Child's Nervous System最新文献

Objective: There is an ongoing debate regarding the optimal treatment for craniosynostosis as diverse factors influence the election between endoscopic and open surgery. Previous evidence favors endoscopic procedures. However, evidence remains unfulfilled by a limited number of patients and clustered in very few centers worldwide making it difficult to define it as a replicable technique in different populations. In recent years, evidence regarding endoscopic-assisted procedures has gone through a considerable spurt showing an increased interest among surgeons globally showing optimal outcomes in different populations and centers. In this systematic review and meta-analysis, we performed an updated analysis of previous reviews, including only non-syndromic patients. We also seek to provide a summary of the tendency of treatment observed in the literature. Similarly, this is the first study to include total costs within its analysis.

Material and methods: Three previous meta-analyses published in 2018 yielded 11 eligible papers. We performed a systematic review and meta-analysis of the literature in MEDLINE and EMBASE databases through PubMed, Scopus, and Ovid to fill the gap of information between 2018 and 2024. Twenty-three total articles were included in the final analysis.

Results: Variables analyzed were baseline characteristics, length of stay, blood loss, transfusion rates and volume, operative time, and costs. The analysis of data concluded a younger age at surgery in patients undergoing endoscopic surgery (p ≤0.00001). Blood loss, transfusion rates, and volumes depicted favored outcomes for endoscopy with less blood loss during surgery (p ≤0.00001), operative time (p ≤0.00001), and transfusion rates (p ≤0.00001) as well as lower transfused volumes (p ≤0.00001).

Conclusion: Endoscopic surgery carries fewer complications than open surgery. Treatment-related costs are highly decreased in endoscopic procedures after including costs related to outpatient care. Open surgery can be considered in older children if no endoscope or experienced surgeons in endoscopic procedures are available.

Primary spinal intradural malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, especially in children with a non-neurofibromatosis background. Scarce pediatric data exist with regard to such tumors. A 4-year-old child with a history of spastic limb weakness was operated for a foramen magnum spinal lesion (intradural and extradural) with imaging suggestive of schwannoma; the histopathology, however, was that of a MPNST. He underwent redo-surgery for recurrent infiltrating lesion, became ventilator dependent, and expired. Along with this case, we briefly discuss the relevant literature on pediatric primary spinal MPNSTs. The report represents an unusual site for spinal MPNST in a child with dual components. It is important for clinicians to consider such malignant lesions among the differentials of paediatric spinal intradural/ extradural lesions. Compared to that of adults and other regions, the prognosis for spinal intradural MPNSTs in children remains grim.

Purpose: Pediatric cervical spine injury (pCSI) is rare. Physiological differences necessitate alternate management from adults. Yet, no standardized pediatric protocols exist. Previous investigations applying adult-validated clinical decision rules (CDRs)-NEXUS Criteria (NX) and Canadian C-spine Rules (CCR)-to children are mixed. We hypothesized a combined NX + CCR approach applied at a delayed 24-h time point would enhance screening efficacy in select patients.

Methods: We conducted a retrospective review of a prospectively-collected database over 15 months at a pediatric-capable Level-1 trauma center. Age and mechanism determined initial inclusion. NX and CCR criteria were collected and retroactively applied on arrival (T0) and 24 h later (T1). Statistical analyses were performed in SPSS.

Results: A total of 306 patients met inclusion. Current practices compel computed tomography (CT) overuse for craniocervical evaluations: 298 (97.4%) underwent ≥ 1 CT. Of cervical spines imaged (n = 175), 161 (92.0%) underwent CT while 74 (42.3%) underwent magnetic resonance imaging with 14 (18.9%) completed after 72 h. Of collars placed on arrival (n = 181), 136 (75.1%) were cleared before discharge with 86 (63.2%) CTs denoting preferred clearance modality; CT utilization was unchanged when stratified by age < 5 years (p = 0.819). Notably, we found more patients met NX + CCR criteria at T1 versus T0 (p = 0.008) without missed pCSI resulting in imaging overutilization in 15 (8.6%) patients.

Conclusion: We showed incorporating a 24-h time delay before a second CDR reapplication may enhance screening efficacy in pCSI. Our new algorithm combines these findings with other literature-based recommendations and may represent a standardizable option for evaluating pCSI in the acute trauma setting.

Intraventricular haemorrhage (IVH) is bleeding within the ventricular system, which in adults is usually mainly secondary to cerebral haemorrhage and subarachnoid haemorrhage. Hydrocephalus is one of the most common complications of intraventricular haemorrhage, which is characterised by an increase in intracranial pressure due to an increased accumulation of cerebrospinal fluid within the ventricular system, and is closely related to the patient's prognosis. Surgical methods such as shunt surgery have been used to treat secondary hydrocephalus in recent years and have been effective in improving the survival and prognosis of patients with hydrocephalus. However, complications such as shunt blockage and intracranial infection are often faced after surgery. Moreover, little is known about the mechanism of hydrocephalus secondary to intraventricular haemorrhage. This review discusses the mechanisms regarding the occurrence of secondary hydrocephalus after intraventricular haemorrhage in adults in terms of blood clot obstruction, altered cerebrospinal fluid dynamics, inflammation, and blood composition.

This case report presents a novel treatment approach for refractory purulent meningitis in a 1-month-old infant caused by penicillin-sensitive group B Streptococcus. Despite initial treatment with intravenous antibiotics, including penicillin and vancomycin, the infant experienced persistent symptoms and bilateral subdural effusions. Conventional therapies failed to resolve these issues, leading to the use of a new technique: subarachnoid puncture via the anterior fontanelle combined with intrathecal vancomycin administration. This minimally invasive procedure allowed for targeted antibiotic delivery, significantly reducing subdural effusions and improving cerebrospinal fluid parameters. The infant showed substantial clinical improvement and was discharged after 68 days with no complications during a 3-month follow-up. This approach offers a promising alternative to more invasive treatments such as craniotomy or subdural external drainage, though further research is needed to confirm its efficacy and safety in broader clinical contexts.

Purpose: The treatment of hydrocephalus aims to facilitate optimal brain development and improve the overall condition of patients. To further evaluate the postoperative recovery process in individuals undergoing hydrocephalus treatment, we investigated the interplay between brain parenchymal and ventricular volumes, alongside neurocognitive parameters.

Methods: In this study, 52 children under the age of 10 undergoing hydrocephalus treatment were included. All participants underwent T1w MR images and Gesell developmental schedule assessments. Initially, we investigated the correlation between patients' brain development and motor assessment scores. This analysis explored the association between cognition and both brain parenchymal and ventricular sizes. Furthermore, we investigated these relationships in the contexts of communicating and obstructive hydrocephalus. Finally, to quantitatively evaluate patients' brain development using more detailed texture information from imaging, we employed three different classification models for prediction. To compare their performances, we assessed these classification frameworks using a fourfold cross-validation method.

Results: Leveraging the deep learning framework, both pre- and postoperative T1w MR images have demonstrated a significant predictive value in estimating patients' brain development, with the accuracy of 0.808 for postoperative images. In the statistical analysis, we identified a correlation between developmental assessments in children with communicating hydrocephalus and postoperative brain parenchymal volume.

Conclusion: The findings indicate that postoperative evaluation of brain development is more closely associated with brain parenchymal and ventricular volumes than the Evans index. Additionally, deep learning frameworks exhibit promising potential as effective tools for accurately predicting patients' postoperative recovery.

Purpose: Tethered cord syndrome (TCS) typically presents with urologic symptoms and abnormal imaging findings. However, some patients present with normal conus medullaris level and filum terminale appearance on MRI. This research seeks to assess the intended surgical results in this particular group of TCS patients who do not present with urologic complaints, under the premise that the surgical approach goes a long way in preventing the onset of urologic abnormalities.

Methods: This retrospective study included 59 operated patients with tethered cord syndrome who had a normal level terminating conus medullaris and a normal looking filum terminale without urologic symptoms. Of these patients, 38 were female and 21 were male. All patients underwent somatosensory-evoked potentials (SSEPs), and magnetic resonance imaging (MRI). The surgical technique used was flavotomy, which involves cutting the filum terminale without performing a laminectomy.

Results: The study population had a mean age of 22.5 years (SD = 13.2). During the mean postoperative follow-up period of 2.5 years, none of the patients developed urinary incontinence. Preoperative SSEP abnormalities included conduction block in 39 patients (66.1%), low amplitude in 12 patients (20.3%), and delayed N22 wave latency in 8 patients (13.5%). The surgical procedures were completed without morbidity or mortality, and all patients showed significant postoperative improvement in SSEP parameters.

Conclusion: Our results indicate that even though the filum terminale might have a normal looking MRI, TCS can also occur due to some potential microscopic or structural abnormality. The study proves SSEP to be useful in TCS diagnosis and it also proposes that if surgery is done early before any urologic complaints arise, chances of their onset will be minimized. Such findings support the view that surgical measures should be entertained in symptomatic patients with abnormal SSEP but normal MRI.

Purpose: This study aims to explore demographic disparities, regional and institutional variations, surgical timing, narcotic use, and management trends in neonatal brachial plexus palsy (NBPP) patients due to limited published literature.

Methods: We conducted a retrospective cohort study using the Pediatric Health Information System (PHIS) database of NBPP patients who underwent surgery within the first 2 years of life. Patients were stratified into two groups based on age at surgery: ≤ 8 months and > 8 months.

Results: A total of 788 patients were identified, with a mean surgical age of 8.1 months. Black patients were disproportionately affected (29%), over twice their national birth rate (14%). Narcotic use was more common in younger patients (63% vs. 53%, p = 0.003), as well as in those treated in the West (71%, p = 0.001) and Northeast (73%, p = 0.004), and by plastic (74%, p < 0.0001) or orthopedic surgeons (69%, p = 0.002). Patients prescribed narcotics had longer hospital stays (1.7 vs. 1.2 days, p < 0.0001) and higher complication rates (7.9% vs. 3.1%, p = 0.009). Narcotic use decreased significantly over the study period (p = 0.002). Short-term outcomes, including complication and readmission rates, were similar across the three primary surgical specialties (plastic, orthopedic, and neurosurgery). High-volume centers had lower complication rates (1.5% vs. 5.4%, p = 0.002) and ICU admissions (5.8% vs. 18%, p < 0.0001) compared to medium-volume centers.

Conclusion: While narcotic use was associated with longer stays and complications, short-term outcomes were consistent across specialties. Standardized care protocols may help improve patient outcomes.

Background: Meningiomas are rare tumors in children compared with adults. Their main peculiarities are the frequent convexity or intraventricular location, the common association with neurofibromatosis-2 (NF-2) and the relatively high rate of aggressive and/or hyperostotic variants. Hyperostosis may complicate the surgical management. The goal of this paper is to provide an update on the main characteristics and the management of hyperostotic meningiomas.

Case description: A 7-year-old girl was admitted to our department because of a long-lasting history of left frontal skull bulging. Neuroimaging examinations revealed a huge hyperostotic meningioma with bony invasion and infiltration of the superior sagittal sinus. Genetic tests were positive for NF-2. The tumor (atypical meningioma) was gross totally resected. During the same operation, a custom-made cranioplasty was realized with the help of a frame-based craniectomy. The patient is asymptomatic and under oncological follow-up.

Discussion and conclusion: Although generally rare, hyperostotic meningiomas are relatively common in children and clinically demanding because of their large size, the possible aggressive behavior and the need of a cranioplasty as additional surgical step. Therefore, a careful preoperative surgical planning is required, taking into account that the extent of surgical resection is an important prognostic factor. The long-term outcome is good.