Two decades ago, a visionary initiative was launched in Latin America with the aim of advancing pediatric neurosurgery education and expertise across the region. Today, as we mark the 20th anniversary of the Latin American Pediatric Neurosurgery Course (LACPN), it is an opportune moment to reflect on its journey, celebrate its achievements, and chart a course for its continued success. The LACPN was established with a clear mission: to provide a platform for knowledge exchange, skill development, and collaboration among neurosurgeons dedicated to caring for children with neurological conditions. Designed to cover the major fields in Pediatric Neurosurgery, the scientific program is divided into annual courses over a 3-year cycle, with each biannual course is based on a four-day program divided in the morning sessions; lectures and case discussion an afternoon session; lectures, video session, "hand-on", and "solve a case". Following the ESPN post-graduate course and Asian-Australasian Course in Pediatric Neurosurgery program. At the heart of the LACPN's success lies its unwavering commitment to education and training, a culture of continuous learning and mentorship, the LACPN has not only raised the standard of care but also inspired a new generation of neurosurgeons dedicated to pediatric neurosurgery in the past 20 years. Over the past 18 years of LACPC more than 350 different trainees (from Brazil, Argentina, Chile, Colombia, Uruguay, Mexico, Venezuela, Bolivia, Cuba, Paraguay, and others) and 73 faculty invitees (from Brazil, Argentina, Chile, Mexico, USA, France, Italy, Costa Rica, Colombia, Turkish, Singapore, Spain, UK, and Australia, South Africa) have attended the course. In 2024, the LACPN become an official course of the Latin American Association for Pediatric Neurosurgery (ASOLANPED). This year the course was held in Pilar, Buenos Aires, Argentina, with the brilliant direction of Dr. Ramiro delRio and Dr. Sebastian G. Jaimovich. As we reflect on the past 20 years, it is evident that the LAPNC has made a profound impact on the field of pediatric neurosurgery in Latin America. Its legacy extends far beyond the confines of the operating room, encompassing a legacy of excellence, collaboration, and compassion that will continue to shape the future of pediatric neurosurgery for generations to come. As we celebrate this significant milestone, we are reminded that our work is far from complete. Challenges remain, ranging from disparities in access to care to the need for continued innovation and research. As we look ahead to the next 20 years and beyond, let us recommit ourselves to the pursuit of excellence, the advancement of knowledge, and the relentless pursuit of better outcomes for the children and families we serve.LACPN is a unique course! Friendship, collaboration and opportunities for everyone are the pillars of this course. In closing, we extend our heartfelt gratitude to all those who have contributed to the success of the Latin American Pediatric Neurosurgery Course over the past two decades – the organizers, faculty, participants, sponsors, and supporters. Your dedication, passion, and commitment have made this journey possible, and we look forward to continuing our shared mission of advancing pediatric neurosurgery in Latin America and beyond. Here's to 20 years of excellence, and to many more years of innovation, collaboration, and impact. See you in Rio de Janeiro 2024!!

BACKGROUND: Pediatric neurosurgical emergencies are prevalent worldwide, often triggered by acute, life-threatening conditions that necessitate immediate surgery to prevent disability and death. Managing these conditions perioperatively poses significant challenges for neurosurgeons and anesthetists due to potential complications like anemia, seizures, electrolyte imbalances, intracranial hypertension, and vision threats, alongside the primary neurosurgical issues. Proper correction and optimization of these physiological derangements before surgery are crucial for favorable postoperative outcomes. PATIENTS AND METHODS: This retrospective study analyzes emergency neurosurgical operations performed on children aged sixteen and under at a neurosurgical center in Sokoto, Nigeria, from January 2018 to December 2021. The center caters to a population of approximately twenty million people from three north-western and one north-central Nigerian states, as well as neighboring Niger and Benin republics. The area features a mostly arid climate with limited seasonal rainfall and experiences the Sahara’s harmattan winds. RESULTS A total of 131 children underwent emergency neurosurgical procedures during the study period. The majority were males (71%), with an average age of 5.6 years. Hydrocephalus was the most frequent emergency condition, leading to 44.3% of surgeries, primarily through ventriculoperitoneal shunt procedures, which accounted for 42.7% of interventions. Anemia was the most common comorbid condition. The mean time from presentation to intervention was 10 days. Postoperatively, 17.9% of patients suffered from surgical site infections, yet 67.9% had favorable outcomes with a mortality rate of 7.1%. CONCLUSION: This study underscores the importance of timely surgical interventions and highlights the predominance of ventriculoperitoneal shunts in treating pediatric hydrocephalus in the region, with generally positive outcomes despite delays

Introductions: Craniosynostosis is a condition where the cranial sutures close prematurely. It is influenced by both genetics and environment. This paper focuses on craniosynostosis in twins, which is an understudied area. It presents a case report of male identical twins and conducts a meta-analysis based on 34 articles to understand the factors affecting concordance in twins who have craniosynostosis. The study considers factors such as zygosity, gender, genetic syndromes, and the type of synostosis. Material and methods: A meta-analysis was conducted on 105 twin pairs (210 patients) identified from studies carried out between 1963 to 2023. The eligible studies, based on PICO criteria, included case reports and case series focusing on twins with craniosynostosis. A systematic literature search was conducted on PUBMED and Mendeley platforms to gather data on gestational age, zygosity, genetic syndromes, affected sutures, and concordance. Results: The report is about two identical twin brothers who had sagittal and metopic suture synostosis. They were treated successfully with cranial remodeling surgery. In a meta-analysis of 105 twin pairs (210 patients) , a total of 25.9% showed concordance. The study found a significant difference in concordance between monozygotic (45.3%) and dizygotic (7.3%) twins. The analysis also revealed that twins with scaphocephaly had a higher degree of concordance than those with trigonocephaly (46.7% vs. 18.9%, respectively). The study did not find any significant correlation between gender, the presence of genetic syndromes, and concordance. Conclusion: This investigation highlights the complex interplay of genetic and environmental factors in craniosynostosis in twins. The higher concordance in monozygotic twins emphasizes the genetic basis. These findings validate existing literature and provide new insights.

Conference presented at the Brazilian Academy of Neurosurgery Pediatric Symposium on December 9th, 2024. Myelomeningocele (MMC) is recognized as the most prevalent neural tube defect (NTD) and the most complex congenital anomaly that is still consistent with life. In the era of folic acid fortification, its incidence has been observed at 3.4 per 10,000 live births. The observed decrease in incidence is attributed to a synergy of enhanced folate supplementation, along with advancements in prenatal diagnostics, and, in certain cases, the option of selective termination. Recently, innovative technology and growing expertise have sparked considerable excitement within the scientific community regarding fetal MMC repair. In this lecture, Dr. Elbabaa shares his surgical outcomes and provides an updated overview of the current state of the art in this surgical field.

Abstract: Anterior clinoidectomy is a routine neurosurgical procedure for the management of paraclinoid aneurysms and tumors in adults; however, it has been performed less extensively in children. The anterior clinoid process of the sphenoid bone is closely related to vital neurovascular structures including the optic nerve, internal carotid artery, and the ophthalmic artery. Therefore, sphenoidal variants, such as the accessory optic canal and caroticoclinoid foramen, pose serious complications in anterior clinoidectomy including potential blindness and death. Case report: This report presents a novel case of concomitant bilateral accessory optic canals and a right-sided caroticoclinoid foramen found within an infantile sphenoid of a 12-month-old black male. The case report documents two co-occurring, clinically relevant variants known to complicate anterior clinoidectomy in an individual from a population that has been underrepresented in the literature. Conclusion: Caroticoclinoid foramina and accessory optic canals can be mistaken for each other on preoperative imaging, and accessory optic canals can additionally be mistaken for pneumatization of the anterior clinoid process, lesser sphenoidal wing, or optic strut. A high index of suspicion for these anatomic variants on preoperative imaging could enable the prevention of adverse outcomes, including hemorrhaging of the internal carotid artery and/or ophthalmic artery and subsequent blindness or death.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among pediatric patients. Head Computerized Tomography (CT) scan has the undoubtedly benefit of diagnosing TBI lesions but is also associated with increased risk of cancer due to radiation. This study was composed of 190 patients evaluated in the emergency setting of a pediatric Brazilian hospital from January 2019 to December 2021. The results of the study demonstrated an increased amount of CT scans in patients with mild TBI during this period. Besides, we noticed that many of these CT scans showed normal results or clinically insignificant findings such as subgaleal hematomas. Knowing the risks related to radiation exposure at such a young age makes us question the validity of the hospital protocol we are following. Also, we believe that a future solution to this issue would be to implement radiation-free complimentary exams such as Magnetic Resonance Imaging (MRI) to our hospital protocol. Emphasizing the importance of justification of procedures and optimization of radiation doses are also crucial to prevent cancer development in pediatric patients.

Introduction: Acute intracranial hypertension (ICH) syndrome is a neurosurgical emergency. Timely diagnosis of ICH is imperative for potential reversibility of the neurological condition. We report the case of a child with bleeding and hydrocephalus secondary to lateral ventricle injury, with an emphasis on the outcome secondary to ICH. Case Report: A 10-year-old girl presented to the emergency department with a history of progressive holocranial headache and vomiting for 1 day. She progressed with a progressive decrease in the level of consciousness. A computed tomography scan of the head was performed only 12 hours after admission, revealing intraventricular hemorrhage associated with calcifications and ventricular dilation. Upon admission to a specialized service, she had bilateral fixed mydriasis and the absence of brainstem reflexes. Emergency ventriculostomy was performed, but the patient developed brain death the following day. Conclusion: Besides the delay in diagnosis, the time between diagnosis and emergency neurosurgical treatment also constituted a significant factor in the unfavorable outcome described. In many ICH situations, a simple procedure like ventriculostomy can prevent an unfavorable outcome. Therefore, proper evaluation of pediatric patients and early recognition of clinical signs indicating intracranial hypertension are crucial for preventing an unfavorable and potentially fatal outcome.

I have great news to share! The Archives of Pediatric Neurosurgery is now indexed on Scopus. This is a significant achievement that will enhance the visibility and accessibility of this valuable resource for researchers and practitioners in the field of pediatric neurosurgery.In the realm of academic publishing, the significance of visibility and recognition cannot be overstated. Researchers and scholars ardently seek acknowledgment, citations, and the dissemination of their work within the scholarly community. A pivotal factor in attaining such recognition is the inclusion of your journal in esteemed databases.In November 2023, the Scopus Content Selection and Advisory Board accepted the Archives of Pediatric Neurosurgery APN) for indexing, recognizing the value of the new addition to the Scopus database and motivating the editorial team to achieve new highs. The acceptance for coverage is indeed a great achievement for the APN editorial team and the Brazilian Society for Pediatric Neurosurgery (SBNPed) support.Over the past decade, Scopus has gained immense importance because of its constantly improving functionality, expanded coverage of quality sources, and scrutinized selection and deselection criteria. Launched in 2004 as an Elsevier database, Scopus has succeeded in outperforming many other indexing systems, with 22,794 active titles and more than 78 million bibliographic records [1]Scopus is widely recognized as a reputable source of scholarly information and is used by researchers, institutions, and organizations worldwide for literature review, citation analysis, and research evaluation.Credibility and Quality Assurance Scopus employs a meticulous evaluation process for journals seeking indexing, ensuring that indexed journals meet certain quality and academic standardsHere are some key reasons why Scopus indexing is considered crucial for academic journals:Visibility and Exposure: Scopus is widely used by researchers, scholars, and academics to discover relevant literature in their fields of study. Indexing in Scopus enhances the visibility of academic journals, making them more accessible to a global audience. This increased exposure can lead to higher citation rates and greater recognition within the academic community.Quality Assurance: Scopus employs a rigorous selection process for indexing journals, considering factors such as editorial quality, regular publication, international diversity, and citation impact. Inclusion in Scopus is often seen as a mark of quality, and it signifies that the journal adheres to certain academic and editorial standards.Global Academic Community Recognition: Scopus is used by researchers and institutions worldwide. Being indexed in Scopus enhances the international recognition of a journal, making it more attractive to authors, readers, and potential collaborators from different parts of the world. This global recognition can contribute to the journal's academic prestige.Citation Analysis: Scopus provides citation analysis tools, allowing researchers and publishers to track the impact of individual articles, authors, and journals over time. This can be valuable for understanding the influence and reach of scholarly work published in a particular journal, and it can be used as a metric for evaluating academic impact.Bibliometric Indicators: Scopus provides various bibliometric indicators, such as the h-index, which can be used to assess the overall impact and influence of a journal. These indicators are often considered by researchers when choosing journals for manuscript submission and by institutions when evaluating the academic performance of researchers.Institutional Evaluation: Universities and research institutions often use Scopus indexing as a criterion for evaluating the research output and impact of their faculty members. Having publications in Scopus-indexed journals can positively contribute to the academic reputation of individual researchers and institutions.Research Funding and Grants: Some funding agencies and institutions may prioritize research published in Scopus-indexed journals when awarding grants or funding. This can create additional incentives for researchers and institutions to publish in journals indexed by Scopus.
 In summary, Scopus indexing plays a crucial role in enhancing the visibility, credibility, and impact of academic journals. It is a key factor for researchers, institutions, and publishers in the competitive academic landscape.