Child's Nervous System最新文献

Purpose: This Hydrocephalus Clinical Research Network (HCRN) study had two aims: (1) to compare the predictive performance of the original ETV Success Score (ETVSS) using logistic regression modeling with other newer machine learning models and (2) to assess whether inclusion of imaging variables improves prediction performance using machine learning models.

Methods: We identified children undergoing first-time ETV for hydrocephalus that were enrolled prospectively at HCRN sites between 200 and 2020. The primary outcome was ETV success 6 months after index surgery. The cohort was randomly divided into training (70%) and testing (30%) datasets. The classic ETVSS variables were used for logistic regression and machine learning models. Predictive performance of each model was evaluated on the testing dataset using area under the receiver operating characteristic curve (AUROC).

Results: There were 752 patients that underwent first time ETV, of which 185 patients (24.6%) experienced ETV failure within 6 months. For aim 1, using the classic ETVSS variables, machine learning models did not outperform logistic regression with AUROC 0.60 (95% CI: 0.52-0.69) for Naïve Bayes (highest machine learning model performance) and 0.68 (95% CI: 0.60-0.76) for logistic regression. After inclusion of imaging features (aim 2), machine learning model prediction improved but remained no better than the above logistic regression with the highest AUROC of 0.67 (95% CI: 0.59-0.75) attained using Naïve Bayes architecture compared to 0.68 (95% CI: 0.59-0.76) for logistic regression.

Conclusions: This contemporary multicenter observational cohort study demonstrated that machine learning modeling strategies did not improve performance of the ETVSS model over logistic regression.

Neuroendoscopic lavage (NEL) is a time-limited neurosurgical intervention that removes intraventricular blood in post-hemorrhagic hydrocephalus (PHH). Preterm neonates are medically complex and fragile, often precluding neurosurgical procedures due to concerns such as extubation risk and body temperature instability during even routine clinical care. In addition, transportation to the operating room can be difficult and risky. Given these factors, our institution developed and implemented a bedside technique to facilitate safe and timely NEL in the neonatal intensive care unit for the treatment of PHH.

Purpose: Neonatal intraventricular hemorrhage (IVH) is a common complication of prematurity as it affects 12.4% of preterm infants weighing under 1500 g. Posthemorrhagic hydrocephalus (PHH) is an important complication of neonatal IVH and can have serious long-term consequences such as cognitive impairment and cerebral palsy. The purpose of this review is to determine whether stem cell transplantation can play a role in the treatment of neonatal IVH mainly focusing on the prevention of the catastrophic sequelae of neonatal IVH, as well as to the improve outcome of these patients.

Methods: A literature search was performed using the PubMed/MEDLINE and Scopus databases, and after meticulous screening, eight articles were finally selected. The authors included both animal and human studies in this narrative review.

Results: Our review included eight articles, five animal studies and three human studies, including one phase 1 clinical trial, one pilot study, and one case report. Intraventricular transplantation of mesenchymal stem cells (MSCs) early after IVH diagnosis seems to prevent the development of PHH, improve myelination, and reduce periventricular cell death, inflammation, and reactive gliosis. It also seems to be a safe and well-tolerated procedure in preterm infants.

Conclusion: Animal and human study findings regarding stem cell transplantation in the treatment of IVH show promising results in reducing the risk of PHH. Further research with larger series is needed to better determine its safety and efficacy. Larger studies such as randomized controlled trials could establish the efficacy and tolerability of the treatment.

Objective: Stereoelectroencephalography (SEEG) is widely used to characterise epileptic networks and guide resection in paediatric epilepsy surgery programmes. The insula, with its extensive connectivity with temporal and extratemporal structures, has increasingly been seen as a possible surgical target. We report our seizure outcomes after SEEG-guided resection of the insula in a paediatric cohort.

Methods: From our paediatric epilepsy surgery database of patients aged 0-19 years, we analysed demographic and clinical data of those who underwent SEEG-guided insula cortex resection.

Results: In total, 11 children (7 females, 4 males) who underwent SEEG-guided resection were identified. The mean age at first SEEG was 13 years old. Mean age at seizure onset was 4.3 years; seizure frequency ranged from 50/day to 2/week. Four children required 1 SEEG study, 6 children 2 SEEG, and 1 child underwent 3 SEEG recordings. The mean follow-up duration was 2.1 years; at the latest follow-up, three children had Engel I, 2 children Engel III, and 6 children Engel IV. One child classified as an Engel IV outcome for insular surgery had Engel class I after 2 failed insula surgeries, after an occult frontal focal cortical dysplasia was later identified and resected. No major complications were noted.

Conclusions: In our paediatric series, one third of the patients undergoing insula cortex surgery after SEEG became seizure free but this may require repeat SEEG implantation, repeat resective surgery and the possibility of changing hypothesis from the insula cortex to nearby foci.

Purpose: This report aims to present a case of a child with holocord pilocytic astrocytoma and review the existing literature to provide insights into current management strategies.

Case presentation: An 11-month-old patient presented with progressive quadriplegia and was initially diagnosed with a spinal abscess. MRI revealed a heterogeneously enhancing cystic intramedullary lesion extending from the cervicomedullary region to the conus medullaris. The patient underwent an emergent T10-L1 total laminectomy and midline myelotomy for presumed abscess drainage. Intraoperative findings, however, were inconsistent with an abscess, suggesting a neoplastic process. Postoperative MRI indicated persistent spinal cord compression and histopathological examination showed no leukocytes or microorganisms. A second surgery the following day extended the laminectomy to T3, achieving gross total resection. Pathology confirmed a grade I pilocytic astrocytoma. Given the patient's age, chemotherapy with vincristine and carboplatin was initiated, as radiotherapy was unsuitable. Early physical therapy was commenced, resulting in significant neurological improvement to 4/5 muscle strength in all extremities according to the Medical Research Council (MRC) scale in the first year. Chemotherapy was discontinued due to systemic complications. At the 1-year follow-up, MRI demonstrated no tumor recurrence.

Conclusion: The management of holocord pilocytic astrocytomas presents significant challenges, particularly in pediatric patients. While surgical resection remains the cornerstone of treatment, the role of chemotherapy requires further investigation. This case underscores the necessity of a multidisciplinary approach and highlights the potential for favorable outcomes with appropriate intervention.

Background: Radical resection of spinal cord lipomas reduces the rate of re-tethering. Current conventional neurophysiological mapping techniques are not able to differentiate between crucial motor nerve roots and sensory roots. Enhanced differentiation could contribute to complete resection. We present our experience with a double-train paradigm to differentiate between motor and sensory roots.

Methods: In children undergoing spinal cord lipoma resection, the double-train mapping paradigm was used with an inter-train interval of 60 ms. Given the longer recovery time due to the H-reflex, a single muscle response was presumed to be elicited from a sensory root, and a double muscle response from a motor root. The primary endpoint was postoperative neurological outcome and bladder function at discharge.

Results: We included 8 children undergoing 10 lipoma resections between 2016 and 2023. Double-train mapping was used in all cases. Motor and sensory roots were clearly differentiated in 6 cases and altered the course of surgery in 4 cases. Post-surgery, no sensory and motor function worsened within 3 months. Bladder function was stable in six and improved in two children. In two patients, bladder function worsened slightly at 3 months and 6 months, at which point one patient was re-operated on for re-tethering.

Conclusion: Intraoperative mapping with the double-train paradigm reliably differentiated between motor and sensory nerve roots. Informing the surgeon on the specific function of a tethering root may help to maximize resection without risking major neurological deficits.

Purpose: To describe the immediate postoperative PICU course and short-term outcomes of children undergoing various epilepsy surgeries.

Methods: Single-center, retrospective observational study. All patients younger than 20 years of age who had been admitted to the PICU between 2018 and 2022 following epilepsy surgery were eligible for study entry.

Results: Fifty-two children (median age 7.9 years) underwent epilepsy surgery during the study period (25 focal lesionectomies and lobectomies [FL], 10 corpus callosotomy [CC], and 17 hemispheric surgeries [HS]). The average number of preoperative antiseizure medications (ASM) was 3, and the average number of failed ASM was 6. Cortical dysplasia was the most frequent etiology (25%). Preoperative cognitive delay and motor deficits were reported in 38 (74%) and 26 (50%) patients, respectively. The median length of stay in the PICU was 1 day (5 for the HS group). No seizures occurred among 44 (85%) children during the first postoperative day nor during the entire hospital stay in 40 (77%) patients (20/25 [82%] in the FL group, 4/10 [40%] in the CC group, and 14/17 [82%] in the HS group). There were no status epilepticus events during the PICU stay. None of patients required hemodynamic support, and only 3(6%) needed respiratory support. Twenty-six patients (50%) had electrolyte abnormalities. Pain was mostly perceived as mild. Fever was present in 28 (54%) patients, most notably in the HS group (94%).

Conclusion: Epilepsy surgery in children is associated with very limited immediate postoperative morbidity and low seizure burden, especially in the FL and HS groups.

Background: Intrathoracic migration of a ventriculoperitoneal shunt (VPS) is a phenomenally rare complication, with the supradiaphragmatic intercostal variant even more so. Whereas it can prove debilitating or even fatal via massive hydrothorax, the causative mechanism and proper management of this occurrence are undefined.

Case presentation: A 17-month-old girl who had undergone VPS insertion at one month of age was brought to our department for somnolence and dyspnea, which had a sudden onset. Despite a previous thoracostomy provided temporary symptom relief, she had relapsed. Computed tomography (CT) of the chest showed a large loop of the right-sided VPS penetrating into the thorax through the anterior wall, as well as marked right hydrothorax. She was subjected to VPS revision and thoracostomy, with the swift, complete, and lasting remission of her complaints.

Conclusion: It is possible that local reaction coupled with negative inspiratory pressure caused the catheter loop to break into the pleural cavity. Our case demonstrates an exceedingly rare event that has a favorable prognosis if diagnosed and treated quickly and appropriately.

Background: The nature of immunotherapy has rendered it a focal point in the management of glioblastoma (GBM). This bibliometric analysis aimed to analyze the top 100 most cited articles about immunotherapy for GBM to expand the knowledge of research related to this therapeutic approach.

Methods: The retrieval of the top 100 articles on "Immunotherapy AND Glioblastoma" was performed using the Web of Science Core Collection database. Relevant details were extracted for bibliometric analysis, and to gain insights, a comparison was made between older and newer articles. Categorical data underwent analysis utilizing Pearson's chi-square test, while continuous data were analyzed using the Wilcoxon rank-sum test.

Results: The top 100 articles were distributed across the years 2000 to 2021, with the number of citations ranging from 135 to 1058. Among these articles, publications peaked in 2017 and 2018 (n = 12), and the most common country of correspondence was the USA (n = 73). Clinical Cancer Research was the most cited journal, and authors SAMPSON JH and LIM M had the highest number of papers (n = 6). Newer articles had significantly higher citation rates (p < 0.01), more authors (p < 0.05), more institutes (p < 0.01), and more collaborations between institutions (p < 0.01). Subspecialties showed a trend of more "TME" (1% vs 7%, p = 0.05945) in the before and after group comparison, although this difference was not statistically significant (p > 0.05).

Conclusion: The study of the top 100 cited articles on immunotherapy for GBM shows that researchers are actively working together to develop novel approaches to GBM immunotherapy. The high citations, leading countries, journals, and authors, along with evolving research characteristics, indicate a field with great interest and potential. Immunotherapy holds significant promise in GBM treatment.