Introduction: This study investigates the hypothesis that anatomical localization on the cranium dictates the internal composition of pediatric inclusion cysts, statistically mapping how specific scalp positions predispose lesions to distinct contents such as fluid or hair. Methods: A retrospective study of 180 pediatric patients who underwent surgical treatment for cranial inclusion cysts was performed. Demographic data, lesion localization, imaging findings, intraoperative characteristics, and histopathological results were analyzed. Results: Median age at surgery was 13 months (range 2–217 months), with equal sex distribution. Most lesions were laterally located (69%) near fusion zones, with frontal localization predominating (77%). Periorbital lesions represented the most common subtype. Bony involvement was identified in 75% of cases; however, no lesions demonstrated intradural extension. Anterior fontanelle midline lesions demonstrated strong positive associations with fluid content (OR 24.2, p < 0.001) and occipital with hair elements (OR 18.1, p < 0.001). Conclusions: Pediatric cranial inclusion cysts demonstrate distinct anatomical and radiological patterns associated with cyst content and histopathological subtype. Midline lesions, particularly anterior fontanelle cysts, are more likely to contain fluid. Occipital cysts are more likely to contain hair elements. Despite frequent bony involvement, intradural extension was not identified in this cohort.
Introduction: Many mild traumatic brain injury (mTBI) cases may not exhibit overt clinical symptoms; however, they still carry a risk of significant intracranial injury and even mortality. While brain computed tomography (CT) is the gold standard for diagnosis, minimizing radiation exposure in children is critical. This study aimed to evaluate whether integrating the Pediatric Emergency Care Applied Research Network (PECARN) rule with serum biomarkers S100B and glial fibrillary acidic protein (GFAP) could reduce unnecessary CT scans and improve the prediction of traumatic brain injury in pediatric patients. Methods: This prospective study included 88 patients with isolated mild head trauma (presenting within 3 hours) and 88 healthy controls. Patients were evaluated using the PECARN rule, and serum S100B and GFAP levels were measured via ELISA. Receiver operating characteristic curve analysis was used to determine diagnostic performance, reporting sensitivity, specificity, positive predictive value, and negative predictive value with 95% CIs. Results: The PECARN algorithm demonstrated 100.0% sensitivity but only 17.9% specificity for predicting abnormal CT findings. The median serum S100B protein level in the patient group was 407.6 ng/L (range: 109.5–12,668.3), while the median GFAP level was 18.5 pg/mL (range: 5.2–112.0). Notably, patients with positive CT findings had significantly elevated median S100B (7,261.6 ng/L vs. 383.4 ng/L; p < 0.001) and GFAP levels (86.0 pg/mL vs. 17.5 pg/mL; p < 0.001) compared to those with negative scans. Median S100B and GFAP levels were significantly higher in the patient group (407.6 ng/L [109.5–12,668.3] and 18.5 pg/mL [5.2–112.0], respectively) compared to healthy controls (324.7 ng/L [148.5–1,733.7] and 13.0 pg/mL [4.4–32.8]) (p = 0.006 and p < 0.001, respectively). Using optimized cut-off values (2,667.14 ng/L for S100B and 61.1 pg/mL for GFAP), both biomarkers achieved high diagnostic accuracy. Conclusion: Our preliminary findings suggest that the addition of S100B and GFAP to the PECARN algorithm could refine CT decision-making in pediatric mTBI. Within the PECARN intermediate-to-high-risk subgroup, serum S100B levels below 2,667.14 ng/L and GFAP levels below 61.1 pg/mL may identify patients in whom CT could potentially be deferred. However, larger cohort studies are required to validate these high cut-off thresholds and mitigate potential overfitting.
A sinus pericranii (SP) is a rare transcranial vascular malformation caused by diploic emissary veins forming an irregular connection between a dural sinus and extracranial veins. It is generally considered a benign condition with few complications1. We report the case of a 5-year-old male patient who sustained a skull fracture from head trauma with development of an epidural hematoma that was traced to an underlying ruptured SP as the source. Non-contrast computer tomography (CT) confirmed epidural hematoma. Craniotomy for evacuation revealed an emissary venous connection along the skull fracture line consistent with an SP that had ruptured. The anomalous venous channel was ligated, and the hematoma was evacuated, with good recovery. To the authors’ knowledge this case represents the only instance of a SP associated with intracranial hematoma In pediatric patients presenting with post traumatic epidural hematoma, especially where the bleeding source is uncertain or non arterial, undiagnosed venous malformations such as SP should be considered. Preoperative vascular imaging and intraoperative awareness of this possibility may be important.
Introduction: Treatment of sagittal craniosynostosis is achieved with a combination of surgery with or without helmet therapy, and a variety of surgical techniques have been described. Our institution utilizes early surgical correction, when possible, with a modified technique, the minimally invasive strip craniectomy-extended (MIS-E) followed by strict post-operative orthotic treatment to achieve maximum correction. Methods: The modified approach emphasizes creation of enlarged anterior and posterior fontanelles to correct bossing, and a goal of 5 cm wide strip craniectomy with 2 cm wide at the base wedge ostectomies aiming toward the squamosal suture. Patients are then prescribed a cranial orthosis to be worn 23 h per day for 12 months to achieve and maintain a normocephalic shape with a goal of a Cephalic Index of 0.8. Retrospective analysis was performed on 18 non-syndromic sagittal craniosynostosis patients treated from 2021 to 2025, assessing surgical metrics and morphologic outcomes using the cephalic index. Results: The mean cephalic index increased from 0.726 to 0.807 by 3 months, 0.815 at 6 months, and 0.820 at 12 months (N = 17). 13/18 patients (72%) received a transfusion during their hospital stay. Average width of strip craniectomy was 5 cm. Conclusion: MIS-E appears to be an effective procedure to rapidly correct sagittal craniosynostosis. At our institution, improved standardization of intraoperative transfusion protocols is needed to better determine the need for transfusions in patients treated with this technique. Assessment of sustained correction following helmet therapy is needed to further assess its long-term efficacy.
Introduction: Pilocytic astrocytoma (PA) is the most common pediatric brain tumor and generally exhibits slow growth and favorable outcomes. However, postoperative growth behavior of residual or recurrent tumors remains variable and is not well quantified. This retrospective study aimed to quantify the tumor growth velocity (TGV) of PAs in a pediatric population and estimate the influence of surgery on these values. We also aimed to determine the impact of absolute and relative measurements on these conclusions. Methods: Only pediatric patients with a histopathologically confirmed diagnosis of PA and with at least two consecutive magnetic resonance imaging (MRI) scans performed at an interval of at least 3 months were included in this study. Patients were excluded if the quality of their imaging data was poor or if additional treatments (e.g., chemotherapy or radiotherapy) were administered. Absence of residual tumor was an exclusion criterion, as visual tumor is necessary for the calculation of growth velocity. Thus, patients who underwent gross total resection could be included in the preoperative cohort but were excluded for the postoperative time points. Tumor sizes were measured on T1+Gd magnetic resonance imaging (MRI) images, using 3D Slicer software. Absolute (ATGV) and relative (RTGV) growth velocities were calculated between scans. Absolute growth velocity was expressed as mL/day, RTGV as percentage of total tumor volume per day. Kruskal-Wallis and Wilcoxon signed rank tests were used to compare TGV across three time points: before surgery, after the first surgery, and after the second surgery. Results: Magnetic resonance imaging scans of 37 patients were analyzed. Not every patient had data available for every time point (some had only 1 preoperative scan, others had no postoperative follow-up scans). In the subgroup of 14 patients with data available for at least two time points, ATGV significantly decreased between the post-first surgery and post-second surgery periods (p = 0.047). Relative tumor growth velocity demonstrated a near-significant decline (p = 0.084). In the total cohort, a decreasing trend in relative TGV was noted between the post-first surgery and post-second surgery periods, but without statistical significance (p = 0.095). Intra-patient analyses showed a consistent decrease in TGV after surgery. Spearman’s correlation showed volume dependency of ATGV, but not of RTGV. Conclusion: Reduced TGV was observed after surgical resection, with the most pronounced decreases observed after a second resection in patients with longitudinal follow-up. The parallel findings for ATGV and RTGV suggest that this effect may not be explained solely by tumor volume reduction. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies.
