Since the first Chinese pediatric neurosurgery meeting was convenced in 2002, the pediatric neurosurgery discipline in China has undergone remarkable transformation and growth. Throughout this period, both general and pediatric hospitals have progressively established dedicated Pediatric Neurosurgery Departments. Additionally, the methodology for training medical professionals in this field has undergone a substantial evolution, shifting from the conventional pediatric surgery training paradigm to a comprehensive system tailored for neurosurgical specialists and postgraduate students. Consequently, there has been a consistent increase in the number of physicians specializing in pediatric neurosurgery nationwide. In relation to surgical instruments and equipment, significant advancements have been achieved in pediatric neurosurgery. Notably, the neurosurgical operating microscope has emerged as a vital tool, significantly enhancing the therapeutic outcomes for a wide range of pediatric neurosurgical conditions. Furthermore, both the Chinese Medical Doctor Association and the Chinese Medical Association have established specialized pediatric neurosurgery subgroups, providing robust support for the continuous development and advancement of this field in China.
Pediatric intracranial germ cell tumors (GCT) are clinically rare but highly heterogeneous tumors, primarily occurring in children and adolescents. The treatment method depends on the tumor type. Pure germinoma can be cured with radiotherapy and chemotherapy, while mature teratomas can be cured with surgical resection. Non-germinomatous germ cell tumors (NGGCT) require comprehensive treatment. Current domestic and international guidelines or expert consensus recommend initial chemotherapy, followed by surgical resection for those not achieving complete remission. However, clinical practice has found that surgery risks increase after chemotherapy, leading some experts to advocate for direct surgery. Beijing Tiantan Hospital, Capital Medical University proposed a clinical diagnosis and treatment strategy for pediatric intracranial NGGCT (2023 Tiantan version), recommending joint evaluation by neurosurgeons and oncologists for individualized treatment to provide better treatment plans for children.
Medulloblastoma is the most common malignant central nervous system tumor in children. The current treatment approach primarily consists of surgery combined with adjuvant radiotherapy and chemotherapy. Postoperative precision treatment plans based on risk stratification effectively prevent overtreatment in low-risk patients while addressing the therapeutic needs of high-risk groups. Traditional clinical risk stratification primarily considers factors such as age, clinical stage, and extent of surgical resection. In recent years, advances in understanding the key molecular markers of medulloblastoma have led to the integration of molecular subtypes and molecular and genetic characteristics into the risk stratification framework. It has resulted in the development of a revised molecular risk stratification system, which makes it possible to distinguish children in different risk groups more efficiently and guides subsequent precision treatment. This paper intends to summarize the pathological characteristics of medulloblastoma, risk stratification based on clinical features and the revised molecular risk stratification which integrates clinical and molecular genetic characteristics, so as to provide a guideline for the formulation of subsequent comprehensive diagnosis and treatment plans.
Spinal and spinal cord tumors in children are rare and often present with non-specific symptoms, leading to delayed diagnosis and potentially catastrophic consequences. Most pediatric spinal tumors in children are benign tumors, primarily including osteoid osteomas, osteoblastomas and aneurysmal bone cysts. Malignant spinal tumors are extremely rare, mainly including osteosarcoma, Ewing's sarcoma, lymphoma and metastatic neuroblastoma. Pediatric spinal cord tumors mostly include astrocytomas, ependymomas and schwannomas. There are also congenital benign tumors, such as lipomas and teratomas, which are relatively not uncommon. This article provides a review of the clinical characteristics of spinal and spinal cord tumors in children, with the aim of improving clinical understanding of pediatric spinal and spinal cord tumors, and guiding diagnosis and treatment.
Pediatric drug-resistant epilepsy (DRE) significantly affects children's neurodevelopment and quality of life, often accompanied by cognitive dysfunction and behavioral abnormalities, imposing a heavy economic and psychological burden on families and society. Surgery is an effective treatment for DRE, especially for children who do not respond to medication. This article reviews the current status of surgical treatment for pediatric DRE, discussing the necessity and timing of surgery, surgical indications, and preoperative evaluation. It introduces the applications of resective and palliative surgeries and explores the development of new technologies such as laser interstitial thermotherapy (LITT) and high-intensity focused ultrasound (HIFU). This review provides a theoretical foundation for the advancement of pediatric epilepsy surgery toward more minimally invasive and precise approaches.
Objective: To review the effect of resection of pediaric craniopharyngioma and the long-term quality of life. Methods: The clinical datas before, during and after operation of 30 pediatric craniopharyngioma patients who were operated in Xuanwu Hospital, Capital Medical University from March 2014 to June 2024 were collected for retrospective analysis. The Katz index, body mass index (BMI), as well as one's ability to paparticipate in normal school life and physical exercise at last follow-up were recorded as key factors of long-term quality of life assesement. Results: There were 7 (23.33%) of pediatric craniopharyngioma patients were identified as obese, 19 (63.33%) patients had endocrine dysfunction and 30 (100%) were identified as Katz index grade A before operation. Total resection of the tumor was achieved in 29 cases, while one case had subtotal resection. Median follow-up time was 38.00 (17.25, 53.00) months. The number of obese children increased to 9 (30%) during the last follow-up, but showed no statistic significance (χ2 = 0.125, P = 0.727). The number of patients with endocrine dysfunction increased to 27 (90%), and showed statistic significance (χ2 = 4.083, P = 0.039). All 30 cases remained Katz index grade A during the last follow-up. During the last follow-up, only one patient hadn't return to normal school life and 2 patients couldn't join physical exercise in school after total resection of craniopharyngioma. Conclusions: Total resection in pediatric craniopharyngioma patients can still achieve good prognosis, and should be the target of surgical treatment.
Objective: To discuss the classification and surgical treatment strategies of complex spinal lipoma in children. Methods: A total of 68 children with complex spinal lipoma were selected for treatment at Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University from January 2015 to January 2023. They were divided into dorsal type (n = 42), transitional type (n = 15) and chaotic type (n = 11) based on XIU-SUN classification. All patients underwent microsurgical treatment under neurophysiological monitoring. The early (within one month after surgery) and long-term (over one year after surgery) efficacy and safety of all patients were evaluated. Results: Early efficacy: according to the Kirollos grading method for intraoperative decompression, 61 cases (89.71%) reached level Ⅰ, 5 cases (7.35%) reached level Ⅱ, and 2 cases (2.94%) reached level Ⅲ; according to the degree of resection, complete resection was achieved in 7 cases (10.29%), subtotal resection in 16 cases (23.53%), and partial resection in 45 cases (66.18%). Long-term efficacy: all patients were followed up for (5.00 ±0.20) years. According to the McCormick spinal cord injury grading system, there was no statistically significant difference in the preoperative and postoperative neurological scores of the dorsal type (χ2 = 0.364, P = 0.549), transitional type (χ2 = 0.125, P = 1.000) and chaotic type (χ2 = 1.500, P = 0.219). MRI examination revealed recurrence of lipoma in 6 cases (8.82%). The postoperative symptoms improved to different degrees, and the progression free survivial rate was 91.18% (62/68). Postoperative complications: 25 cases (36.76%) of postoperative complications were observed, including urinary and fecal dysfunction in 13 cases (19.12%), decreased muscle strength in 9 cases (13.24%), cerebrospinal fluid leakage in 3 cases (4.41%), central nervous system infection leading to acute hydrocephalus in 2 cases (2.94%), with 2 cases presenting with both decreased muscle strength and urinary and fecal dysfunction. Conclusions: XIU-SUN classification has a guiding role in surgical strategy. In cases of dorsal type and most of transitional types, a subtotal or complete resection can be chosen. For chaotic type and medullary type, a reduction-based approach is recommended. All types of spinal lipoma should undergo detachment release.
Objective: To explore the surgical treatment of depressed fracture of skull in neonates. Methods and Results: Eight neonates with depressed fracture of skull who underwent surgery in Children's Hospital Affiliated to Shandong University from January 2021 to December 2023 were included, and all of them underwent CT thin-slice scan + 3D reconstruction of skull before surgery. According to the location, extent and depth of the depression, the depressed edge was drilled and the depressed skull was reduced by bone pry (3 cases). The depressed skull collapsed again after the bone was pried up, the skin incision was extended to reveal the depressed area, and the shaped absorbable connector was fixed in the depressed area after prying up (2 cases). Blunt separation of the skull and dura mater at the lateral corner of the anterior fontanelle, and deep bone pry to pry up the depressed skull for reduction (one case). The skull and dura mater were bluntly separated from the coronal suture at the edge of the depression, and the depressed skull was pried up and reduced by deep bone pry (2 cases). On the first day after surgery, the reexamination of CT thin-slice scan + 3D reconstruction of skull showed that the depression reduction was satisfactory. Spontaneous fracture healing was happened in one case with linear fractures; hemorrhage resorption spontaneously was happened in one case with epidural hematoma. The average follow-up was 6.80 months, and the re-examination of CT thin-slice scan + 3D reconstruction of skull showed that the skull development was normal and there was no re-depression. Conclusions: Immediate reduction of depressed fracture of skull can be achieved with surgery, and for fractures close to the anterior fontanelle or suture, the depression can be prying up through the lateral angle of the anterior fontanelle or the unclosed suture, which is more minimally invasive.
Objective: To research new methods and materials for cranioplasty in children with various types of skull defects. Methods and Results: A total of 40 childrens with different locations, sizes and reasons of skull defects underwent surgery using 3 classes of homogeneous yet heterogeneous biomimetic hydroxyapatite collagen bone materials developed by Tsinghua University. These include porous mineralized collagen scaffolds (pMC), compact mineralized collagen scaffolds (cMC), and biphasic mineralized collagen composite scaffolds (bMC). Cranioplasty was successful in all cases, with no serious postoperative complications and good recovery outcomes. After 3 months to one year of follow-up, there was no displacement of the implants, the shape of the head was normal, the incisions healed well. Reexamination CT showed that the biomimetic hydroxyapatite collagen bone material implants were not shifted, and imaging fusion was partially achieved. The pMC CT HU-value was 300-400 HU, and the cMC CT HU-value was 700-900 HU, and the CT HU-value was close to normal bone tissue over time. Conclusions: The use of different types of biomimetic hydroxyapatite collagen composites allows for personalized cranial reconstruction based on individual needs, and has been proven to possess good bio-compatibility and osteoinductive capacity. This approach is thus promising for research and clinical applications, with significant value.
Objective: To compare the agreement in judging the responsible vessels for hemifacial spasm (HFS) between the preoperative 3D Slicer 3D reconstruction and the actual intraoperative judgment of microvascular decompression (MVD). Methods: A total of 62 patients with HFS who underwent MVD in Dong'e County People's Hospital of Shandong Province from July 2018 to January 2024 were included. 3D fast inflow with the steady state precession (3D-FIESTA) and 3D time-of- flight (3D-TOF) MRA were performed before surgery. 3D Slicer software was used to fuse 3D-FIESTA and 3D-TOF MRA images and 3D reconstruction to clarify the responsible vessels. The actual intraoperative judgment was taken as the "gold standard", and the agreement between preoperative 3D reconstruction and actual intraoperative judgment was compared. Results: There were 61 cases whose responsible vessels were identified by preoperative 3D reconstruction, including anterior inferior cerebellar artery (AICA) in 47 cases, posterior inferior cerebellar artery (PICA) in 6 cases, vertebral artery (VA) in 5 cases, VA + AICA in 2 cases, and superior cerebellar artery (SCA) in one case. The 59 cases were consistent with actual intraoperative judgment. In one case, the preoperative 3D reconstruction was considered as VA compression, and the intraoperative evidence was VA + AICA compression; in one case, preoperative 3D reconstruction was AICA compression, and the intraoperative evidence was AICA + labyrinthine artery compression; no significant responsible vessels were found in one case, and the intraoperative evidence was arteriole compression. The accuracy of preoperative 3D reconstruction was 95.16% (59/62). Agreement test showed a high consistency between preoperative 3D reconstruction and actual intraoperative judgment (κ = 0.886, P = 0.000). Conclusions: It is very accurate to define the responsible vessels by 3D reconstruction before MVD in patients with HFS, which is helpful to make the surgical plan and provide the basis for the judgment of the responsible vessels during the operation.
Objective: To compare the clinical efficacy and safety of levetiracetam and oxcarbazepine in the treatment of focal epilepsy. Methods: A total of 476 patients with focal epilepsy treated at Fujian Provincial Hospital from October 2020 to October 2022 were selected. Based on their medication, they were divided into the levetiracetam group (n = 275) and the oxcarbazepine group (n = 201). Both groups underwent continuous treatment for 12 months. The overall effective rate and incidence of adverse reactions in both groups and different subgroups were analyzed. Results: The overall effective rate in the levetiracetam group was 57.82% (159/275), and in the oxcarbazepine group was 46.77% (94/201). The overall effective rate in the levetiracetam group was higher than that in the oxcarbazepine group (χ2 = 5.696, P = 0.017). Efficacy analysis of levetiracetam monotherapy across different age subgroups showed statistically significant differences (χ2 = 6.785, P = 0.034), with the overall effective rate in younger patients being higher than that in minors (χ2 = 3.898, P = 0.048) and middle-aged/older patients (χ2 = 4.946, P = 0.026). Levetiracetam was more effective in patients with initially normal imaging compared to those with abnormal imaging (χ2 = 5.349, P = 0.021). In the oxcarbazepine monotherapy subgroup analysis, oxcarbazepine was also more effective in patients with initially normal imaging (χ2 = 10.036, P = 0.002). Efficacy analysis of the same subgroup with different medications indicated that for younger patients with focal epilepsy, levetiracetam was superior to oxcarbazepine (χ2 = 6.591, P = 0.010). In the levetiracetam group, 13 cases (4.73%) experienced adverse reactions, while the oxcarbazepine group had 19 cases (9.45%). The incidence of adverse reactions in the oxcarbazepine group was higher than that in the levetiracetam group (χ2 = 4.135, P = 0.042). Conclusions: Compared to oxcarbazepine monotherapy, levetiracetam monotherapy demonstrated better clinical efficacy in treating focal epilepsy, particularly in younger patients. The incidence of adverse reactions in levetiracetam was lower. Both medications were more effective in patients with initially normal imaging compared to those with abnormal imaging.
Objective: To summarize the electrophysiological and muscle pathological characteristics of Lambert-Eaton myasthenic syndrome (LEMS). Methods and Results: Twelve LEMS patients referred to China-Japan Friendship Hospital between January 2010 and December 2021 were included. Clinically, they all showed proximal muscle weakness and reduced or disappeared tendon reflexes. Electrophysiologically, all 12 patients showed decreased compound muscle action potential (CMAP) amplitudes, normal distal motor latency (DML), and normal motor and sensory conduction velocities. Ten patients underwent repetitive nerve stimulation (RNS) test: all had amplitude increments of more than 100% at high-frequency RNS, and 8 had amplitude decrements of more than 15% at low-frequency RNS. Three patients completed the post-exercise facilitation (PEF) test: the ulnar nerve CMAP amplitude reached a peak immediately after maximum voluntary contraction of the abductor digiti minimi for 5-10 s and then gradually decreased to near baseline level after contraction for 60 s; the ulnar nerve CMAP amplitude reached a peak immediately after maximum voluntary contraction for 10 s, and then rapidly decreased to near baseline level after 15 s. On needle EMG, 8 patients showed normal motor unit action potential (MUAP), 3 showed short-duration MUAP mimicking myopathy, and one showed long-duration MUAP mimicking neuropathy. Two patients with normal MUAP underwent biceps biopsy, which showed selective type Ⅱ fiber atrophy. Conclusions: Electrophysiologically, CMAP amplitudes of LEMS patients are usually diffusely low or borderline. LEMS patients have amplitude increments of more than 100% at high-frequency RNS, and some have amplitude decrements of more than 15% at low-frequency RNS. PEF test shows a transient but significant CMAP amplitude increase after 5-10 s maximum voluntary contraction. Needle EMG is usually normal, but some show myogenic lesions, and some show neurogenic lesions. Muscle biopsy shows selective type Ⅱ fiber atrophy. Needle EMG myogenic lesion may not be associated with pathologically selective type Ⅱ fiber atrophy.
The stigma associated with functional neurological disorder (FND) is greater than that associated with other neurological conditions, seriously affecting the quality of life of patients and increasing the burden on caregivers. This article reviews the concept, the current situation and harms, the influence factors and intervention strategies of FND stigma. The aim is to further develop our country as a reference for the study of stigma in FND.
