To investigate and identify the predictors associated with the incidence of seizures in patients with encephalocele (EC). A retrospective analysis was undertaken of patients treated for EC at a tertiary medical center in Tehran between 2010 and 2021. Data including age at presentation, gender, location, size and contents of EC, ventriculomegaly, hydrocephalus, associated anomalies, and neurodevelopmental delay (NDD) were evaluated for their prognostic value. In addition, detailed univariate and multivariate statistical analysis was were performed to identify correlation between independent predictors and seizure incidence. One hundred and two cases of EC were identified. Seventy-one ECs (69.6%) were posterior ECs while 31 (30.4%) were anterior. Neural tissue was found in 43 (42.2%) of the ECs. Thirty-three patients (32.4%) had ventriculomegaly, of which 90.9% underwent shunt placement for progressive or symptomatic hydrocephalus. Seizure was found in 26 (25.5%) patients. On a univariate analysis, presence of other anomalies, post-operative infections and NDD were associated with seizure (p< 0.05). When the anomalies were categorized to intracranial and extracranial groups in univariate analysis none was associated with statistically significant increase in seizure (p value of 0.09 and 0.61 respectively). Although according to multivariate analysis only the association between other associated anomalies and seizure was statistically near significant (OR: 2.0, 95% CI; 0.95-4.2, p=0.049). When the anomalies were categorized to intracranial and extracranial groups none was associated with statistically significant increase in seizure (p value of 0.09 and 0.61 respectively). Children with NDD and postoperative infection were respectively 3.04 and 1.3 (95% CI; 0.9-4.2, p=0.46) times more likely at risk to experience seizures compared to other patients without NDD. We found a rate of 25.5% risk of seizure in patients with EC. This study could not find any significant predictor of seizure in patients children with EC. However, pediatric patients with postoperative infections including sepsis and wound infection and NDD require adequate more considerationstreatment to reduce the risk of seizure.

Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high-risk for morbidity and mortality. Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency and shunt revisions within a year of ventriculitis resolution. Patients demonstrated a mean 74% decrease in CSF protein following each neuroendoscopic lavage and trended towards a shorter time to infection clearance in comparison to previously published literature. Patients required 0-2 shunt revisions at 1-yr follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/- 0.8). Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the cerebrospinal fluid (CSF) protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection.

Closed spina bifida (CSB) is a rare condition with a challenging prenatal diagnosis. Herein, we assess the conventional two-dimensional (2D) ultrasound (US) combined with three-dimensional (3D) ultrasound (US) and MRI in the prenatal diagnosis of CSB. In this retrospective study, we included 20 cases of fetal CSB confirmed by postnatal MRI, post-mortem pathological examination, or postpartum surgery. Prenatal 2D US complemented with the 3D US was performed in all fetuses to evaluate the characteristics of the conus, vertebral arch, and scoliosis. Moreover, magnetic resonance imaging (MRI) was performed to establish the split vertebrae, with or without a bulging mass. Thereafter, we compared the performance of the US and MRI. Diagnosis accuracy of US were comparable with MRI (70% vs 75%, κ=0.62); US detected more cases with interpediculate distance ≥ 95% (55% vs 35%, κ=0.22) than MRI. On the other hand, MRI had a superior capacity for identifying vertebral arch fissures (20% vs 35%,κ=0.39). MRI and ultrasound had good agreement in conus medullaris (65% vs 70%,κ=0.42) and scoliosis (45% vs 35%, κ=0.59).Both US and MRI detected 1 (5.0%) case with 'lemon sign' and 'banana sign'. The missed diagnosis rates of US and MRI were 15%(3/20) and 5%(1/20), respectively. The misdiagnosis rates of US and MRI were 15.0% (3/20) and 20.0% (4/20), respectively. Both MRI and 2D US combined with the 3D US had excellent performance in prenatal diagnosis of CSB.

Paediatric low grade gliomas (pLGGs) are the most common primary brain tumour in children. Though considered benign, slow-growing lesions with excellent overall survival, their long-term morbidity can be significant, both from the tumour and secondary to treatment. Vast progress has been made in recent years to better understand the molecular biology underlying pLGGs, with promising implications for new targeted therapeutic strategies. A multi-layered classification system of biologic subgroups, integrating distinct molecular and histological features has evolved to further our clinical understanding of these heterogenous tumours. Though surgery and chemotherapy are the mainstays of treatment, many tumours are not amenable to surgery and/or refractory to conventional chemotherapy. Therapies targeting common genetic aberrations in the RAS-mitogen-activated protein kinase (RAS/MAPK) pathway have been the focus of many recent studies and offer new therapeutic possibilities. Here, we summarise the updated molecular classification of pLGGs and provide a review of current treatment strategies, novel agents and open trials.

Neuroimaging has evolved from anatomical imaging towards a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion weighted imaging, permeability imaging, diffusion weighted and diffusion tensor imaging (DWI, DTI), tractography, metabolic imaging, connectomics, event related functional imaging, resting state functional imaging, and much more is now being offered. Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. In the current manuscript we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility weighted imaging (SWI) and 1H magnetic resonance spectroscopy (MRS), various perfusion weighted imaging approaches including arterial spin labeling (ASL), dynamic contrast enhanced (DCE) imaging and dynamic susceptibility contrast (DSC) imaging. Pre-, intra and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image guided laser ablation and MR guided high intensity focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.

Spinal tumors are rare pathology in the pediatric population. The tumors can be classified as extradural, intradural extramedullary, or intramedullary. Any of the spinal tumors can eventually lead to spinal deformity. The progressive spinal deformity can be part of the initial presentation or evolve on long follow-up, even years after the initial intervention and treatment. Management of spinal deformity associated with spinal tumors in children is not well defined. Patients with progressive symptoms and even neurological deficits need correction for their deformity when diagnosed. Patients that don't have pain or related neurological deficits should be evaluated for the severity of their deformity and followed long-term. Special consideration is needed for young patients who need multi-level surgery or have deformity at presentation. When considering the need for instrumentation and fusion, the surgeon should examine the patient's age, growth potential, neurologic status, extent of initial deformity, and the number of vertebral levels involved by tumor, especially when the instrumentation can affect imaging at follow-up.

Introduction: We present the largest series of paediatric intracranial empyemas occurring after COVID-19 infection to date, and discuss the potential implications of the pandemic on this neurosurgical pathology. Methods: Patients admitted to our centre between January 2016 and December 2021 with a confirmed radiological diagnosis of intracranial empyema were retrospectively reviewed, excluding non-otorhinological source cases. Patients were grouped according to onset before or after onset of the COVID-19 pandemic and COVID-19 status. A literature review of all post-COVID-19 intracranial empyemas was performed. SPSS v27 was used for statistical analysis. Results: Sixteen patients were diagnosed with intracranial empyema: n = 5 prior to 2020 and n = 11 after, resulting in an average annual incidence of 0.3% prior to onset of the pandemic and 1.2% thereafter. Of those diagnosed since the pandemic, 4 (25%) were confirmed to have COVID-19 on recent PCR test. Time from COVID-19 infection until empyema diagnosis ranged from 15 days to 8 weeks. Mean age for post-COVID-19 cases was 8.5 years (range: 7–10 years) compared to 11 years in non-COVID cases (range: 3–14 years). Streptococcus intermedius was grown in all cases of post-COVID-19 empyema, and 3 of 4 (75%) post-COVID-19 cases developed cerebral sinus thromboses, compared to 3 of 12 (25%) non-COVID-19 cases. All cases were discharged home with no residual deficit. Conclusion: Our post-COVID-19 intracranial empyema series demonstrates a greater proportion of cerebral sinus thromboses than non-COVID-19 cases, potentially reflecting the thrombogenic effects of COVID-19. Incidence of intracranial empyema at our centre has increased since the start of the pandemic, causes of which require further investigation and multicentre collaboration.

Introduction: Hydrocephalus is a common pediatric neurosurgical pathology, typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the present study was to validate a predictive model of pediatric shunt complications with data retrieved from the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD). Methods: The HCUP NRD was queried from 2016 to 2017 for pediatric patients undergoing shunt placement using ICD-10 codes. Comorbidities present upon initial admission resulting in shunt placement, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) at admission classifications were obtained. The database was divided into training (n = 19,948), validation (n = 6,650), and testing (n = 6,650) datasets. Multivariable analysis was performed to identify significant predictors of shunt complications which were used to develop logistic regression models. Post hoc receiver operating characteristic (ROC) curves were created. Results: A total of 33,248 pediatric patients aged 6.9 ± 5.7 years were included. Number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04–1.07) and initial neurological admission diagnoses (OR: 3.83, 95% CI: 3.33–4.42) positively correlated with shunt complications. Female sex (OR: 0.87, 95% CI: 0.76–0.99) and elective admissions (OR: 0.62, 95% CI: 0.53–0.72) negatively correlated with shunt complications. ROC curve for the regression model utilizing all significant predictors of readmission demonstrated area under the curve of 0.733, suggesting these factors are possible predictors of shunt complications in pediatric hydrocephalus. Conclusion: Efficacious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm delineated possible variables predictive of shunt complications with good predictive value.

Not Applicable (Letter to the editor).