Bedside transfontanelle drain placement reduces the need for operative intervention in infants with subdural fluid collections.

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.

Refining the role of cervical spine immobilization and stabilization in pediatric non-accidental trauma, a retrospective series of 1008 patients.

Introduction: Prompt detection of traumatic cervical spine injury is important as delayed or missed diagnosis can have disastrous consequences. Given the understood mechanism of non-accidental trauma (NAT), it is reasonable to suspect that cervical spine injury can occur. Current management of young children being evaluated for NAT includes placement of a rigid collar until clinical clearance or an MRI can be obtained.

Pediatric pineal region masses: a single-center experience over 25 years.

Purpose: Pineal region tumors (PRT) represent less than 1% of brain neoplasms. The rare and heterogeneous nature of these tumors is reflected in the variety of treatment modalities employed.

Methods: A single-center retrospective review of all pediatric patients with pineal region tumors between November 1996 and June 2021 was performed.

Neurosurgery for Optic Pathway Glioma: Optimizing Multidisciplinary Management.

Optic pathway glioma (OPG) comprises 10% of pediatric brain tumors and 40% of all pediatric low-grade gliomas (pLGGs). While generally considered benign pathologically, many require interventions with chemotherapy, radiation, or targeted therapies. Management has historically foregone tissue diagnosis given the classical clinical/radiographic presentation of these tumors, inability to safely remove the lesions surgically, and efficacy and safety of available chemotherapy options.

Successful flow diversion treatment of ruptured infectious middle cerebral artery aneurysms with the use of Pipeline Flex with Shield technology.

Background: Rupture of infectious intracranial aneurysms (IIAs) is associated with a high likelihood of mortality. Endovascular treatment of IIAs via parent artery sacrifice offers good efficacy and outcomes; however, depending on the lesion's location, neurologic deficit may result.

Case Description: We describe a pediatric patient with ruptured IIAs off the left middle cerebral artery (MCA) treated with coil embolization and endovascular flow diversion using the Pipeline Flex Embolization Device (PED) with Shield technology.

Atypical teratoid/rhabdoid tumor presenting with subarachnoid and intraventricular hemorrhage.

Background: Sellar masses comprise 14-18% of all intracranial tumors. Pituitary adenomas account for 85% of these lesions, while 15% of sellar masses stem from other etiologies. Intratumoral hemorrhage (apoplexy), while not exceptionally common, can be discovered at presentation.

Early analysis of operative management of Chiari I malformation in pediatric cystic fibrosis patients.

Introduction: Chiari I malformation, defined as herniation of the cerebellar tonsils at least 5 mm below the foramen magnum, can result from congenital or acquired pathology. While the mechanism is not well understood, an association between Chiari I and cystic fibrosis has been described in the literature. The lifelong respiratory status management necessitated by cystic fibrosis creates a greater risk of Chiari symptomatology as well as post-operative CSF-related complications in the setting of duraplasty secondary to recurrent transient increases in intracranial pressure.

A case of astroblastoma: Radiological and histopathological characteristics and a review of current treatment options.

Background: Astroblastoma is a rare neuroepithelial tumor that often originates in the cerebral hemisphere of children and young adults. Diagnosis of this obscure neoplasm can be difficult because these tumors are so infrequently encountered and share common radiological and neuropathological features of other glial neoplasms. As such, it should be included in the differential diagnosis of astrocytoma and ependymoma if the clinical and radiographic features suggest it.

Systematic Review of Urologic Outcomes from Tethered Cord Release in Occult Spinal Dysraphism in Children.

Tethered cord syndrome describes a condition of multisystem end organ dysfunction due to fixation of the spinal cord. This systematic review focuses on the closed skin variant of this condition, occult spinal dysraphism. The embryology, pathophysiology, presentation, and classification of occult spinal dysraphism are explained to develop a simple framework for discussions regarding this often confusing condition.

Osteolytic calvarial lesions as initial presentation of latent neurosyphilis.

We report a patient with human immunodeficiency virus infection whose initial presentation of neurosyphilis was painful calvarial lesions. A literature search reveals seven previous cases of calvarial involvement in early acquired syphilis but none in patients diagnosed with neurosyphilis. This patient emphasizes the need to consider atypical infections when encountering skull lesions, especially in the setting of human immunodeficiency virus co-infection.