Journal of neurosurgery. Pediatrics
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OBJECTIVE Even in the absence of a clinically diagnosed concussion, research suggests that neurocognitive changes may develop in football players as a result of frequent head impacts that occur during football games and practices. The objectives of this study were to determine the specific situations in which high-magnitude impacts (accelerations exceeding 40 g) occur in youth football games and practices and to assess how representative practice activities are of games with regard to high-magnitude head impact exposure. METHODS A total of 45 players (mean age 10.7 ± 1.1 years) on 2 youth teams (Juniors [mean age 9.9 ± 0.6 years; mean body mass 38.9 ± 9.9 kg] and Seniors [mean age 11.9 ± 0.6 years; mean body mass 51.4 ± 11.8 kg]) wore helmets instrumented with accelerometer arrays to record head impact accelerations for all practices and games. ⋯ Back players, who were often positioned in the open field, were shown to experience elevated levels of head impact exposure relative to players at other positions. The analysis also suggests that practice intensity, which may be influenced by coaching style, may also affect high-magnitude head impact exposure. Future studies should investigate this aspect as a factor affecting head impact exposure.
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J Neurosurg Pediatr · Dec 2017
Multicenter StudyIsolated optic nerve gliomas: a multicenter historical cohort study.
OBJECTIVE Isolated optic nerve gliomas (IONGs) constitute a rare subgroup of optic pathway gliomas (OPGs). Due to the rarity of this condition and the difficulty in differentiating IONGs from other types of OPGs in most clinical series, little is known about these tumors. Currently, due to lack of evidence, they are managed the same as any other OPG. ⋯ CONCLUSIONS Isolated optic nerve gliomas are highly dynamic tumors. Radiological progression and visual deterioration occur in greater percentages than in the general population of patients with OPGs. Response to chemotherapy may be better in this group, and its use should be considered early in the course of the disease.
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J Neurosurg Pediatr · Dec 2017
Comparative StudyEvolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?
OBJECTIVE Although the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI. ⋯ CONCLUSIONS The VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.
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OBJECTIVE Readmission and return to operating room after surgery are increasingly being used as a proxy for quality of care. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in health care costs. The authors set out to analyze the incidence of readmission at their center, to define causes of unplanned readmission, and to determine the preoperative and surgical variables associated with readmissions following pediatric neurosurgery. ⋯ Clearly, readmission reduction has the potential for significant cost savings in pediatric neurosurgery. Future efforts, such as targeted education related to complication signs, should be considered in the attempt to reduce unplanned events. Given the single-center, retrospective study design, the results of this study are primarily applicable to this population and cannot necessarily be generalized to other institutions without further study.
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J Neurosurg Pediatr · Dec 2017
Case ReportsResting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience.
OBJECTIVE Cerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. ⋯ These features make rs-fMRI an ideal technology for cerebral mapping in pediatric neurosurgical patients. This review of the use of rs-fMRI mapping in an initial pediatric case series demonstrates the feasibility of utilizing this technique in pediatric neurosurgical patients. The preliminary experience presented here is a first step in translating this technique to a broader clinical practice.