Endoscopic third ventriculostomy (ETV) is an established treatment for selected pediatric patients with obstructive hydrocephalus. Although the foramen of Monro constitutes the principal anatomical corridor to the third ventricle, its preoperative radiological characterization has been scarcely investigated. This study aimed to describe the radiological characteristics of the foramen of Monro in a consecutive pediatric ETV cohort treated with a small-diameter rigid neuroendoscope and to explore its relationship with ventricular morphology and clinical outcome. A retrospective observational study was performed including the complete consecutive series of 17 pediatric patients who underwent ETV at our institution between March 2022 and November 2024. All procedures were performed using the PaediScope® neuroendoscope. The radiological diameter of the right foramen of Monro was measured on axial T2-weighted MRI together with the Evans Index and third ventricular diameter. Clinical, radiological, and operative variables were retrospectively collected. Correlations between radiological parameters and clinical outcome were analyzed using non-parametric statistical methods. The mean radiological diameter of the right foramen of Monro was 2.79 ± 0.81 mm. Moderate positive correlations were observed between the foramen of Monro diameter and the preoperative Evans Index (ρ = 0.588, p = 0.013), preoperative third ventricular diameter (ρ = 0.606, p = 0.010), and postoperative third ventricular diameter (ρ = 0.568, p = 0.017). No significant association was found between the radiological diameter of the foramen of Monro and the subsequent requirement for definitive ventriculoperitoneal shunt placement or postoperative ventricular reduction. Three patients (17.6
Varicella-zoster virus (VZV) infection is typically benign in infants but may rarely cause neurological complications. The occurrence of chronic subdural haematoma following VZV infection in children has not previously been reported. We report the case of a 6-month-old male infant who developed chicken pox with fever, irritability, and generalized vesicular rash. His rash and fever settled over 2 weeks, but he had persistent irritability, decreased feeding, intermittent vomiting, regression of developmental milestones, and developed progressive weight loss (50th to 9th centile). At 7 months, due to vomiting and persisting irritability, he was evaluated and found to have bilateral subdural collections resembling those typically seen following non-accidental injury. His subdural collections increased over next 3 weeks and he developed a tense fontanelle; therefore he underwent an ultrasound-guided trans-fontanelle aspiration yielding blood-stained fluid resulting in transient improvement. Rapid re-accumulation of the subdural collections necessitated bilateral burr-hole evacuation with creation of subdural pockets. Subsequent recurrence of the subdural collections was finally managed with a right-sided subduro-peritoneal shunt. His subdural fluid tested positive for VZV IgG which was indicative of previous VZV CNS encephalitis or vasculitis. On follow-up, the child recovered fully, regaining weight and developmental milestones. Bilateral subdural haematoma following VZV infection in infancy is a rare and delayed but life-threatening complication which requires prompt recognition and intervention. It can mimic findings seen following non-accidental injury. Prolonged neurological symptoms following VZV infection should raise the possibility of intracranial complications and needs prompt investigation and management.
Pediatric central nervous system (CNS) tumors are the second most common childhood malignancies after leukemia and remain the leading cause of cancer-related mortality in children. Recent advances in molecular pathology have significantly refined their classification and prognostic stratification. To evaluate the histopathological spectrum of pediatric brain tumors at a tertiary care cancer center in North India and classify them according to the 2021 World Health Organization (WHO) Classification of Central Nervous System Tumors. A retrospective observational study was conducted using the electronic medical records of the Department of Oncopathology, from a tertiary care cancer center in North India. Pediatric CNS tumors diagnosed between January 2019 and December 2024 were included. Demographic characteristics, tumor location, histopathological diagnosis, immunohistochemical findings, and WHO grade were analyzed. A total of 92 pediatric brain/CNS tumors were diagnosed during the study period, with a male-to-female ratio of 2.5:1. Embryonal tumors constituted the largest group (38.02
Endoscopic strip craniectomy (ESC) provides a safe surgical approach for the management of metopic craniosynostosis. However, it has a higher reported blood transfusion requirement than ESC for other sutures. We sought identify factors that may be related to greater blood transfusion use. Retrospective consecutive case series. All metopic ESC cases were identified from the institutional database. Case notes reviewed following pre-drafted proforma, with regression analysis to identify risk factors for transfusion. One hundred two consecutive cases of ESC for metopic synostosis were identified. At the time of ESC, the mean age was 4.4 months (range: 2–10 months) and the mean weight was 7.0 kg (range 4.8–10.3 kg) at the time of surgical intervention. Our mean operative time was 75 min (range 33–142 min). Twenty-seven (26.5
Unilateral lambdoid craniosynostosis (ULC) is a rare cranial deformity requiring intervention to correct asymmetry of the posterior skull. Conventional open remodeling and distraction osteogenesis offer robust expansion but carry risks of higher blood loss, hardware complications, or reoperation. We report a novel, minimally invasive technique combining endoscopic lambdoid suturectomy with barrel-stave osteotomies, supplemented by a literature review. A 2-month-old healthy male presented with classic left ULC features, including occipitoparietal flattening, ipsilateral mastoid bulge, contralateral parietal bulge, and ear level asymmetry, confirmed by 3D computed tomography. Under endoscopic guidance through two small incisions, a 10-cm-long by 1.2-cm-wide lambdoid suturectomy was performed. To enhance immediate intraoperative expansion, seven 3-cm barrel-stave osteotomies were placed perpendicularly along the superior (4 cuts) and inferior (3 cuts) suture margins and gently greenstick-fractured outward. The estimated blood loss was 10 mL without perioperative complications. Postoperative cranial molding helmet therapy was initiated on day 10. At the 4-month follow-up visit, 3D surface scanning demonstrated marked improvement in head shape and symmetry. Our method, endoscopic suturectomy and barrel-stave osteotomies on a single patient with unilateral lambdoid craniosynostosis, demonstrated safe and favorable outcomes. We believe the addition of barrel-stave osteotomies to suturectomy may yield superior clinical outcomes, compared to conventional endoscopic-assisted procedures with suturectomy alone. However, it is necessary to accumulate a larger number of cases and conduct long-term follow-up studies to further validate this hypothesis.
