Journal Of Neurosurgery. Pediatrics[JOURNAL]
Sun
200 papers
Editorial. Defining the role of LITT in pediatric extratemporal lobe epilepsy.
Grant G, Adebayo B
J Neurosurg Pediatr · 2026 Jun · PMID 42284610 · Publisher ↗
Abstract loading — click title to view on PubMed.
Risk of mood, anxiety, and substance use disorders following adolescent traumatic brain injury: a retrospective cohort study.
Kennemer AA, Nag A, Shah VS … +1 more , Zhou X
J Neurosurg Pediatr · 2026 Jun · PMID 42284609 · Publisher ↗
OBJECTIVE: The aim of this study was to determine whether adolescent traumatic brain injury (TBI) is associated with long-term risk of depression, anxiety, suicide ideation, suicide attempt, and substance use disorders,...
OBJECTIVE: The aim of this study was to determine whether adolescent traumatic brain injury (TBI) is associated with long-term risk of depression, anxiety, suicide ideation, suicide attempt, and substance use disorders, and whether these risks differ by sex and injury severity. METHODS: This retrospective cohort study used electronic health record data from January 1, 2000, to January 1, 2019, with a 5-year follow-up period. Data were obtained from the TriNetX platform, which aggregates deidentified information from 60 US healthcare organizations across all 50 states. A total of 262,262 adolescents aged 10-18 years diagnosed with mild or moderate to severe TBI were included. Cohorts were stratified by sex and TBI severity and matched to controls without TBI by race, socioeconomic factors, and prior psychiatric or head injury diagnoses. Exposures were defined by ICD-10 codes for TBI severity, and outcomes included incidence of depression, anxiety, alcohol dependence, nicotine dependence, suicide ideation, and suicide attempt within 5 years of TBI diagnosis. RESULTS: Among 262,262 adolescents with TBI (154,149 male and 108,113 female), mild TBI was associated with increased risk of depression, anxiety, suicide ideation, suicide attempt, alcohol dependence, and nicotine dependence in both males and females compared with matched controls. Females with mild TBI had a higher risk of mood disorders and suicidality, whereas males had higher risk of substance use. Moderate to severe TBI was not associated with higher risk for these disorders compared with mild TBI. CONCLUSIONS: Adolescent TBI, regardless of severity, was associated with increased risk of psychiatric disorders and substance use, with females showing greater vulnerability to mood disorders and suicidality.
Seizure outcomes after laser interstitial thermal therapy for pediatric extratemporal lobe epilepsy.
Owen BS, Gaulden AL, Karsonovich T … +6 more , Greiner HM, Arya R, Leach JL, Horn PS, Skoch J, Mangano FT
J Neurosurg Pediatr · 2026 Jun · PMID 42284607 · Publisher ↗
OBJECTIVE: Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in loca...
OBJECTIVE: Approximately one-third of patients with epilepsy develop drug-resistant epilepsy (DRE). Extratemporal lobe epilepsy (ETLE) represents 30%-40% of focal epilepsy cases. ETLE poses significant challenges in localization and treatment because these patients often have diffuse and complex epileptogenic networks. Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative for localizable DRE, yet data for its use in the pediatric ETLE population remain limited. This study aimed to evaluate the safety and efficacy of LITT in pediatric ETLE and identify predictive factors for favorable seizure outcomes. METHODS: This retrospective study reviewed pediatric patients who underwent LITT for ETLE at a single National Association of Epilepsy Centers level 4 epilepsy center from 2015 to 2023. Patients with prior LITT for temporal lobe epilepsy, hypothalamic hamartomas, or corpus callosotomies were excluded. Preoperative evaluations included noninvasive testing (e.g., video-EEG, MRI, PET, magnetoencephalography) and invasive monitoring with stereo-EEG. The primary study endpoints were 1) International League Against Epilepsy (ILAE) classification at 12 months after the index LITT or additional surgical intervention for the treatment of seizures, and 2) procedure-related complications. Secondary analyses examined imaging concordance with the final ablation location, total ablation volume, and perioperative metrics. RESULTS: Twenty-nine patients underwent an index LITT procedure for ETLE. At 12 months, 14 patients (48.3%) achieved a good outcome (ILAE class 1-3), and 12 (41.4%) were seizure free (ILAE class 1). There were 6 patients (20.7%) who required additional surgery within 12 months. Concordant PET with the final LITT ablation volume independently predicted seizure outcome (p = 0.04). The total ablation volume ranged from 0.66 to 8.45 cm3, and was not statistically different between groups. In the perioperative period, 3 patients developed transient steroid-responsive LITT-related edema, while no permanent neurological deficits, hematomas, surgical site infections, or deaths occurred. CONCLUSIONS: This study demonstrated that LITT is a safe and effective treatment option for pediatric ETLE and may achieve acceptable rates of seizure freedom with a minimally invasive approach. Concordance between noninvasive imaging (particularly PET) with LITT targets was associated with favorable outcomes, underscoring the importance of thorough preoperative evaluations to determine appropriate ablation candidates. Future multicenter prospective studies are warranted to further refine patient selection criteria and optimize treatment paradigms.
Efficacy and safety profile of volume-staged stereotactic radiosurgery for ruptured, large pediatric arteriovenous malformations: a multicenter cohort analysis.
Shinya Y, Tos SM, Hajikarimloo B … +58 more , Mantziaris G, Chan JW, Sneed PK, McDermott MW, Seymour ZA, Grills I, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin R, Bin-Alamer O, Lunsford LD, Niranjan A, Peker S, Samanci Y, Lee CC, Yang HC, Sheehan D, Sheehan K, Liscak R, Chytka T, Alzate J, Kondziolka D, Meng Y, Martinez Moreno N, Martinez-Álvarez R, Hallan DR, Fritch C, Jareczek F, Sciscent BY, Mathieu D, Carrier L, Abdelsalam A, Starke RM, Benjamin C, Almeida T, Singh SP, Tripathi M, Speckter H, Lazo E, Chen CJ, Esquenazi Y, Becerril-Gaitan A, Amsbaugh MJ, Blanco AI, Upadhyay R, Palmer JD, Franzini A, Picozzi P, Lanterna LAA, Bowden GN, Peterson JL, Chiang VL, Pikis S, Xu Z, Sheehan JP
J Neurosurg Pediatr · 2026 Jun · PMID 42284606 · Publisher ↗
OBJECTIVE: Ruptured, large pediatric arteriovenous malformations (AVMs) pose a significant management challenge due to high rerupture risk and the morbidity of conventional treatments. Volume-staged stereotactic radiosur...
OBJECTIVE: Ruptured, large pediatric arteriovenous malformations (AVMs) pose a significant management challenge due to high rerupture risk and the morbidity of conventional treatments. Volume-staged stereotactic radiosurgery (VS-SRS) has emerged as an alternative; however, evidence for its use in this specific population is limited. This study aimed to evaluate the long-term efficacy and safety of VS-SRS for ruptured, large AVMs in a dedicated pediatric cohort. METHODS: This international, multicenter, retrospective cohort study from 21 centers analyzed outcomes for 42 pediatric patients (age < 18 years) with previously ruptured, large AVMs treated with VS-SRS. The primary outcome was complete AVM obliteration, and secondary outcomes included post-SRS hemorrhage, radiation-induced changes (RICs), and favorable outcome. Favorable outcome in this study was defined as obliteration without post-SRS hemorrhage or permanent RIC. RESULTS: At the initial SRS, the median patient age was 14.5 years, and the median AVM volume was 15.0 cm3; most AVMs were high grade (Spetzler-Martin grades IV and V). With a median follow-up of 41.5 months, complete AVM obliteration was achieved in 21 patients (50.0%). The cumulative obliteration rate was 37% at 5 years and 56% at 10 years. Patients with a nidus volume of ≤ 10 cm3 had significantly higher cumulative obliteration rates than those with a nidus volume > 10 cm3 (log-rank test, p = 0.021). Similarly, patients treated with a prescription dose > 17 Gy showed significantly higher cumulative obliteration rates compared to those treated with a dose ≤ 17 Gy (log-rank test, p = 0.012). The cumulative 5-year incidences of hemorrhage and RICs following VS-SRS were 19% and 7%, respectively. In multivariable analysis, only larger total AVM volume was an independent predictor of a lower likelihood of favorable outcome (hazard ratio 0.89, 95% CI 0.80-0.99; p = 0.036). CONCLUSIONS: In this multicenter pediatric cohort, VS-SRS for ruptured, large AVMs provides a reasonable chance of long-term obliteration, but generally acceptable risks of post-SRS hemorrhage and RICs exist. VS-SRS should be considered as an option for pediatric patients with large, ruptured AVMs.
Targeted GLP-1 nanotherapy for Wnt/β-catenin activation to enhance endothelial progenitor cell-mediated re-endothelialization and prevent intracranial aneurysm recurrence.
Yu G, Hu L, Pan T … +5 more , Li G, Wang B, Zhang W, Yang GY, Zhu W
J Neurosurg · 2026 Jun · PMID 42284605 · Publisher ↗
OBJECTIVE: Intracranial aneurysm (IA) is a leading cause of subarachnoid hemorrhage, characterized by complex pathogenesis and high mortality rates due to rupture. The aim of this study was to develop a targeted glucagon...
OBJECTIVE: Intracranial aneurysm (IA) is a leading cause of subarachnoid hemorrhage, characterized by complex pathogenesis and high mortality rates due to rupture. The aim of this study was to develop a targeted glucagon-like peptide-1 (GLP-1) nanodelivery system to mobilize endothelial progenitor cells (EPCs) and enhance re-endothelialization in a rat model of coiled IA. METHODS: In this study, a matrix metalloproteinase-2 (MMP-2)-targeted nanodelivery platform (hereafter GLP-1@tMSN [targeted mesoporous silica nanoparticle]) based on MSNs functionalized with GLP-1 was developed to mobilize EPCs and accelerate vascular repair. The efficacy of GLP-1@tMSN in promoting EPC recruitment and re-endothelialization was evaluated in a rat coiled aneurysm model, alongside mechanistic studies of the Wnt/β-catenin signaling pathway. RESULTS: In a rat model of coiled IA, GLP-1@tMSN significantly enhanced the recruitment of EPCs and promoted re-endothelialization. Histological analysis demonstrated the formation of mature endothelial-like tissue after 28 days, in contrast to the fibrous tissue observed in the control group. Immunofluorescence analysis confirmed the preferential accumulation of CD34+VEGFR2+ EPCs at the lesion site, with concurrent activation of the Wnt/β-catenin pathway, implicating its pivotal role in driving vascular repair. Preliminary safety evaluations further indicated a favorable biocompatibility profile for the nanotherapeutic system. CONCLUSIONS: The developed functionalized nanodelivery platform represents a promising therapeutic strategy to enhance localized GLP-1 efficacy, facilitating rapid re-endothelialization and potentially reducing long-term recurrence of IAs after embolization. This approach shows substantial potential for improving outcomes for patients with IA.
Heterogeneity of catheter insertion rates: an initial benchtop assessment of shunt catheter insertion for hydrocephalus.
Menkara A, Horbatiuk J, Johnston JM … +8 more , Arynchyna-Smith A, Brinkley T, Hale AT, Feldman MJ, Najera RA, Gonzalez Gomez M, Blount JP, Harris CA
J Neurosurg Pediatr · 2026 Jun · PMID 42284602 · Publisher ↗
OBJECTIVE: The aim of this study was to investigate hydrocephalus shunt insertion dynamics and variability across a group of clinicians using a polyvinyl alcohol (PVA)-Phytagel-based brain-mimicking model for ventricular...
OBJECTIVE: The aim of this study was to investigate hydrocephalus shunt insertion dynamics and variability across a group of clinicians using a polyvinyl alcohol (PVA)-Phytagel-based brain-mimicking model for ventricular catheter placement. METHODS: The rate of catheter insertion through a simplified PVA-Phytagel-based brain mimic was assessed in a group of clinicians at an academic pediatric neurosurgery division. Lateral and longitudinal catheter position and motion throughout insertion depth were assessed and analyzed. Additionally, survey data were collected to better understand the intentionality and thought process underlying each surgeon's insertion approach. RESULTS: A total of 57 insertions were collected across 19 participants, of whom 16 were neurosurgeons and included in the final analysis. Based on survey results, the authors found that there was a positive correlation between the surgeons' attempt to speed up at earlier anatomical landmarks (ependyma) and slow down at deeper anatomical landmarks (deeper ventricular levels) throughout the depth of insertion. However, in practice, there was no correlation between the intended insertion rate and the actual insertion rate of the surgeons. Additionally, the authors found a high degree of variability in both the longitudinal and lateral directions for both position and velocity, independent of trial number, individual surgeon, or insertion depth. CONCLUSIONS: In the brain mimic of compliant uniform hydrogel, the surgeon's insertion rate throughout insertion and across samples was found to not be uniform, with catheter insertion rates being highly heterogeneous and nonrepeatable. Analogous fields within the neural implant space have regulated output for both insertion rates and dynamics in order to optimize implant outcome and minimize neuroinflammatory response. The authors believe this study sets a precedent to begin exploration of hydrocephalic tissue response in vivo to differential longitudinal and lateral catheter velocities.
Long-term treatment results of staged stereotactic radiosurgery for posterior fossa brain metastases with volume larger than 4 mL.
Yomo S, Yako T, Kitazawa K … +2 more , Oda K, Oguchi K
J Neurosurg · 2026 Jun · PMID 42284601 · Publisher ↗
OBJECTIVE: Managing large posterior fossa brain metastases (PFBMs) poses significant challenges. Although staged stereotactic radiosurgery (SRS) is an effective and minimally invasive alternative for large brain metastas...
OBJECTIVE: Managing large posterior fossa brain metastases (PFBMs) poses significant challenges. Although staged stereotactic radiosurgery (SRS) is an effective and minimally invasive alternative for large brain metastases, its clinical utility for large PFBMs has not yet been fully elucidated. The aim of this study was to evaluate the safety and efficacy of staged SRS in the treatment of large PFBMs. METHODS: This retrospective analysis included patients who underwent upfront staged SRS for PFBMs measuring 4 mL or larger between 2010 and 2024 at a single tertiary cancer center. Patients who had received prior local treatment were excluded from the study. The radiosurgical protocol encompassed delivering 24-30 Gy in 2 fractions, with a time interval of 3-4 weeks between sessions. Outcome measures, including overall survival, local control of large PFBMs, and leptomeningeal metastasis (LM), were assessed using time-dependent analyses, considering competing events when appropriate. RESULTS: A consecutive cohort of 92 patients (49 male, median age 68 years) with 96 large PFBMs was included in the study. Primary cancers were small cell lung cancer, non-small cell lung cancer, and colorectal, breast, genitourinary, and upper digestive tract cancers in 11, 30, 24, 16, 7, and 4 patients, respectively. Eighty-two patients (89%) exhibited neurological symptoms, and the median volume of large PFBMs was 9.0 mL. At the time of the second session, the median PFBM volume had decreased by 49% to 4.6 mL. During the treatment interval, 2 patients underwent urgent craniotomies due to tumor bleeding and obstructive hydrocephalus. The 1- and 2-year overall survival rates following staged SRS were 51% and 30%, respectively (median 12.2 months). The 1- and 2-year local failure rates for large PFBMs were 17% and 23%, respectively. Rapid tumor response (defined as a 50% or greater volume reduction at the second session) was the sole factor associated with higher probability of local tumor control (HR 0.32, 95% CI 0.12-0.86; p = 0.024). The mean Karnofsky Performance Status (KPS) score improved from 71 at the first SRS session to 85 at the second; the first follow-up mean KPS score was 90 (p < 0.001). The 1- and 2-year LM rates remained low at 11% and 14%, respectively. CONCLUSIONS: These results suggest that staged SRS is a safe and less invasive treatment option for selected patients with PFBMs larger than 4 mL, achieving reasonable local control rates and low LMs rates in the long term.
Quality of life and mental health in pediatric patients with low-grade CNS tumors treated with surgery alone.
Roak AS, Rahm SP, Howell SG … +9 more , Mahavadi AK, Warren EAH, McRae EM, Madan-Swain A, Landier W, Schwebel DC, Barnes M, Rocque BG, Mrug S
J Neurosurg Pediatr · 2026 Jun · PMID 42247710 · Publisher ↗
OBJECTIVE: Pediatric patients with low-grade CNS tumors can experience an array of physical, cognitive, and psychosocial late effects, even in the absence of adjuvant therapy. It is unclear to what extent these late effe...
OBJECTIVE: Pediatric patients with low-grade CNS tumors can experience an array of physical, cognitive, and psychosocial late effects, even in the absence of adjuvant therapy. It is unclear to what extent these late effects impact long-term quality of life (QOL). The aim of this study was to evaluate QOL and mental health in children with low-grade CNS tumors treated with surgery alone compared with healthy children and children with chronic illness. METHODS: Medical records were retrospectively reviewed to identify children (age ≤ 18 years) who underwent surgical treatment of a low-grade CNS tumor (WHO grades I or II) without adjuvant therapy. Caregivers of enrolled patients (1-8 years after resection) completed a demographic questionnaire, the PedsQL Generic Core Scales, and the BASC-3 Parent Rating Scales. Scores were compared with published levels of QOL and mental health in healthy children and children with chronic illness. RESULTS: Sixty-six patients and their caregivers enrolled in the study; the mean patient age at enrollment was 13.47 years, with a mean time from surgery to enrollment of 4.26 years. These patients demonstrated significantly lower patient-reported QOL scores compared with their healthy peers for all scales. The mean PedsQL scores showed that 58% of children experienced difficulty with school-related functioning, 49% fell at or below the age-appropriate cutoff for emotional QOL, 42% experienced decreased physical QOL, and 30% experienced social challenges. The proportion of patients with BASC-3 scores (n = 51) that met or exceeded the cutoff for at-risk or clinically relevant difficulties ranged from 8% (depression) to 14% (anxiety and attention, each). CONCLUSIONS: Children treated for low-grade CNS tumors with surgery alone can face challenges that impact their long-term QOL and mental health. Psychosocial functioning of these children should be routinely assessed at follow-up visits in neurosurgery clinics. Other providers and families should be made aware of the potential long-term consequences associated with low-grade CNS tumors treated with surgery alone. Similar to the psychosocial care recommendations for children with chronic illness, interventions should be developed for patients with low-grade CNS tumors to mitigate risk of impaired long-term QOL and mental health.
Enhanced Recovery After Surgery in clipping surgery for unruptured cerebral aneurysm: prospective nonrandomized controlled trial.
Yu J, Kim JJ, Youn S … +5 more , Han HJ, Park KY, Kim YB, Kim S, Oh J
J Neurosurg · 2026 Jun · PMID 42247709 · Publisher ↗
OBJECTIVE: As endovascular coiling has grown in popularity, clipping has evolved to reduce operative burden. Yet, improvements have largely focused on surgical techniques, with little emphasis on perioperative care. Enha...
OBJECTIVE: As endovascular coiling has grown in popularity, clipping has evolved to reduce operative burden. Yet, improvements have largely focused on surgical techniques, with little emphasis on perioperative care. Enhanced Recovery After Surgery (ERAS) programs have improved outcomes across various surgical fields but remain inconsistently applied in neurosurgery. Given the lack of standardized, pathology-specific ERAS frameworks, this study evaluated whether implementing an ERAS protocol for elective aneurysm clipping could enhance recovery by improving pain control, reducing postoperative nausea and vomiting (PONV), and promoting overall recovery quality. METHODS: This single-center, prospective, open-label study included adults undergoing elective clipping for unruptured intracranial aneurysms at Severance Hospital, Seoul. Consecutive patients were assigned to pre-ERAS (January 2023-February 2024) or ERAS (February-December 2024) cohorts. The ERAS protocol incorporated preoperative education, optimized fasting, local anesthesia, antiemetics, and early ambulation with nonopioid analgesia. Pain score, PONV incidence, and recovery quality survey (Quality of Recovery-40 [QoR-40]) results were compared between the groups using the Mann-Whitney U-test, Fisher's exact test, and multivariate regression to adjust confounders. RESULTS: A total of 414 elective aneurysm-clipping procedures were analyzed (234 pre-ERAS, 180 ERAS). Baseline demographics and aneurysm characteristics were comparable between the groups. Postoperative pain scores were significantly lower in the ERAS group across postoperative days (PODs) 0-3 (all p < 0.001), and ERAS implementation was the only independent protective factor for pain. Opioid use decreased markedly, with earlier transition to oral nonopioid analgesics. The incidence of PONV was significantly lower from PODs 1 to 3, and ERAS remained an independent protective factor after multivariate adjustment. QoR-40 scores on POD 2 were higher in the ERAS group, indicating improved comfort and well-being, while hospital stay and complication rates were comparable. CONCLUSIONS: The ERAS protocol improved pain control, reduced PONV, and enhanced recovery in patients undergoing aneurysm clipping. These findings support the feasibility of ERAS in craniotomy surgery and highlight the potential for further optimization to improve outcomes.
Evaluating rapid spine MRI in pediatric imaging: utility, outcomes, and patient selection.
Malueg MD, Tevendale M, Stockman IG … +9 more , Shah S, Riea S, Hobika LJ, Boojraj GR, Maranto SD, Soliman MAR, Khan A, Li V, Reynolds RM
J Neurosurg Pediatr · 2026 Jun · PMID 42247708 · Publisher ↗
OBJECTIVE: Rapid spine MRI offers a sedation-free alternative for pediatric imaging, minimizing the risks associated with sedation for diagnostic imaging of suspected spinal anomalies. This study was designed to evaluate...
OBJECTIVE: Rapid spine MRI offers a sedation-free alternative for pediatric imaging, minimizing the risks associated with sedation for diagnostic imaging of suspected spinal anomalies. This study was designed to evaluate the clinical utility of this modality through analysis of imaging outcomes and patient selection to inform its integration into pediatric imaging protocols. METHODS: In this retrospective study, the authors reviewed chart data from pediatric patients diagnosed with congenital malformations of the spine, spinal cord, or both between January 1, 2014, and October 25, 2024, who were under 18 years of age and had undergone at least one rapid or one regular MRI evaluation. Variables included were demographic characteristics, conversion from rapid MRI to regular MRI, need for further imaging, and clinical outcomes. Analyses included the t-test, chi-square test, and logistic regression with variance inflation factor adjustment to identify predictors of outcomes. RESULTS: Among 788 patients, 151 underwent initial rapid MRI and 637 underwent initial regular MRI. Patients who received rapid MRI were younger (43.7 ± 67.9 months vs 56.5 ± 97.7 months, p = 0.001) and had longer hospital stays after surgery (9.02 ± 23.73 days vs 3.56 ± 8.62 days, p = 0.002). On multivariate regression analysis, significant positive predictors of conversion to regular MRI or need for further imaging included lower body mass index (BMI) (β = -0.255, p = 0.002), developmental delays (β = 1.772, p < 0.001), and leg weakness (β = 1.789, p = 0.036). Rapid MRI patients required more further imaging (β = 1.680, p < 0.001) but fewer surgical interventions (β = -1.393, p < 0.001). There was no significant difference between rates of conversion to rapid MRI or return to regular MRI. CONCLUSIONS: Rapid MRI is a valuable alternative to conventional MRI in pediatric neurosurgery, particularly for patients in whom sedation poses an elevated risk. In this cohort, lower BMI, leg weakness, and developmental delays were predictors of the need for further imaging. These findings support the targeted use of rapid MRI in select pediatric populations for whom further imaging would not be necessary in order to reduce sedation exposure during first-line imaging.
Spinal intradural epidermoid cysts in pediatric patients: illustrative cases and systematic review.
Ibrahim S, Balasubramanian K, Gulsuna B … +2 more , Jea A, Sader N
J Neurosurg Pediatr · 2026 Jun · PMID 42247707 · Publisher ↗
OBJECTIVE: Spinal intradural epidermoid cysts (sIECs) are rare, benign neoplasms comprising < 3% of intraspinal tumors in children. Their nonspecific clinical presentation and rarity often lead to diagnostic delays, part...
OBJECTIVE: Spinal intradural epidermoid cysts (sIECs) are rare, benign neoplasms comprising < 3% of intraspinal tumors in children. Their nonspecific clinical presentation and rarity often lead to diagnostic delays, particularly in the pediatric population. Authors of this study present 2 pediatric sIEC cases and conduct a systematic review of the literature to characterize the clinical features, management strategies, and outcomes of pediatric sIEC. METHODS: A systematic review was conducted according to PRISMA guidelines, searching the PubMed, Embase, Web of Science, and Cochrane databases from inception to December 2024 for English-language case reports and case series describing pediatric sIEC with clinical, radiological, and follow-up data. Two illustrative pediatric cases managed at the authors' institution are also described. RESULTS: Thirty-eight studies comprising 48 pediatric patients were included in the analysis, as were 2 cases from the authors' institution, yielding a pooled cohort of 50 pediatric patients. The median age at presentation was 7.5 years (IQR 9.75 years), with males representing 49% of the patients. Muscle weakness (78%), sensory deficits (38%), bowel or bladder dysfunction (38%), gait disturbance (34%), and back pain (30%) were common symptoms. Spinal dysraphism (48%) and infection (20%) were frequently associated with sIECs. Tumors most often involved the thoracic (30%) and lumbar (30%) spine, with 72% of cases spanning multiple levels. Gross-total resection (GTR) was achieved in 71% (34/48) of cases, and GTR significantly reduced recurrence (3% vs 29% for non-GTR, p = 0.03, OR 0.09, 95% CI 0.01-0.86). At the last follow-up (median 8 months), 64% (28/44) of patients were symptom free and 30% (13/44) experienced symptom improvement. The tumor recurred in 12% (6/50) of cases, and overall survival was 98% (49/50 patients). GTR with complete symptom resolution was achieved in both illustrative cases. CONCLUSIONS: In this first systematic review addressing sIEC in children, patients typically presented with progressive neurological deficits and the cyst was frequently associated with congenital spinal anomalies. Diffusion-weighted imaging was essential for diagnosis and surgical planning. GTR was associated with significantly lower recurrence rates and favorable neurological outcomes.
Editorial. Advances in diffusion tensor imaging and its clinical implications for patients with spina bifida.
Groves ML, Strahle JM
J Neurosurg Pediatr · 2026 Jun · PMID 42247706 · Publisher ↗
Abstract loading — click title to view on PubMed.
Applying Lean principles to pediatric neurosurgery: quantifying residents' perception of complexity of common procedures and concomitant effect on operating room efficiency.
O'Neill BE, Elsawaf Y, Godil J … +5 more , Bowden SG, McIntyre MK, Liu JJ, Sayama CM, Selden NR
J Neurosurg Pediatr · 2026 Jun · PMID 42247705 · Publisher ↗
OBJECTIVE: Enhancing operating room efficiency while preserving resident surgical education remains a priority for teaching hospitals. Applying Lean principles to pair residents' step-level risk and comfort perceptions w...
OBJECTIVE: Enhancing operating room efficiency while preserving resident surgical education remains a priority for teaching hospitals. Applying Lean principles to pair residents' step-level risk and comfort perceptions with step-level time may reveal training targets that reduce operative duration and improve safety. This study quantified the relationship between residents' step-level perceived risk or comfort and operative time during filum terminale lysis (FTL) and primary vagus nerve stimulator (VNS) placement. METHODS: Attending pediatric neurosurgeons defined 11 FTL and 10 VNS placement steps. A 2-part survey captured step-specific comfort and perceived risk from junior residents, senior residents, and faculty members (for VNS placement, 11 junior residents, 10 senior residents, and 3 faculty members were surveyed; for FTL, 11 junior residents, 9 senior residents, and 4 faculty members). Responses were mapped to a risk matrix with a "danger zone" (high-risk score of 3-5 and low-comfort score of 1-3) and a "safe zone" (low-risk score of 1-2 and high-comfort score of 4-5). Step-level times were prospectively recorded across FTL (n = 16) and VNS (n = 24) cases. Analyses included the Fisher's exact test, Spearman correlations, and linear-by-linear tests for training-level trends. RESULTS: Risk-matrix analysis showed significant junior resident-faculty member differences for both procedures, with no senior resident-faculty member differences. In FTL, significant junior resident-faculty member differences were observed for dural closure (p = 0.004). In VNS placement, junior residents more often labeled carotid sheath exposure, vagus nerve exposure, and lead placement as the danger zone (all p = 0.0027). Excluding closure, VNS placement demonstrated positive associations between perceived danger and both step time and share of cases (for junior residents, ρ = 0.73, p = 0.025; senior residents, ρ = 0.75, p = 0.020; faculty members, ρ = 0.58, p = 0.10). In FTL, no association was observed. Training-level trends showed increasing high comfort (≥ 4) with seniority across most steps (10/11 steps for FTL; 7/10 steps for VNS placement). Step timing highlighted skin closure for VNS placement (median [IQR] 1769 [1447-2304] seconds) and dorsal bony exposure (700 [427-1037] seconds), dural closure (932 [336-1387] seconds), and fascial closure (695 [563-828] seconds) for FTL as the most time-consuming phases. CONCLUSIONS: Combining step-level risk-comfort matrices with timing can yield procedure-specific teaching targets. In FTL, danger perception aligns with time burden, supporting focused coaching on dural closure and exposure; in VNS placement, the main time-intensive step is low-risk closure, which may yield areas for improvement via workflow and team-based interventions, while danger-labeled exposure/lead steps merit targeted supervision for safety. This Lean principle-based framework enables training level-specific interventions to improve both efficiency and safety.
Anatomy of the bony canal containing the middle meningeal artery for a vessel-sparing craniotomy in moyamoya disease.
Mertens R, Vajkoczy P, Iqbal MA … +9 more , Stahnke M, Spindler P, Hofmann VM, Pudszuhn A, Grosser S, Wessels L, Hecht N, Höltje M, Kuroda S
J Neurosurg · 2026 Jun · PMID 42247704 · Publisher ↗
OBJECTIVE: The middle meningeal artery (MMA) often traverses a bony canal, rendering it vulnerable during craniotomy. In moyamoya disease (MMD), it serves as a collateral pathway for cerebral perfusion, making vessel pre...
OBJECTIVE: The middle meningeal artery (MMA) often traverses a bony canal, rendering it vulnerable during craniotomy. In moyamoya disease (MMD), it serves as a collateral pathway for cerebral perfusion, making vessel preservation essential during bypass surgery. This study examined the anatomy of MMA bony canals in dry skulls and compared findings in patients with MMD and atherosclerotic cerebrovascular disease (ACVD). METHODS: A total of 175 adult and pediatric dry skulls and cranial CT scans of MMD (n = 100) and ACVD (n = 100) patients were analyzed retrospectively. The relationship of bony canals to the convergence of the coronal, sphenofrontal, and sphenoparietal sutures, serving as an anatomical landmark, was assessed. RESULTS: Bony canals containing the frontal MMA branch were present in 91.2% of adult skulls (≥ 18 years). Before fontanelle closure (< 2 years), the incidence was 1.8%, increasing to 47.7% in skulls ≥ 2 years (p < 0.0001). The mean canal length was 12.0 ± 5.9 mm in adult skulls, 10.1 ± 4.5 mm in skulls ≥ 2 years, and 7.5 ± 3.5 mm in skulls < 2 years (p = 0.212). In adult skulls, the mean distances of the canal entry and exit points posterior to the landmark were 11.6 ± 4.8 mm and 13.8 ± 6.4 mm, respectively. Parietal branch canals were rare (≤ 12.9%) and typically located below the squamous suture. Clinically, MMD patients were younger than ACVD patients (41.6 ± 12.2 vs 55.0 ± 11.6 years, p < 0.0001) and had a similar prevalence of frontal branch canals (80.0% vs 84.0%, p = 0.36). Bony canals were longer (15.9 ± 9.7 mm vs 13.3 ± 6.2 mm, p = 0.02) and wider (1.6 ± 0.4 mm vs 1.3 ± 0.5 mm, p < 0.0001) in MMD patients. CONCLUSIONS: After fontanelle closure, the likelihood of the MMA traversing a bony canal located within one thumb's width posterior to the pterion increases with age. Comprehensive knowledge of MMA anatomy is crucial for its preservation during bypass surgery.
Systematic review of diffusion tensor imaging in spina bifida myelomeningocele: clinical implications in the era of prenatal repair.
Gandy K, Castillo H, Corroenne R … +6 more , Whitehead WE, Klugh A, Belfort M, Sanz Cortes M, Huisman TAGM, Castillo J
J Neurosurg Pediatr · 2026 Jun · PMID 42247703 · Publisher ↗
OBJECTIVE: Spina bifida myelomeningocele (SBM) is a neural tube defect associated with altered brain development and impaired cognitive function. Structural brain abnormalities in SBM are well documented but less is know...
OBJECTIVE: Spina bifida myelomeningocele (SBM) is a neural tube defect associated with altered brain development and impaired cognitive function. Structural brain abnormalities in SBM are well documented but less is known about potential white matter abnormalities. Diffusion tensor imaging (DTI) is a unique MRI technique able to evaluate the integrity of brain microstructure. The primary objectives of this systematic review were to describe the utility of MRI/DTI and discuss the neuroanatomical and neuropsychological effects of affected tracts, as well as the potential clinical implications in SBM care. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that the studies 1) included patients with SBM who had undergone pre- or postnatal repair, and 2) reported DTI metrics for the brain in postnatal imaging studies. RESULTS: Nineteen articles met the designated eligibility criteria. Abnormal microstructural anomalies were detected in the corpus callosum (n = 8), limbic fiber tracts (n = 4), tectocortical pathways (n = 4), and caudate putamen tract (n = 3). Disruptions were also noted in the middle cerebellar peduncle (n = 2), interhemispheric temporal tracts (n = 2), internal capsule (n = 2), inferior longitudinal fasciculus (n = 2), arcuate fasciculus (n = 1), inferior fronto-occipital fasciculus (n = 1), uncinate fasciculus (n = 1), and thalamotemporal tract (n = 1). CONCLUSIONS: SBM is associated with white matter brain abnormalities that have the potential to impact cognitive functioning (e.g., self-management skills) and related clinician recommendations. The detection of white matter microstructural injury in SBM may be useful to improve point-of-care recommendations and family education. Systematic review registration no.: CRD420251252084 (PROSPERO).
Harry J. Buncke to M. Gazi Yaşargil: a historical lesson in cross-specialty microsurgical innovation.
Harris JC, Gandhi OH, Almasri S … +6 more , Edavettal M, Glauser G, Feroze AH, Kovach SJ, Zager EL, Choudhri O
J Neurosurg · 2026 Jun · PMID 42247702 · Publisher ↗
This historical review examines Dr. Harry J. Buncke's development of microsurgical instrumentation and anastomotic techniques for submillimeter vessels, discusses the 1966 Vermont Microvascular Surgery Conference where t...
This historical review examines Dr. Harry J. Buncke's development of microsurgical instrumentation and anastomotic techniques for submillimeter vessels, discusses the 1966 Vermont Microvascular Surgery Conference where technical knowledge was exchanged between plastic surgeons and neurosurgeons, and highlights how Buncke's methods directly informed Dr. M. Gazi Yaşargil's cerebral revascularization procedures. Buncke's innovations in microsuture technology, jeweler's tool adaptation, vasospasm control protocols, and vessel repair techniques for arteries < 1 mm in diameter, demonstrated through successful rabbit ear replantation in 1964, provided the technical foundation for intracranial vessel anastomosis. The 1966 conference facilitated direct transmission of these peripheral vessel techniques to neurosurgical applications, with Yaşargil performing the first superficial temporal artery-to-middle cerebral artery bypass in 1967 using instruments and methods derived from Buncke's work. This cross-specialty collaboration established the laboratory training paradigm, atraumatic handling principles, and anastomotic protocols that remain fundamental to contemporary microneurosurgical practice, including current surgical management of moyamoya disease and complex cerebrovascular pathology.
Pseudarthrosis in modern instrumented pediatric cervical spine fusion.
Hartman E, Verhofste B, Staffa S … +2 more , Proctor MR, Hedequist D
J Neurosurg Pediatr · 2026 Jun · PMID 42247701 · Publisher ↗
OBJECTIVE: Instrumented fusion for management of pediatric cervical spine conditions has significant morbidity risk due to rare underlying pathologies, small anatomical dimensions, limited bony surface area, poor bone qu...
OBJECTIVE: Instrumented fusion for management of pediatric cervical spine conditions has significant morbidity risk due to rare underlying pathologies, small anatomical dimensions, limited bony surface area, poor bone quality, and potential effects on future growth. Pediatric cervical spine fusions are often subject to pseudarthrosis, reportedly as high as 38%. The aim of this study was to evaluate a single institution's clinical experience with modern instrumented cervical spine fusion in pediatric patients to identify risk factors and management techniques for pseudarthrosis. METHODS: Medical records were retrospectively reviewed for pediatric patients (age ≤ 21 years) who underwent instrumented cervical spinal fusion using current fixation techniques at a single institution between 2005 and 2023. Demographic and diagnosis characteristics, surgical details, and follow-up clinical and imaging findings were collected. RESULTS: Overall, 150 patients (82 male, mean age at surgery 11.7 ± 5.0 years) were included. Underlying diagnoses included 51 patients with congenital deformity, 35 with instability, 24 with traumatic injury, 22 with tumor, and 18 with os odontoideum. The mean duration of follow-up was 5.9 ± 3.7 years. Twelve patients (8%) experienced nonunion, defined by a lack of osseous bridging (n = 6), screw lucency (n = 5), or both (n = 1) on CT or radiography. Eight patients in the nonunion group had an underlying syndromic diagnosis (p = 0.03), including 6 of 12 patients (50%) with Down syndrome (p < 0.005). The median time from index surgery to pseudarthrosis diagnosis was 11 months (range 3 months-3.07 years). Eleven secondary procedures were performed to address pseudarthrosis, with instrumentation revision in 10, autograft used in 6, and recombinant bone morphogenetic protein used in 7. A postoperative halo was used in 36% of revisions. One patient who underwent a secondary procedure for pseudarthrosis required a subsequent revision. CONCLUSIONS: Pediatric cervical spinal fusions had a pseudarthrosis rate of 8%. Syndromic patients, specifically patients with Down syndrome, have higher risk of nonunion and thus require counseling in this regard, as well as closer follow-up. However, syndromic patients with Ehler-Danlos and neurofibromatosis were not at increased risk of nonunion. The pathology and etiology of instability was not a significant contributor to pseudarthrosis. In most cases of nonunion, a single revision surgery was sufficient treatment.
Endoscopic endonasal and transcranial approaches to sellar/suprasellar arachnoid cysts: indications and outcomes.
Abou-Al-Shaar H, Albalkhi I, Garcia JH … +6 more , Peto I, Choby G, Wang EW, Snyderman CH, Gardner PA, Zenonos GA
J Neurosurg · 2026 Jun · PMID 42247700 · Publisher ↗
OBJECTIVE: Distinguishing between sellar/suprasellar arachnoid cysts (ACs) and Rathke cleft cysts (RCCs) can be challenging due to their similar clinical presentations and imaging characteristics. Endoscopic endonasal ap...
OBJECTIVE: Distinguishing between sellar/suprasellar arachnoid cysts (ACs) and Rathke cleft cysts (RCCs) can be challenging due to their similar clinical presentations and imaging characteristics. Endoscopic endonasal approaches (EEAs) are typically used to marsupialize RCCs, while ACs require fenestration to the suprasellar cisterns, often via a transcranial approach (TCA). This study aimed to identify indications and outcomes of EEA versus TCA for sellar/suprasellar AC management. METHODS: The authors performed a retrospective analysis focusing on patients with sellar/suprasellar ACs who underwent surgical intervention, focusing on indications, clinical outcomes, and complications. RESULTS: A total of 17 patients with a median age of 58 years underwent surgical treatment of sellar (n = 6) or sellar with suprasellar extension (n = 11) ACs. Most patients presented with visual deficits (88%) and headaches (65%). EEA was performed in 11 cases, while TCA was used in 6 cases. The most common indications for EEA were an initial impression of RCC (n = 9), or cystic pituitary adenoma (n = 2), as well as a primarily sellar location/perceived narrow transcranial window (n = 6). During a median follow-up of 39 months, vision improved or remained stable in all patients who underwent either TCA or EEA. Complications in the EEA group included CSF leakage in 6 patients (with sellar-type AC) and transient diabetes insipidus in 1 patient. The TCA group reported no postoperative complications, but did have 1 recurrence, which was managed by an EEA. CONCLUSIONS: Both EEA and TCA provide long-term control and favorable clinical and visual outcomes in the management of sellar/suprasellar ACs. TCA remains the primary strategy for ACs with suprasellar extension, when feasible, due to the high CSF leak rates associated with EEA. EEA was able to successfully manage both purely sellar cases and those with suprasellar extension, while TCA cases all had suprasellar extension. All CSF leaks in this series occurred in purely intrasellar AC cases. EEA offers a viable option, particularly for purely sellar cases, unclear diagnosis, narrow transcranial window for safe fenestration, or in recurrent lesions following TCA.
Repeat radiofrequency thermocoagulation for multiple sclerosis-associated versus idiopathic trigeminal neuralgia: a comparison of long-term pain control.
Greve T, Kuklinski M, Ringel F … +2 more , Muacevic A, Mehrkens JH
J Neurosurg · 2026 Jun · PMID 42247695 · Publisher ↗
OBJECTIVE: Radiofrequency thermocoagulation (RFT) of the gasserian ganglion provides rapid pain relief in trigeminal neuralgia (TN) and is minimally invasive. In multiple sclerosis (MS)-associated TN (MS-TN), recurrence...
OBJECTIVE: Radiofrequency thermocoagulation (RFT) of the gasserian ganglion provides rapid pain relief in trigeminal neuralgia (TN) and is minimally invasive. In multiple sclerosis (MS)-associated TN (MS-TN), recurrence may be more frequent than in idiopathic/classic TN (Id-TN), possibly due to demyelinating pathology. This study compared RFT outcomes between these etiologies. METHODS: The authors conducted a STROBE-compliant, single-center retrospective cohort study that screened 636 patients with TN treated between March 2012 and September 2021. Structured telephone interviews were completed in 350 patients, including the 5-level EQ-5D (EQ-5D-5L) for health-related quality of life (HRQOL). Of these patients, 182 received RFT as their first invasive treatment. The primary endpoint was the pain-free interval (PFI), defined as the time to recurrence (Barrow Neurological Institute Pain Intensity Scale score ≥ II or medication restart), analyzed using Kaplan-Meier curves and Cox proportional hazards regression models. Secondary outcomes included repeat interventions, permanent sensory deficits, and HRQOL. RESULTS: Of 182 eligible participants, 77 had MS-TN and 105 had Id-TN. Patients with MS-TN were younger (mean age 55.8 [SD 10.6] vs 70.5 [SD 8.6] years, p < 0.001). The median PFI was 33.9 (95% CI 15.5-52.3) months for MS-TN versus 87.0 (95% CI 43.1-130.9) months for Id-TN (p = 0.0493, log-rank test). The mean overall follow-up duration was 68.4 months. Despite earlier recurrence, repeat interventions achieved comparable adequate pain control at the last follow-up (68.8% in MS-TN vs 77.1% in Id-TN, p = 0.139). EQ-5D-5L scores improved significantly and converged at follow-up (p = 0.085). CONCLUSIONS: After the first RFT, pain control was shorter in MS-TN than in Id-TN. However, retreatment effectively restored long-term pain control and HRQOL, supporting the role of RFT in managing MS-TN. Regular follow-up is recommended to facilitate timely intervention.
Combined accelerometry and writing analysis for quantifying tremor during focused ultrasound thalamotomy.
Toader AE, Useinovic N, Shafie B … +7 more , Henn MC, Joyce M, Smith HD, Neilson LE, Safarpour D, Raslan AM, Cleary DR
J Neurosurg · 2026 Jun · PMID 42247693 · Publisher ↗
OBJECTIVE: MRI-guided focused ultrasound (MRgFUS) thalamotomy is used to treat tremors. Identifying the correct area to ablate relies on subjective physician assessment of tremor improvement during treatment. To address...
OBJECTIVE: MRI-guided focused ultrasound (MRgFUS) thalamotomy is used to treat tremors. Identifying the correct area to ablate relies on subjective physician assessment of tremor improvement during treatment. To address this limitation, objective quantification of tremor severity during MRgFUS is needed. The aim of this study was to develop and evaluate an objective method for quantifying tremor progression during MRgFUS using an MRI-compatible accelerometer and tablet. METHODS: Forty patients (30 male, mean age 74.5 years) who underwent MRgFUS thalamotomy to treat tremor were included in this analysis. All patients were evaluated during the procedure using analysis of drawn Archimedean spirals and a pen-mounted accelerometer. The severity of the tremor was determined by analysis of the rhythmic oscillatory patterns present in the drawings and accelerometer recordings after each sonication delivered. The patient's drawings were evaluated by two movement disorder neurologists using the drawing subsection of The Essential Tremor Rating Assessment Scale (TETRAS), and subsequently compared with the TETRAS score. RESULTS: Using these methods, the mean ± standard error of the improvements in tremor after MRgFUS thalamotomy was 63.6% ± 7% by accelerometer analysis, 72.4% ± 9.9% by written spiral analysis, 68% ± 6.7% by combining the accelerometer and written spiral analyses, and 33.6% ± 3.1% by TETRAS analysis. When stratifying based on temperature, improvement was 22.8% ± 4.4% at < 50°C, 48.9% ± 5.5% at 50°C-53°C, and 70.8% ± 2.9% at > 53°C. CONCLUSIONS: The measurements from the accelerometer and written spiral analysis were comparable with expert analysis of TETRAS scores, but the accelerometer had greater sensitivity for subtle improvement in tremor. This system of analysis provides an objective and instantaneous measure of tremor improvement during MRgFUS, potentially making the procedure safer and more efficient.
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