Child's Nervous System最新文献

Extraventricular neurocytoma (EVN) is a rare neuronal tumor with a marked tendency towards ganglionic or glial differentiation. Although EVN commonly occurs in young adults, congenital cases are extremely rare, and standardized therapeutic strategies remain undetermined. The presence of atypical features such as increased mitotic activity on histological analysis is correlated with a higher rate of recurrence and poor prognosis. A 3-d-old infant with no abnormalities at birth presented with recurrent apnea and paroxysmal eye deviation on the upper right side. Magnetic resonance imaging revealed a large intracranial tumor located anterior to the brainstem. The patient underwent biopsy via craniotomy, leading to a histological diagnosis of EVN with atypical features. Despite the absence of adjuvant radiation therapy or chemotherapy, the lesion remained stable over 18 months, and the patient's growth was within normal limits. EVN is an important differential diagnosis of congenital brain tumors. Therapeutic strategies for congenital cases should be distinguished from those used for older children, and treatment decisions should be based on individual patient risks.

Purpose: Pediatric hydrocephalus imposes a significant clinical and financial burden in developing countries. Traditional treatment by ventricular shunting in this setting suffers a high rate of shunt infection and malfunction. This study aims at assessing the efficacy and safety of endoscopic third ventriculostomy (ETV), either alone or combined with choroid plexus cauterization (CPC), for preventing shunt dependence in pediatric hydrocephalus within a healthcare setting of a tertiary hospital in Egypt.

Methods: A prospective clinical case series included patients aged 16 years or younger with clinical manifestations of hydrocephalus requiring CSF diversion. Cases with active infection or brain imaging showing prohibitive anatomical distortion or multiloculated hydrocephalus were excluded. Failed ETV + / - CPC cases were categorized into early (< 3 months) and late (> 3 months) failure groups, each with specific management strategies.

Results: A total of 40 patients were admitted to Ain Shams University Hospital between March 2022 and August 2023 and underwent ETV/CPC (n = 32) for those younger than 2 years and ETV alone (n = 8) for patients > 2 years old, using a flexible neuroendoscope. Aqueductal stenosis was the most common etiology, observed in 13 patients (32.5%), followed by Chiari type 2 in 11 patients (27.5%), and post-infectious causes in 6 patients (15%). The median age of the patients was 5.05 months (mean 22 months; range 0.23-169.27 months). The median preoperative ETV success score (ETVSS) was 50. Overall, 25 patients (62.5%) achieved successful outcomes following either ETV alone or ETV/CPC procedures, with no procedure-related morbidity or mortality. Fifteen patients (37.5%) experienced ETV failure, of whom 6 underwent ETV redo procedures. Across the entire cohort, 28 patients (70%) remained shunt-free, with a mean follow-up of 12 months.

Conclusion: The addition of CPC to ETV (for patients < 2 years) using the flexible scope demonstrates effectiveness in decreasing the necessity for shunt placement in younger patients with a likelihood of ETV failure. Moreover, being a safe procedure, it supports a sustainable and cost-effective approach to hydrocephalus treatment.

Introduction: This study investigated the effects of selective dorsal rhizotomy (SDR) on dystonia and dystonic posture in patients with cerebral palsy (CP) presenting with mixed spasticity and dystonia.

Method: A prospective, single-centre study was conducted at a UK supra-regional centre from May 2013 to September 2022. All children with spasticity, dystonia and/or dystonic posture undergoing SDR were included. The primary outcome measure was pre- and postoperative assessment of dystonic posture. Dystonia severity was measured using the Barry-Albright dystonia (BAD) scale.

Results: Two hundred and fifty-seven patients (aged 3-18 years) underwent SDR. Forty-three patients had dystonia and 52 exhibited dystonic posture without dystonia. At 3-month follow-up (n = 29), GMFCS levels tended to decrease, returning to baseline at 6 months (n = 25). Two patients required medication adjustments post-surgery. Dystonia levels remained unchanged in the dystonia group. In the dystonic posture group, 33 patients showed no change, while 21 improved.

Conclusion: SDR may be beneficial for carefully selected patients with dystonia or dystonic posture, without worsening these conditions. Optimal patient selection, clear communication of surgical goals and multidisciplinary involvement are crucial.

Ventriculoperitoneal shunt malfunction is a common complication in patients with lifelong hydrocephalus. We present a case of a 40-year-old man who successfully underwent endoscopic third ventriculostomy (ETV) for shunt malfunction following neonatal meningitis. Despite long-term shunt dependency and an infectious etiology, ETV effectively managed his hydrocephalus, probably due to aqueductal stenosis and preserved cerebrospinal fluid absorption. This suggests that ETV is a viable option for adult hydrocephalus patients experiencing shunt malfunction, even those with lifelong shunt dependency and a history of infectious etiology.

Introduction: In an effort to maximize benefit and minimize morbidity when performing fronto-orbital distraction osteogenesis (FODO) for unilateral coronal synostosis (UCS), we have transitioned to an endoscopic-assisted approach ("endo-FODO"). This study compares photogrammetric outcomes of patients who underwent FODO via an endoscopic-assisted versus open approach.

Methods: We retrospectively reviewed patients treated for UCS from 2013 to 2023. Photogrammetric outcomes at one to three years postoperatively were compared between patients who underwent endo-FODO and age- and sex-matched controls who underwent open FODO. Differences between pre- and postoperative periorbital symmetry ratios, canthal tilt symmetry, and orbital dystopia angle (ODA) were calculated.

Results: Twenty patients (ten per group) underwent surgery at a mean age of 6.1 ± 1.8 and 5.4 ± 1.1 months (p = 0.426) and were photographed at 1.6 ± 0.9 and 1.8 ± 0.9 years (p = 0.597) postoperatively in the endo-FODO and open FODO groups, respectively. Patients who underwent endo-FODO demonstrated significant improvements in margin-reflex distance 1 (MRD1) symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.004), canthal tilt symmetry (p = 0.020), and ODA (p = 0.009). Patients who underwent open FODO likewise demonstrated significant improvements in MRD1 symmetry ratio (p = 0.004), palpebral height symmetry ratio (p = 0.033), and ODA (p = 0.004). All postoperative measurements as well as degrees of improvement were similar between groups (p > 0.05).

Conclusions: Endo- and open FODO were associated with significant and comparable improvements in soft tissue periorbital symmetry and orbital dystopia at nearly two years postoperatively. While continued follow-up until cranial maturity is needed to assess the durability of aesthetic results, these data support a minimally invasive, endoscopic alternative to fronto-orbital distraction.

Objective: Subdural fluid collection is a common neurosurgical condition in the pediatric population. Patients requiring surgical intervention have historically been managed with subdural drains, subdural-subgaleal shunting, subdural-peritoneal shunting, and mini-craniotomies. An alternative procedure for patients with an open anterior fontanelle is bedside transfontanelle drainage. This study aims to evaluate the efficacy of the transfontanelle angiocatheter drain placement including complications and the need for any further surgery.

Methods: We performed a single-center retrospective review of all patients who underwent placement of transfontanelle drain to treat subdural fluid collections from January 2013 to June 2023. Data points collected included demographics, comorbidities, mechanism of subdural collection, neurologic status on presentation, subdural size, amount of drainage, complications, and need for further intervention.

Results: We identified 28 patients who underwent bedside transfontanelle subdural angiocatheter placement between January 2013 and June 2023. The patient age range was 0-11 months (avg 3.96). Twenty-three patients were male (82%). Nineteen patients (68%) had new seizures on presentation or during hospitalization. Eighteen patients (64%) suffered non-accidental trauma. The subdural on the side of the drainage ranged from 4 to 18 mm in size. On average, a total of 590 mL (22-1648) of fluid was drained over 3.5 (1-9) days. One medically complex patient on aspirin for cardiac comorbidities had post-procedural complication of new hemorrhage and one patient developed meningitis. Nineteen patients did not require any further treatment. Six patients underwent subsequent subdural-peritoneal shunting, two required subsequent placement of surgical subdural drains, and one underwent bilateral burr hole craniotomies with subdural drain placement. Patients who suffered NAT were more likely to not need further intervention than those with other mechanisms of subdural fluid collections.

Conclusions: This retrospective review demonstrates that bedside transfontanelle drain placement is an effective practice to reduce the need for operative intervention in infants with an open anterior fontanelle. The procedure can be performed expeditiously in the emergency room, ICU, or floor setting without the need for general anesthesia. While future larger prospective studies are warranted, our series documented this practice to be performed safely.

Background and objective: Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations.

Methods: A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015-January 2021. Articles were screened by title and abstract so only studies with children < 18 years of age and those focusing on mTBI were included.

Results: A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%).

Conclusion: Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes.

Objective: Patients are often observed overnight after ventricular shunt revision for hydrocephalus. We believe that a same-day discharge after a shunt revision is safe in the appropriate population. The purpose of this study was to determine the appropriate patient population and the safety profile for a same-day discharge following a ventricular shunt revision.

Methods: We conducted a retrospective chart review of all shunt revisions at a single center from 2014 to 2021. We compared rates of emergency department visits, hospitalization, and revision at 30 and 90 days between same-day discharge and control patients following shunt revision. Non-parametric, logistic regression, and chi-squared testing were performed to measure statistical significance with and without propensity score matching.

Results: A total of 996 patients were examined, with 56 (5.6%) patients being discharged on the same day as the surgery. Patients with a same-day discharge were older, more likely to have distal shunt failure, more likely to have undergone scheduled surgery, and less likely to have visited the emergency department in the prior 30 days. Propensity score matching compared 29 revisions in each group; all covariates were non-significant (p > 0.05), and 30-day and 90-day outcomes were not significantly different the between same-day and non-same day discharge.

Conclusions: These findings validate the safety profile for the same-day discharge in post-operative shunt patients and describe our patient cohort's preferred characteristics. Scheduled, distal shunt failure patients are preferred for early discharge post-operatively. When validated by further studies, this would provide improved patient comfort and decreased healthcare expenses for a shunt failure.

Objective: Endoscopic third ventriculocisternostomy (ETV) became the relevant treatment option for non-communicating pediatric hydrocephalus. ETV success was predicted in relation to age, diagnosis, and previous shunt implantation. Radiological factors are usually taken for indication decision-making. The aim of this study is to investigate radiological signs of non-communicating hydrocephalus for ETV success in a single-center retrospective analysis.

Patients and methods: ETV interventions were collected from a 10-year period (2010-2019) from our institution. Clinical patient characteristics such as prematurity, age, diagnosis, and previous shunt treatment and follow-up in terms of possible shunt implantation or revision surgeries were investigated. Radiological data was retrieved from the in-house PACS system to analyze preoperative signs for non-communicating hydrocephalus such as ventricular size, pressure gradients at the third ventricle, and any signs of obstruction from internal towards external cerebral spinal fluid communication. Fisher's test was used to demonstrate the significance of each individual predictor. A multivariable model was built using the backward elimination method with multiple logistic regression.

Results: From 136 ETV interventions, 95 met the inclusion criteria (age < 18 years; > 6-month follow-up; MR image data availability, treatment goal for shunt independence). In chi-square statistical evaluation of single parameters age > 6 months (OR 32.5; 95% CI 4.8-364), ventricular width (FOHR < 0.56; OR 6.1; 95% CI 2.2-16.3) and non-post-hemorrhagic hydrocephalus as underlying diagnosis (OR 13.1; 95% CI 1.9-163) showed significant increased odds ratio for shunt independence during follow-up. Logistic regression analysis for multiple parameters showed age > 6 months (OR 29.3; 95% CI 4.1-606) together with outward bulged lamina terminalis (OR 4.6; 95% CI 1.2-19.6), smaller FOHR (continuous parameter; OR 2.83 × 10^-5; 95% CI 4.7 × 10^-9-0.045), and non-4th-ventricular-outlet obstruction (4thVOO; OR 0.31; 95% CI 0.09-1.02) as significant factors for ETV success.

Conclusion: ETV has become a relevant treatment for non-communicating hydrocephalus, with typical MR image characteristics. Analyzing radiological markers as predictors for success smaller ventricular width and outward displaced lamina terminalis was relevant in combination with age > 6 months. Since the analysis is based on single-center experience, a larger cohort of patients with a multi-center approach should further investigate the combined clinical and radiological criteria.

Purpose: Intraventricular hemorrhage (IVH) is a common and severe complication in premature neonates, leading to long-term neurological impairments. Early prediction and identification of risk factors for IVH in premature neonates are crucial for improving clinical outcomes. This study aimed to predict IVH in premature neonates and determine risk factors using machine learning (ML) algorithms.

Methods: This study investigated the medical records of premature neonates admitted to the neonatal intensive care unit. The patients were labeled as case (IVH) and control (No IVH). The independent variables included demographic, clinical, laboratory, and imaging data. Machine learning algorithms, including random Forest, support vector machine, logistic regression, and k-nearest neighbor, were used to train the models after data preprocessing and feature selection. The performance of the trained models was evaluated using various performance metrics.

Results: Data from 160 premature neonates were collected including 70 patients with IVH. The identified risk factors for IVH were the gestational age, birth weight, low Apgar scores at 1 min and 5 min, delivery method, head circumference, and various laboratory findings. The random forest algorithm demonstrated the highest sensitivity, specificity, accuracy, and F1 score in predicting IVH in premature neonates, with a great area under the receiver operating characteristic curve of 0.99.

Conclusion: This study revealed that the random forest model effectively predicted IVH in premature neonates. The early identification of premature neonates at higher risk of IVH allows for preventive measures and interventions to reduce the incidence and morbidity of IVH in these patients.