Paediatric meningiomas: a multi-centre case series of 27 patients.

Purpose: This study presents a series of paediatric meningiomas and discusses aetiology, risk factors and outcomes with comparison to current literature.

Methods: This is a retrospective review of surgically treated paediatric meningiomas from three UK centres: the University Hospital of Wales, Alder Hey Children's Hospital and Royal Manchester Children's Hospital. Twenty-seven patients aged 16 and under at the time of their first procedure were identified over a 15-year period (1 January 2007 and 1 March 2023).

Follow up of infants with skull fractures by neurosurgeons due to the risk of growing fractures; is it needed?

Introduction: Growing skull fractures are a rare complication of paediatric skull fractures. Despite its rarity, a large proportion of resources go towards detecting this complication. This study aims to identify the factors associated with growing skull fracture development to determine which children require follow-up.

Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales.

Objective: This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature.

Design And Setting: A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months.

Is postoperative high dependency care really needed for children undergoing supratentorial brain tumour surgery?

Purpose: We present our analysis of the existing Paediatric High Dependency Unit (HDU) admission policy at our institution and discuss our thoughts for its revision in the context of paediatric supratentorial tumour surgery.

Materials And Methods: We screened our prospectively maintained database of all children undergoing supratentorial craniotomy for resection of paediatric brain tumours over a fifteen-year period. The post-operative course of each patient was reviewed, assessing the number of patients who had true HDU needs in the immediate post-operative period, and the relative depth of input from paediatric HDU specialists that each patient received.

Don't make a mountain out of dermoid cysts of the anterior fontanelle.

Dermoid cysts are ectodermal inclusion lesions which can occur at the bregma, preventing complete closure of the anterior fontanelle. Various management strategies have been suggested for children presenting with such lesions. We describe the experience of managing a series of 13 consecutive patients at the University Hospital of Wales, Cardiff, including pre-operative workup, operative strategy, post operative care and follow up.

Suspected abusive head trauma in children - when do they really need to be transferred to a neurosurgical unit?

Objectives: Transferring paediatric patients with suspected abusive head trauma (AHT) to paediatric neurosurgical centres, disrupts safeguarding investigations. Therefore, it is desirable that suspected AHTs are transferred only when clinically necessary. The aim of this study was to describe referral patterns of patients referred to a tertiary paediatric neurosurgical centre with suspected AHT, with the view of informing future transfer of AHT patients.

Pre-operative dosing of dexamethasone for the management of children with posterior fossa tumours: are we getting it right?

Introduction: Posterior fossa (PF) tumours are associated with vasogenic oedema causing symptoms of raised intracranial pressure. Preoperatively this is managed with dexamethasone. To minimise steroid related complications, the lowest effective dose should be administered.

The efficacy of cystoperitoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: A systematic review of the literature.

Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort.

Surgical outcomes of congenital arachnoid cysts and their association with neurodevelopmental disorders.

Background: To evaluate the surgical outcomes of arachnoid cyst decompression in patients less than 16 years of age with an associated neurodevelopmental disorder (NDD).

Methods: A retrospective analysis of surgically treated congenital arachnoid cyst within South Wales between 2010-2019. Surgical outcomes are measured according to clinical (COG; clinical outcome score) and radiological (NOG; neuroimaging outcome score) outcomes and the complication profiles are described.

The Impact of the COVID-19 Pandemic on Traumatic Brain Injury Management: Lessons Learned Over the First Year.

The COVID-19 pandemic has had widespread consequences on health care systems around the world. It resulted in extensive changes to the referral patterns, management, and rehabilitation of surgical conditions. We aimed to evaluate the effect the COVID-19 pandemic has had on traumatic brain injury (TBI) specifically.

Surgical site infection in paediatric posterior fossa surgery: does pathology matter?

Objectives: The aim of this study was to explore the rates and potential risks of surgical site infection (SSI) after posterior fossa surgery for tumour resection in children.

Methods: We retrospectively reviewed our local paediatric (age < 16 years) database for all cases of posterior fossa (PF) brain tumour surgery between November 2008 and November 2019. We collected patient demographics, tumour histology/location, and the event of postoperative surgical site infection.

Is cerebrospinal fluid sampling necessary at the time of first ventriculo-peritoneal shunt insertion in paediatric patients?

Objective: We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future VP shunt infection or guide its management.

Methods: 83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified from patient case notes and electronic clinical databases.

Mollaret's triangle: An important neuroanatomical territory for all clinicians.

Background: Hypertrophic olivary degeneration is a rare condition caused by damage within the triangle of Guillain and Mollaret. We discuss the anatomical, radiological, and clinical history of this rare condition.

Case Description: A 32-year-old lady presented with sub-acute headache, photophobia, and dizziness.

Unusual cause of a painless soft tissue mass of the scalp: a rare presentation of primary intracranial neuroendocrine neoplasm.

Incidental soft tissue lumps in the scalp are a common presenting complaint in clinical practice. However, they may signify more sinister underlying pathologies. Our report examines a 63-year-old man presenting with impaired co-ordination in his left hand following a 3-month history of a painless left retroauricular scalp lump.

The need for hair removal in paediatric brain tumour surgery?

Introduction: Preoperative hair removal is conventional practice within neurosurgery in an attempt to maintain antisepsis. However, there is a lack of evidence to suggest that it makes a difference with regards to infection. This article aims to relate preoperative hair removal to SSIs for paediatric patients.

Towards improved outcome in children treated surgically for spontaneous intracranial suppuration in South Wales.

Introduction: Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales.

Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade's experience.

Background: Paediatric brain tumour resection rates have been shown to correlate with outcome and, it is argued, are linked to operator volume and caseload. The British paediatric neurosurgery community has previously debated centralisation of paediatric neuro-oncology. At the 2018 British Paediatric Neurosurgery Group (BPNG) meeting, a commitment was made to prospectively collect tumour resection data at each Neurosurgical Unit (NSU).

Infected congenital cervical dermal sinuses leading to spinal cord abscess: two case reports and a review of the literature.

Purpose: Congenital dermal sinuses are a rare form of spinal dysraphism. The developmental defects are located along the midline neuroaxis, with sinuses in the cervical region being the least common. Congenital dermal sinuses can be associated with intraspinal infection as they act as a direct route from the skin and subcutaneous tissues into the spinal cord.

Clinical features associated with the development of hydrocephalus following TBI in the paediatric age group.

Introduction: Predictive factors for post-traumatic hydrocephalus (PTH) in adults have been elucidated but remain uncertain for children. We aimed to identify the prevalence of PTH in paediatric patients and identify clinical/radiological factors which may increase the probability of children developing PTH.

Methods: This was a retrospective study of all patients < 16 years old admitted to our unit with traumatic brain injury (TBI) between March 2013 and June 2018, 108 patients in total.

Unilateral akathisia and choreoathetosis as an unusual presentation of a frontal lobe dermoid cyst.

Objective: To consider an unusual presentation of a frontal lobe dermoid cyst. Intracranial masses very rarely present with movement disorders. We describe a highly unusual presentation of an intracranial dermoid with unilateral choreoathetosis, akathisia and facial tics.

Meningioma with rhabdoid features combined with meningioangiomatosis in infancy: a novel combination.

Meningioangiomatosis is a rare histologically distinct abnormality that is occasionally associated with intracranial meningioma. The rhabdoid variant of meningioma is also uncommon and is classified as a World Health Organization Grade III tumour. We report a case of meningioangiomatosis in conjunction with a meningioma with prominent rhabdoid features, in an infant male who underwent complete surgical resection of the lesion.

Outcomes with respect to extent of surgical resection for pediatric atypical teratoid rhabdoid tumors.

Purpose: To evaluate overall survival for atypical teratoid rhabdoid tumors (ATRTs) in relation to extent of surgical resection.

Methods: The neurosurgical tumor databases from three UK Pediatric centers (University Hospital of Wales, Alder Hey and Royal Manchester Children's Hospital) were analyzed. Patients with a diagnosis of ATRT were identified between 2000 and 2018.

Cerebrospinal fluid diversion versus bariatric surgery in the management of idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is a condition affecting predominantly young women with increased body mass index (BMI). Obesity with the related metabolic and biochemical complications are thought to be involved in the pathogenesis of the condition. The aim of this study is to evaluate the safety, outcomes and economic implications of two treatment options for IIH.

Surgical management of raised intracranial pressure secondary to otogenic infection and venous sinus thrombosis.

Purpose: This study reviews paediatric patients with raised intracranial pressure as a result of venous sinus thrombosis secondary to otogenic mastoiditis, requiring admission to the paediatric neuroscience centre at the University Hospital Wales, Cardiff. The consensus regarding the management of otogenic hydrocephalus in the published literature is inconsistent, with a trend towards conservative over surgical management. We reviewed our management of this condition over a 9-year period especially with regard to ventriculo-peritoneal (VP) shunting.