Same-day discharge (SDD) after neurosurgical procedures in children remains underexplored. To our knowledge, this represents one of the first modern North American single-institution series to include SDD after major pediatric spinal instrumentation and procedures performed on children of elevated anesthetic risk. A retrospective review of all neurosurgical procedures performed at an academic, tertiary referral center was conducted. Patients were identified as those who underwent surgery and were discharged on the same calendar day (length of stay [LOS] = 0 days). Patient demographics, procedural details, operative times, ASA classification, intraoperative complications, postoperative outcomes, and symptom status at follow-up were recorded. Of 976 neurosurgical encounters, 87 (8.9
In recent years, artificial intelligence-based language models have emerged as a means of rapid access to health-related information. This study aimed to evaluate the quality, reliability, understandability, and readability of ChatGPT’s responses to frequently asked questions by families of children with cerebral palsy (CP). Responses generated by the free version of ChatGPT to the ten most frequently asked questions posed by families of children with CP were obtained. These responses were evaluated across four dimensions: quality, reliability, understandability, and readability. Content quality was evaluated using the DISCERN instrument. Reliability was assessed by 20 physiotherapists holding MSc or PhD degrees using a 5-point Likert scale. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), while readability was analyzed using the Flesch–Kincaid Grade Level (FKGL). The median DISCERN score was 45, reflecting average content quality. The median Likert scale score across all questions was 4 out of 5, indicating reliable responses. No significant differences were observed between PhD and MSc expert raters in their Likert scale ratings. The median PEMAT-P was 69.23; however, only 40
To evaluate indications, safety, and early outcomes of MRI-guided laser interstitial thermal therapy (LITT) in a nationwide prospective pediatric cohort and to assess the feasibility of same-session stereotactic biopsy. All consecutive pediatric patients (≤ 18 years) who underwent LITT at the Danish National Referral Center between June 2021 and October 2025 were prospectively enrolled. Demographic, clinical, radiological, and surgical variables were recorded. Safety outcomes included complications, neurological deficits, length of stay, and 30-day readmission. Seizure outcomes were assessed by Engel classification and tumor response on follow-up MRI. A total of 27 children (mean age 11.6 ± 4.3 years) underwent LITT, including 18 treated for drug-resistant epilepsy and 9 for tumor indications. Same-session stereotactic biopsy was performed in 10 patients without biopsy-related complications or interference with ablation. Transient neurological deficits were observed in 5 patients and persistent deficits in 3. Hospital stay was 1–2 days in 23 patients, and no 30-day readmissions occurred. Seizure freedom (Engel class I) was achieved in 67
Routine preoperative blood testing in healthy children is common, but evidence suggests it has minimal impact on perioperative management. This retrospective study evaluated testing practices, testing duplications, costs and clinical utility in elective paediatric neurosurgery procedures in a paediatric tertiary centre. All elective paediatric neurosurgical procedures in children from January 2022 to June 2025 were reviewed. Data collected included demographics, procedure type and prior and preoperative blood testing within 30 days of the operation, test results, sample quality, clinical impact and direct costs. Descriptive statistics were performed. 226 procedures for a total of 198 patients were analysed. The mean age was 10.5 and the majority of patients were male (58
Dexmedetomidine (DEX) is increasingly utilized in pediatric anesthesia; however, its impact on the bulbocavernosus reflex (BCR) remains unclear. The objective of this study was to elucidate the suppressive effects of DEX on the BCR and to establish a safe therapeutic window for its administration during pediatric spinal untethering surgery. A retrospective two-stage investigation was conducted, enrolling 66 children. Cohort 1 (exploratory, n = 46) aimed to identify independent risk factors for BCR attenuation under standard anesthesia where DEX was initiated before dural opening. Multivariate analysis was performed to distinguish DEX effects from other variables. Cohort 2 (pharmacodynamic, n = 20) was designed to validate findings and define the safety threshold; DEX was administered after dural closure to isolate pharmacological effects from surgical manipulation. We analyzed the correlation between predicted plasma DEX concentrations (Potts model) and BCR amplitude using logistic regression. Cohort 1 identified DEX administration as the sole independent risk factor associated with BCR amplitude decline (p = 0.01), whereas others showed no significant impact. Cohort 2 confirmed a specific concentration-dependent suppression. A statistically significant amplitude reduction was observed starting 12 min after initiation. Logistic regression identified a critical inflection point at 0.67 ng/mL in predicted plasma concentration, around which BCR reliability was significantly compromised (p = 0.005). DEX suppresses BCR monitoring in a concentration-dependent manner during pediatric spinal untethering surgery. A predicted plasma concentration of approximately 0.67 ng/mL may represent a critical threshold for reliable BCR monitoring, although prospective validation using direct blood sampling is required.
Congenital dermal sinus tract (DST), a rare spinal dysraphism, typically presents as a solitary midline lesion. Lateral and multiple DSTs are extremely rare, and their embryological basis remains unclear. Here, we report a case of triple DSTs and review the literature on lateral and multiple DSTs to better characterize their clinical and anatomical features. A unique case of a 1-month-old infant with triple DSTs (left and right laterals and a midline) at the sacrococcygeal level with intradural convergence, complicated by meningitis and an associated dermoid cyst, is reported. A literature review of lateral and multiple DST case reports was performed in PubMed. Three independent DSTs converged into the dural sac, all requiring surgical excision. Complete resection was achieved without neurological complications. At the latest follow-up, neurological function was preserved, with no signs of recurrent infection or lesion recurrence. The literature review revealed that lateral DSTs are rare and multiple DSTs are exceptionally uncommon. Very few reports described bilateral or intradural convergence patterns; none reported this specific triple-tract configuration. DSTs may present as multiple and non-midline lesions. Bilateral and midline DST coexistence with intradural continuity cannot be fully explained by the conventional focal nondisjunction theory. It is necessary to consider not only “simple localized failure of separation during the primary neural tube formation stage”—the conventional model—but also caudal developmental process abnormalities, including the secondary neural tube formation stage. Awareness of non-midline and multiple DSTs is essential for early diagnosis, comprehensive imaging, and complete surgical treatment.
Abusive head trauma (AHT) is a leading cause of severe brain injury, mortality and long-term neurological disability in infants. Data on clinical indicators for neurosurgical intervention and long-term neurological outcome remain limited. This study aimed to describe clinical characteristics, indicators for neurosurgical management, and long-term outcomes of pediatric AHT. We conducted a retrospective single-center cohort study including all children younger than two years with suspected or confirmed AHT between 1993 and 2024. Clinical, radiological, treatment, and outcome data were extracted from medical records. Neurological outcome was assessed using the Pediatric Cerebral Performance Category (PCPC) score at discharge and last follow-up. A total of 101 children presenting at University Hospitals of Leuven were included. Neurosurgical intervention was required in 72
Symptomatic ectopic salivary tissue in the sellar region is extremely rare. A few cases were reported in the literature. Its radiological features overlap with those of other sellar lesions, making a definitive preoperative diagnosis difficult. This case report presents the youngest treated symptomatic patient who was diagnosed with ectopic salivary tissue in the sellar region. A 6-year-old symptomatic girl presented with chronic headache, polyuria, polydipsia, and short stature. The hormonal assay revealed hypopituitarism with low growth hormone. Magnetic resonance imaging (MRI) of the brain demonstrated a cystic sellar lesion with an enhanced intracystic nodule. The cyst was drained, and the nodule was grossly resected via an endoscopic endonasal transsphenoidal approach. Histopathological examination confirmed a salivary gland choristoma. Postoperatively, she was started on hormone replacement therapy. Follow-up brain imaging showed no evidence of residual lesion. Sellar salivary choristoma is extremely rare in pediatric population. Histopathology examination is crucial for diagnosis. Surgical treatment of a symptomatic case has a favorable prognosis.
Vagal nerve stimulation (VNS) is an established adjunctive treatment for children with medically intractable epilepsy. It is common practice to admit these children overnight for observation due to concern of airway compromise and other medical complications. We wanted to determine the safety of vagal nerve stimulator insertion in the immediate peri-operative period to determine if same-day discharge is feasible and safe in children. We conducted a retrospective review of all paediatric patients (age less than 19 years of age) who underwent vagal nerve stimulator (VNS) implantation at our institution between January 2002 and December 2022. In total, 197 patients were included in the analysis. Mean age at surgery was 11.1 years (SD 4.1). Median length of stay was 1 day (IQR 1–1); 21 children (10.7
Bulbocavernosus reflex (BCR) monitoring assesses sacral S2 to S4 pathway integrity during pediatric spinal surgery; however, its intraoperative utility is limited when responses are absent or unilateral. We prospectively evaluated a sequential intraoperative protocol designed to improve the interpretation of these patterns and reduce uncertainty during sacral monitoring. We prospectively studied 242 consecutive pediatric patients aged 0.4–12 years who underwent spinal surgery between 2023 and 2025. Bilateral external anal sphincter (EAS) recordings were obtained using subdermal-needle electrodes. Intramuscular placement was verified using tetanic stimulation. BCR responses were elicited using single-train stimulation (STS), followed by double-train stimulation (DTS). A persistent absence with failed EAS verification was classified as a pattern consistent with efferent nonacquisition, whereas a persistent absence despite preserved verification was classified as a pattern consistent with afferent nonacquisition. Final BCR acquisition was achieved in 225 of 242 patients (93.0
External ventricular drain (EVD) insertion, a standard procedure for treating acute hydrocephalus, is also associated with significant risks. This retrospective study compares two surgical techniques routinely employed at our clinic and analyzes the influence of surgeon experience and the operative setting on complication rates in a pediatric population. The study population was divided into two cohorts based on the surgical procedures used to access the ventricular system: the BoltKit system (BS) or drain tunnelling (DT). Statistical analysis balanced age, sex, site and side of the drainage, neurosurgical experience, i.e. junior surgeons (JS) or senior surgeons (SS), and operating settings, i.e. intensive care unit (ICU) or operating room (OP), with complications such as cerebrospinal fluid infection, multiple insertion attempts (MIA), malpositioning, revision, and bleeding. This retrospective study included 101 patients (62 males, 39 females, mean age 7.1 years): 79 were treated with DT, and 22 with BS. Overall, 81 EVDs were placed frontal, 18 occipital, 68 at the right and 25 at the left side; 22 revisions (22
To compare the procedural efficiency of bedside versus operating-room external ventricular drainage (EVD) insertion in a neonatal intensive care unit (NICU) and to describe culture-positive EVD-associated infections. We performed a retrospective single-center cohort study of NICU infants who underwent EVD insertion between 2011 and 2025. Operative time and insertion characteristics were analyzed at the insertion level. Culture-positive EVD-associated infections acquired at the study hospital were described, and annual infection incidence was explored in relation to unit methicillin-resistant Staphylococcus aureus (MRSA) acquisition rates. Sixty-six infants underwent 161 EVD insertions (115 bedside, 28 operating room, 18 outside hospital). Among 140 study-hospital insertions with documented operative time, bedside insertion was faster than operating-room insertion (24.5 (11.4) vs 57.4 (35.2) min; adjusted difference, 32.5 min; 95
The influence of age on radiosurgical outcomes in pediatric arteriovenous malformations (AVMs) remains unclear. This study evaluated the efficacy and safety of Gamma Knife radiosurgery (GKRS) across pediatric age subgroups. We retrospectively analyzed pediatric patients (≤ 18 years) who underwent GKRS for intracranial AVMs between 2000 and 2025. Patients were stratified into preadolescent (≤ 12 years) and older pediatric (> 12 years) groups. Clinical, radiological, and treatment-related parameters were compared. Time-to-event analyses were performed to evaluate nidus obliteration and post-GKRS hemorrhage. The study included 136 patients who underwent 194 GKRS sessions. Fifty-seven patients (41.9
Elevated intracranial pressure (ICP) in isolated single-suture craniosynostosis (SSC) may contribute to neurodevelopmental impairment, yet reported prevalence varies widely. This systematic review and meta-analysis estimate the pooled prevalence of elevated ICP in isolated SSC and evaluate potential modifiers including suture subtype, measurement timing, and assessment modality. PubMed, MEDLINE, Embase, Web of Science, and Scopus were searched (inception to February 2026). Eligible studies reported ICP outcomes in children with isolated SSC using invasive monitoring or optical coherence tomography (OCT). Pooled prevalence was estimated using random-effects meta-analysis with Freeman-Tukey transformation, stratified by measurement modality (invasive vs. OCT). Subgroup analyses evaluated suture type and measurement timing. Heterogeneity was explored through meta-regression and sensitivity analyses. Seventeen studies (720 patients; 1982–2025) met inclusion criteria. All invasive studies applied a uniform ≥ 15 mmHg threshold; OCT studies used four distinct retinal nerve fiber layer algorithms approximating this threshold. Pooled prevalence was 38
Programmable cerebrospinal fluid (CSF) shunt valves permit noninvasive adjustment of opening pressure but remain vulnerable to inadvertent setting changes when exposed to magnetic fields. This study evaluated the incidence, direction, and clinical significance of MRI-associated setting changes across six contemporary programmable valve models at both 1.5-T and 3-T field strengths. All brain MRI scans performed between October 2023 and October 2025 in patients with cranially implanted programmable valves at a single tertiary pediatric center were prospectively documented using a standardized pre- and post-MRI valve-check protocol. Valve type, magnet strength, and setting changes were recorded, and statistical analyses incorporated Fisher’s exact testing and mixed-effects logistic regression to account for repeated scans. A total of 240 MRI examinations were performed in 87 patients. Overall, 64/240 scans (26.7
Childhood medulloblastoma (MB) survivors face elevated second primary malignancy (SPM) risk because of multimodal treatment. Prior studies were limited by small samples, older data, and methods that ignored competing risks. We aimed to quantify SPM risk using contemporary SEER data and competing risk methodology. Using the SEER 17 registries database (2000–2023), we identified 1806 patients diagnosed with MB at ages 0–19 years. Standardized incidence ratios (SIRs) were calculated using the MP-SIR module. Cumulative incidence functions (CIFs) were estimated within a competing risk framework, with non-SPM death as the competing event. Fine-Gray regression was fitted to identify independent predictors of SPM, yielding subdistribution hazard ratios (sHRs). Of 1806 MB patients, 104 (5.8
Postoperative meningitis remains an important complication following pediatric posterior fossa tumor (PPFT) surgery and is associated with increased morbidity, prolonged hospitalization, and delays in adjuvant therapy. However, data regarding its incidence and perioperative risk factors in children remain limited. To determine the incidence, risk factors, microbiological profile, and cerebrospinal fluid (CSF) characteristics of postoperative meningitis in PPFTs. A retrospective analysis of 116 PPFT cases was performed. Patients with postoperative meningitis were compared with those without meningitis to identify potential risk factors. Meningitis cases were further classified into culture-positive and culture-negative groups, and CSF biochemical and cytological parameters were analyzed. Statistical analysis was performed with significance set at p < 0.05. Among 116 patients (age = 9 ± 4 years; male:female::2.2:1), postoperative meningitis occurred in 19 (16.4
The purpose of this study is to define the perioperative outcomes and long-term aesthetic outcomes of patients with unicoronal craniosynostosis (UCS) treated with fronto-orbital distraction osteogenesis (FODO) and compare them to a contemporaneous cohort treated with conventional fronto-orbital advancement and remodeling (FOAR). A retrospective review was performed for all patients treated at the Children’s Hospital of Philadelphia for non-syndromic UCS from 2009–2025. Demographic and perioperative data were collected. Preoperative and 5-year or greater postoperative frontal 2D photographs were used to assess for facial, and specifically periorbital, symmetry. Symmetry ratios were calculated to assess periorbital facial morphometry. Sixty-two patients were included in the study, 34 FODO, and 28 FOAR. FODO demonstrated significantly shorter anesthesia and surgical times, lower estimated blood loss, and shorter length of stay (all p < 0.001). The overall complication rate was similar (p = 0.175), but postoperative infection was more commonly reported in the FODO group (24 vs 1
