Happy birthday Archives of Pediatric Neurosurgery: we are two years old!

An unlikely idea became a reality in June 2019 when we gathered an enthusiastic group and started testing the platform & workflow by OJS/PKP thus turning an idea into something concrete. The next step would be choosing the name of the journal and creating the website. Finally, the choice of the national and international editorial board based on academic and scientific criteria. Archives of Pediatric Neurosurgery (APN) was born. We published the very first issue of the APN in September 2019. The decision was to use of the Internet and related technologies as an enabler and infrastructure for health innovations. The use of information and communication technologies and the web helps to empower patients (not least through peer-to-peer communications), provides a platform for communication, clinical information and telemedicine (these days often through mobile devices), and revolutionizes information access and medical education [1]. We were not only innovating on content, but also on form. We were the first open access electronic-only journal in pediatric neurosurgery, and also, we are on social media as Facebook, Instagram and tweeter. We have different types of publication highlighted the clinical case, video clinical case, and clinical video lecture. Our YouTube channel, together with SBNPed, has a total of 48 videos and more than a thousand inscriptions. The Archives of Pediatric Neurosurgery is a triannual peer-reviewed medical online journal and was recognized in September 2020 as the official publication of the Brazilian Society for Pediatric Neurosurgery. We believe APN will contribute in furthering efforts to make our dream a reality getting a pediatric neurosurgery medical journal to be recognize in the world as option to publish original papers, clinical case, video clinical case, and others. Some statistics related to APN: MOST DOWNLOADED PDF ARTICLE: Dezena et al. Anatomy of the ventricular system: Historical and morphological aspects MOST READ ABSTRACT: Furlanetti et al. Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence MOST CITED ARTICLE: de Oliveira RS, Ballestero MFM. The Covid-19 Outbreak and Pediatric Neurosurgery guidelines Submissions Received 112 In two years, APN has published 62 international peer-review medical journals in 5 issues from September, 2019 to August, 2021. All articles are available online and free license to open access and download. All the papers were peer-reviewed (Figure 1). During this period, we included a specialized consultancy and we were able to index the APN in several indexing bases: Google Scholar, Cengage, REDIB, Crossref, Dimensions, and the most recent J-Gate. On this special occasion the editorial office would like to extend their greatest appreciation to all editors, and reviewers who have been supportive, and devoted much of their time and effort in nurturing APN. The journal, in particular, would like to thank the authors for placing their faith in this new, bold journal when it was still in its beginning stages. This continuous support has been pivotal to the development of the journal. In the times to come, APN will remain committed to publishing novel, high-quality, and valuable content. APN endeavors to bring readers the most up-to-date information in a wide variety of fields in the hopes of ultimately benefiting patients, all while ensuring the largest possible readership for all articles published in the journal. In our modern globalized academic community, APN recognizes the importance of international collaborations, and seeks to promote itself as an international journal. We have organized a series of articles focusing on important topics in various fields, and invited international prominent experts to co-author. Based on data from Google Analytics, APN is gaining momentum and attracting interest from readers. The number of accesses to abstracts has been increasing progressively since 2019 (Figure 2). As Section Editors, they keep track of the latest and significant research in their areas and recommend international key opinion leaders to review and write editorial comments on those important topics. We will pursue the serious work and include the APN in more indexing databases, expanding its importance in pediatric neurosurgery. Yes, it's time to celebrate this incredible achievement! but continue the professional work. Happy Birthday Archives of Pediatric Neurosurgery! A long life for everyone!

Pioneer shunt implantation surgery in Brazil

One of the first experiences of shunt implantation in the world occurred in 1949, by Nulsen and Spitz, who implanted a rubber catheter with a ball valve system, from the lateral ventricle to the internal jugular vein [1]. In the 1950s, the shunt systems had great development, especially the Spitz-Holter system, first used in 1956, consisting of the first system produced on a large scale. The second patient who benefited from this new system was Holter's son Casey, who had myelomeningocele [2,3]. From these first American reports, the shunt surgery had great worldwide dissemination in the 1960s. One of the first CSF shunts in Brazil and Latin America occurred in 1966, in the city of Uberaba, Minas Gerais, by Prof. Francisco Mauro Guerra Terra, founder of the Chair of Neurosurgery at Triângulo Mineiro Medical School, today part of Federal University of Triângulo Mineiro (UFTM). The procedure was performed at the Children's Hospital of Uberaba, at the time one of University Hospitals, and the patient was a 7-month-old baby named Maria Beatriz. The child suffered from hydrocephalus, as a complication of tuberculous meningitis, and was diagnosed by pneumoventriculography, a procedure described by Dandy, and widely used in the era before tomography [4] (Fig. 1). The child was submitted to a ventriculo-atrial shunt (Figs. 2, 3 and 4), with implantation of a catheter without a valve, an option widely used at the time. Besides Prof. Guerra, the surgical team was composed by the then medical students Jaime Olavo Marquez, later titular of the Neurology Department of UFTM, Antônio Luiz da Costa Sobrinho, later a neurosurgeon, who later settled in Presidente Prudente, São Paulo, Brazil Carlos Antunes de Paula, also later a neurosurgeon, who settled in the city of Santos, São Paulo, Brazil and the anesthesiologist Dr. Newton Camargo Araújo, from Uberaba (Fig. 5). There is a postoperative image of the case, showing the success of the procedure (Fig. 6). The surgery had great repercussion in the national media at the time (Fig. 7).

Prognostic Models of Mortality from Accidental Severe Traumatic Brain Injury in Children and Adolescents: A Systematic Review

Introduction: Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcomes. Objective: Identify prognostic models of mortality developed and published in the medical literature for possible applicability in children and adolescents victims of severe traumatic brain injury (TBI). Methods: Systematic review in the Medline electronic database (PubMed platform) of scientific articles published from 2006 (year of publication of the last systematic review on prognostic models for TBI before 2017) until July 29, 2017. Results: Ten studies on prognostic models of mortality in children and adolescents victims of severe TBI were identified for final inclusion in the review. There were eight development and two validation studies conducted in different countries. Conclusion: The analysis of this systematic review makes it possible to conclude that the ten prognostic models included in the final sample provide health professionals with a scientific evidence-based understanding of the severity of pediatric victims of severe TBI. This systematic review is classified as presenting 2A and 1 level of evidence (systematic review of homogeneous cohorts), according to the 2009 and 2011 classifications, respectively, of the Oxford Center for Evidence-Based Medicine

Prof. Dr. Michel Zerah

Michel Zerah was born on May 22, 1956 in Paris, France. He finished his medical study in 1985 at Faculté de médecine de CRETEIL (Paris, France) and graduated in Neurosurgery in April, 1988. Quickly took over as head of Clinic-Assistant of Paris Hospitals, “Service de Neurochirurgie de l’hôpital de Bicêtre” (1989) and as university professor (1998) at “Service de Neurochirurgie pédiatrique” of hospital group “Necker-Enfants Malades”. Prof. Zerah was a great teacher and mentor to countless neurosurgeons, around the world and here in Brazil. He participated in several courses and congresses, highlighting his unconditional dedication to teaching. With his knowledge, his humility and incredible charisma he made countless friends and students wherever he went. His lectures have always been unique experiences, approaching each subject in a masterly way, with emphasis on craniocervical transition diseases and spinal dysraphimos. He has authored more than 261 scientific articles and several books and book chapters, with emphasis on lumbar lipomas surgery, Chiari, deposit diseases, among others. His last project was the development of fetal surgery at Necker Hospital. Michel Zerah had an incredible ability to bring people together and, thus, he walked a path of respect, affection and friendship wherever he went. He was head of the Pediatric Neurosurgery Service at Hospital Necker, Paris, France where he devoted a large part of his life, teaching and operating numerous children. An immense and irreparable loss for everyone who knew him and who had the privilege of working and living with him. Short Biography: Head of the Pediatric Neurosurgery Service – Hospital Necker, Paris, France President of the European Society for Pediatric Neurosurgery (ESPN) President of the French Society of Pediatric Neurosurgery Member of the French National Academy of Surgery PhD in Mathematics, Statistics and Computer Science Coordinator of the European Course on Pediatric Neurosurgery between 2002 and 2014. Collaboration with the Society of Neurosurgery of Vietnam where he practiced solidarity work and trained numerous professionals. 324 communications or conferences in National or International Meetings 32 Chapters in Books 123 articles in Scientific Journal

Dorsal intramedullary giant dermoid tumor

Intramedullary dermoid tumors are rare benign neoplasms that correspond to 1 to 2% of all intramedullary tumors, affecting specially the lumbosacral region. Those tumors are composed of remnants of embryonic tissue derived from the ectoderm, whose walls secretions cause slow growth rate. Despite its benign character, neurological injury comes from the tumor's expansive process and the collateral damage derived from the complete resection of the cyst wall, which can cause hypoesthesia and radicular pain, besides other effects as neuromuscular scoliosis. The primary treatment for intramedullary tumor is resection surgery. The case reported involves an infant with an extensive dorsal intramedullary dermoid tumor without association with spinal dysraphism, presenting clinically complete paraplegia, lower limbs atrophy, hypoesthesia from the T4 level and urinary incontinence. The physical examination revealed upper motor neuron syndrome in the lower limbs, mild cognitive delay and a significant scoliosis. Image exams showed a Cobb angle from T3 to L2 with 115º sitting and 68º with traction, besides a massive expansive intramedullary formation extending from C5 to the T9 plane. The patient underwent extensive cervical and thoracic laminotomy followed by median myelotomy and the resection of the lesion. An arthrodesis treated the secondary vertebral deformity. The postoperative period showed good surgical recovery and the control exams revealed ample resection of the lesion and adequate control of scoliosis with partial maintenance of rotational deformity.

Neuroendoscopic followed by microsurgical approach for the treatment of pilocytic astrocytoma of the pineal region

Pilocytic astrocytoma is a low-grade tumor that can affect the pineal region and has a potential life-threatening presentation with obstructive hydrocephalus. This video presents the case of a child who underwent an endoscopic third ventriculostomy with tumor biopsy and for whom a supracerebellar infratentorial approach was chosen after confirmation of the diagnosis of a pilocytic astrocytoma. Herein, we discuss the technical details of both procedures, such as the single burr hole in the neuroendoscopic approach, the ventricular landmarks and identification of the venous sinus through neuronavigation, the anatomical landmarks during the supracerebellar infratentorial approach, and the use of ultrasonographic aspiration.

Management of Pseudotumor Cerebri Secondary to Dural Venous Sinus Thrombosis in Children

Background: The purpose of this study is to follow the clinical course and required management of children suffering from Pseudotumor cerebri (PTC) secondary to Dural Sinus Thrombosis (DST) to understand the natural history of a rare condition and its need for surgery as well as outcome after Cerebro-Spinal Fluid (CSF) diversion surgeries. Methods: A retrospective consecutive case series study based on examining medical records of patients who were referred to neurosurgical pediatric clinic suffering from PTC secondary to DTS. Data review included patients’ archives for clinical, radiological, surgical records and follow up visits. Only patients below 18 years old were included. Results: Fourteen patients met inclusion criteria, 7 of them required CSF diversion procedure, while the other 50% responded to medical conservative therapy. Headache improved immediately for most of the surgical group, while took 7 weeks to reach satisfactory results for medical group. Visual improvement took place for both groups approximately at the same time interval with average 5 weeks. Conclusion: Surgical intervention in the form of CSF diversion procedure was required for 50 % of the patients, which is safe and effective line of treatment to prevent further deterioration of vision for case who were not responsive to medical therapy.

Imaging differentiation on extra-axial fluid collections: a clinical Image.

A 3 month – old male patient with a history of seizures presents to the Pediatric neurosurgery department with his parents, on initial evaluation a head circumference of 47.5 cm (> percentile 99 on the WHO chart) was seen. A brain MRI was performed and an extra axial fluid collections (Chronic subdural hematoma and benign external hydrocephalus) was diagnosed. His parents refer a normal delivery without any complication and the medical history and records denied any previous trauma. A neurosurgical evacuation of the subdural hematoma was performed, and a complete improvement of his seizure was seen on 3 months follow up. Benign external hydrocephalus (BEH) has been proposed as a risk factor for the presence of chronic subdural hematoma (SDH) in infants (1). The SDH formation in the presence of BEH has been reported to be a venous rupture either spontaneously or following minor trauma from the bridging veins traversing the subdural/subarachnoid space (Red arrow , image D ) that are stretched with enlarged extra?axial collections (2). Epidemiologically there are striking similarities between these entities (3) that can be differentiated by some MRI findings.The signs that help us in the differentiation are: the subarachnoid layer visible (yellow arrow image B, showing a displaced subarachnoid layer downward by a fluid between it and the dura) the absence of the cortical vein sign and the differential on fluid intensity on T1-T2 weighted images (Images A,B,C,D) (4). Surgery evacuation is necessary for the patients with chronic subdural hematoma associated with BEH and neurological signs of increased intracranial pressure like macrocrania, seizures and altered level of consciousness (Image F , showing the subdural space without hematoma and the subarachnoid layer downward it ) (5).

Torkildsen shunt as an option for hydrocephalus associated with optic pathway glioma

Hydrocephalus caused by optic pathway glioma (OPG) is most often treated with a ventriculoperitoneal shunt (VPS), but this treatment may present complications such as ascites. Hence, ventriculocisternal shunt is an option worth considering. This article reports a case in which it was decided to place a ventriculocisternal or Torkildsen shunt in a patient with hydrocephalus caused by OPG. Case Report: A 12-year-old girl, amaurotic, with a VPS due to hydrocephalus caused by an OPG, reported to the emergency room with abdominal distension and pain and difficulty in walking. Computed tomography of the abdomen was performed, and a large amount of fluid was evidenced in the peritoneal cavity (ascites). Liver and kidney functions were normal. In the surgical procedure, the distal extremity of the ventriculoperitoneal catheter was exposed, and 3 L of ascites fluid of cerebrospinal origin was drained. After 10 days of antibiotic therapy, a ventriculocisternal or Torkildsen shunt was placed. After 4 years of follow-up, the patient has no complaints. Discussion: Arne Torkildsen was the first to perform a ventriculocisternal shunt in 1937; it is indicated in cases of hydrocephalus with obstruction of the aqueduct or third ventricle. In OPG, increased protein levels in CSF and the use of platinum-based chemotherapy agents would explain the development of ascites after VPS placement. In these cases of hydrocephalus with third ventricle tumor infiltrating the hypothalamus, the ventriculocisternal shunt can be used as an option in specific cases.

Spinal cord untethering after fetal myelomeningocele repair

The incidence of tethered cord syndrome after myelomenigocele (MMC) repair is higher in patients undergoing in utero than postnatally. However, a paucity of studies have described the details of untethering in children which MMC was corrected during fetal life. In this technical note, we describe the spinal cord untethering of a girl after MMC in utero repair, highlighting the main steps regarding the anatomic recognition as well as neurophysiological monitoring finding role.