-up (OR 3.36, 95% CI 0.46-24.79; p < 0.01) compared with the 158 who received VPS, but no significant differences were observed for complications and mortality between the two groups (p > 0.05).

Conclusions: This review offers a comprehensive summary of pediatric hydrocephalus in Africa, highlighting shunting as the primary treatment. However, the observed variations across studies highlight the need to establish standardized guidelines for reporting patient characteristics, management strategies, and outcomes to ensure consistency and comparability in articles.

目的:非洲对脑积水的发病率、管理和治疗效果的研究仍然不足。本研究旨在分析非洲小儿脑积水的人口统计学和临床特征,评估治疗策略,并评估神经系统的治疗效果:根据 PRISMA 指南,使用 PubMed、Google Scholar 和 Web of Science 电子数据库对文献进行了系统性回顾,以确定描述非洲小儿脑积水患者的文章:结果:共纳入 74 篇回顾性和前瞻性研究以及 33 篇病例报告,涉及 12,355 名患者。在 54 篇报告患者人口统计学特征的回顾性文章中,53.8%(3926/7297)的患者为男性,平均年龄为 12.3 个月。19项研究报告称,巨头畸形(80.2%,1639/2043 例)是最常见的表现形式。27篇文章报告的脑积水病因为感染后(41.0%,2303/5614),10篇文章报告的病因为先天性(48.6%,1246/2563)。有 11 篇文章报道 46.7% 的患者(609/1305)患有交流性脑积水,53.3% 的患者(696/1305)患有阻塞性脑积水。诊断成像包括 CT(76.1%,2435/3202;n = 29 篇文章)、超声波检查(72.9%,2043/2801;n = 15 篇文章)和核磁共振成像(44.8%,549/1225;n = 11 篇文章)。在 51 篇文章中,83.1%(7365/8865)的患者进行了脑室腹腔分流术(VPS),而 33 篇文章描述了 54.1%(2795/5169)的患者接受内镜下第三脑室造口术(ETV)进行脑积水手术治疗。术后并发症包括败血症(6.9%,29/421;n = 4 篇文章)、手术部位感染(5.1%,11/218;n = 4 篇文章)和 CSF 漏(2.0%,15/748;n = 8 篇文章)。分流相关并发症包括感染(4.3%,117/2717;n = 21 篇文章)和堵塞(4.1%,34/829;n = 6 项研究)。在 15 篇文章中,9.0%(301/3358)的分流患者进行了翻修。平均随访时间为 18.9 ± 16.7 个月,总死亡率为 7.4% (397/5383; n = 29 篇文章)。在对比研究分析中,与接受 VPS 的 158 名患者相比,接受 ETV 的 160 名患者手术成功的几率(OR 1.54,95% CI 0.51-4.69;P = 0.03)和最后随访时神经功能改善的几率(OR 3.36,95% CI 0.46-24.79;P <0.01)明显更高,但两组患者在并发症和死亡率方面无明显差异(P >0.05):本综述全面总结了非洲小儿脑积水的情况,强调分流是主要的治疗方法。结论:本综述全面总结了非洲的小儿脑积水情况,强调分流是主要的治疗方法,但观察到的不同研究之间的差异突出表明,有必要为报告患者特征、管理策略和结果制定标准化指南,以确保文章的一致性和可比性。
{"title":"Presentation, management, and outcomes of pediatric hydrocephalus in Africa: a systematic review and meta-analysis of 12,355 patients.","authors":"Kwadwo Darko, Mina Guirguis, Shravya Kakulamarri, Michael Farid, Pooja Venkatesh, Emmanuel Kwadwo Osei Adjei, Nancy Abu-Bonsrah, Umaru Barrie, Brett Whittemore, Salah G Aoun, Bruno P Braga, Mabel Banson, Teddy Totimeh","doi":"10.3171/2024.5.PEDS23595","DOIUrl":"10.3171/2024.5.PEDS23595","url":null,"abstract":"<p><strong>Objective: </strong>The prevalence, management, and outcomes of hydrocephalus remain underexplored in Africa. This study aimed to analyze demographic and clinical features, evaluate treatment strategies, and assess neurological outcomes of pediatric hydrocephalus in Africa.</p><p><strong>Methods: </strong>A systematic review of the literature using the PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to identify articles describing pediatric patients in Africa with hydrocephalus.</p><p><strong>Results: </strong>Seventy-four retrospective and prospective studies and 33 case reports involving 12,355 patients were included. In 54 retrospective articles reporting patient demographics, 53.8% (3926/7297) were male with a mean age of 12.3 months. Nineteen studies reported macrocephaly (80.2%, 1639/2043) as the most common presentation. The etiology of hydrocephalus was reported as postinfectious (41.0%, 2303/5614) across 27 articles and congenital (48.6%, 1246/2563) in 10 articles. Eleven articles reported 46.7% (609/1305) of patients had communicating hydrocephalus while 53.3% (696/1305) had obstructive hydrocephalus. Diagnostic imaging included CT (76.1%, 2435/3202; n = 29 articles), ultrasonography (72.9%, 2043/2801; n = 15 articles), and MRI (44.8%, 549/1225; n = 11 articles). In 51 articles, 83.1% (7365/8865) of patients had ventriculoperitoneal shunting (VPS) while 33 articles described 54.1% (2795/5169) receiving endoscopic third ventriculostomy (ETV) for hydrocephalus surgical management. Postoperative complications included sepsis (6.9%, 29/421; n = 4 articles), surgical site infections (5.1%, 11/218; n = 4 articles), and CSF leaks (2.0%, 15/748; n = 8 articles). Shunt-related complications included infections (4.3%, 117/2717; n = 21 articles) and blockages (4.1%, 34/829; n = 6 studies). In 15 articles, 9.0% (301/3358) of patients with shunts had revisions. The mean follow-up duration was 18.9 ± 16.7 months with an overall mortality rate of 7.4% (397/5383; n = 29 articles). In the analysis of comparative studies, the 160 patients undergoing ETV demonstrated significantly higher odds of a successful operation (OR 1.54, 95% CI 0.51-4.69; p = 0.03) and neurological improvement at last follow-up (OR 3.36, 95% CI 0.46-24.79; p < 0.01) compared with the 158 who received VPS, but no significant differences were observed for complications and mortality between the two groups (p > 0.05).</p><p><strong>Conclusions: </strong>This review offers a comprehensive summary of pediatric hydrocephalus in Africa, highlighting shunting as the primary treatment. However, the observed variations across studies highlight the need to establish standardized guidelines for reporting patient characteristics, management strategies, and outcomes to ensure consistency and comparability in articles.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"315-327"},"PeriodicalIF":2.1,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878873","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}
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Journal of neurosurgery. Pediatrics
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