Intraventricular baclofen for the treatment of pediatric spasticity in cerebral palsy: technique and outcomes.

Objective: Intraventricular baclofen (IVB) administration is used for the treatment of secondary dystonia associated with cerebral palsy (CP), but it has not been reported as a first-line infusion technique for spasticity. In this study, the authors report outcomes of patients with mixed or isolated spasticity treated with IVB administration.

Methods: A retrospective analysis was performed of consecutive patients treated with IVB between 2019 and 2023.

Validation of the Subaxial Cervical Spine Injury Classification score in children: a single-institution experience at a level 1 pediatric trauma center.

Objective: The Subaxial Cervical Spine Injury Classification (SLIC) score has not been previously validated for a pediatric population. The authors compared the SLIC treatment recommendations for pediatric subaxial cervical spine trauma with real-world pediatric spine surgery practice.

Methods: A retrospective cohort study at a pediatric level 1 trauma center was conducted in patients < 18 years of age evaluated for trauma from 2012 to 2021.

A survey of preferences and expectations for surgical interventions targeting atonic seizures in Lennox-Gastaut syndrome.

Purpose: To assess preferences and outcome expectations for vagus nerve stimulation (VNS) and corpus callosotomy (CC) surgeries in the treatment of atonic seizure in Lennox-Gastaut syndrome (LGS).

Methods: A total of 260 surveys were collected from patients are caregivers of LGS patients via Research Electronic Data Capture (REDCap).

Results: Respondents reported an average acceptable atonic seizure reduction rate of 55.

The Utility of Responsive Neurostimulation for the Treatment of Pediatric Drug-Resistant Epilepsy.

Drug-resistant epilepsy (DRE) has a strongly negative impact on quality of life, as well as the development of pediatric patients. Surgical treatments have evolved over time, including more invasive craniotomies for resection or disconnection. More recently, neuromodulation techniques have been employed as a less invasive option for patients.

Minimally invasive modification of the Goel-Harms atlantoaxial fusion technique: a case series and illustrative guide.

Objective: The Goel-Harms atlantoaxial screw fixation technique for the treatment of atlantoaxial instability and unstable odontoid fractures is reliable and reproducible for a variety of anatomies. The drawbacks of the technique are the potential for significant bleeding from the C2 nerve root venous plexus and the risks associated with posterior midline exposure and retraction, such as pain and wound complications. The authors developed a minimally invasive surgical (MIS) modification of the Goel-Harms technique using intra-articular grafting to facilitate placement of percutaneous lateral mass and pars screws with extended tabs for minimally invasive subfascial rod placement.

Risk factors for proximal junctional kyphosis after pediatric spinal deformity surgery with halo gravity traction.

Purpose: To determine risk factors for proximal junctional kyphosis (PJK) in pediatric patients with scoliosis undergoing halo gravity traction (HGT) prior to posterior spinal fusion (PSF).

Methods: Data from consecutive patients who underwent PSF after HGT with 2-year follow-up were retrospectively collected from a single center. Patients were divided into two groups: PJK vs.

Pediatric Neurosurgery in Primary Care: Masses of the Scalp and Skull in Children.

There are a wide variety of scalp and skull lesions that can affect the pediatric population, many of which are first encountered by primary care physicians. The differential consists of a broad range of more common congenital lesions, sequelae of trauma, and vascular anomalies, to very rare neoplastic processes. It is important to understand signs and symptoms that may indicate whether a lesion may be benign versus life threatening, what imaging studies are appropriate and how to interpret them, and when to seek referrals to specialists.

Tactile Skill-Based Neurosurgical Simulators Are Effective and Inexpensive.

Background: Regulations limit residency work hours and operating time, limiting the amount of hands-on surgical training. To develop alternative hands-on training, many programs teach surgical skills in laboratories and workshops with the use of simulators. The expense of computer simulators and lack of replication of the manual skills and tactile feedback of surgery limit their usefulness.

Potential utility of FLAIR in MRI-negative Cushing's disease.

OBJECTIVE Accurate presurgical localization of microadenomas in Cushing's disease (CD) leads to improved remission rates and decreased adverse events. Volumetric gradient recalled echo (3D-GRE) MRI detects pituitary microadenomas in CD in up to 50%-80% cases as a focus of hypointensity due to delayed contrast wash-in. The authors have previously reported that postcontrast FLAIR imaging may be useful in detecting otherwise MRI-negative pituitary microadenomas as foci of hyperintensity.

Somatostatin receptor expression on von Hippel-Lindau-associated hemangioblastomas offers novel therapeutic target.

Von Hippel-Lindau (VHL)-associated hemangioblastomas (VHL-HB) arise in the central nervous system (CNS), and are a leading cause of morbidity and mortality in VHL disease. Currently, surgical resection is the most effective way to manage symptomatic VHL-HBs. Surgically unresectable VHL-HBs or those in frail patients are challenging problems.

Simulating vasogenic brain edema using chronic VEGF infusion.

OBJECTIVE To study peritumoral brain edema (PTBE), it is necessary to create a model that accurately simulates vasogenic brain edema (VBE) without introducing a complicated tumor environment. PTBE associated with brain tumors is predominantly a result of vascular endothelial growth factor (VEGF) secreted by brain tumors, and VEGF infusion alone can lead to histological blood-brain barrier (BBB) breakdown in the absence of tumor. VBE is intimately linked to BBB breakdown.

Characterization of the blood brain barrier in pediatric central nervous system neoplasms.

Objective: The normal blood-brain barrier (BBB) is composed of tight junctions between endothelial cells and surrounding astrocyte foot processes. Breakdown of the physiological astrocyte-endothelial cell relationship occurs in adult metastatic and primary brain tumors. However, the astrocyte-endothelial cell relationship has not been studied in pediatric tumors.

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery.

OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing's disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed.