Introduction and importance Pediatric acute ischemic stroke is a rare but devastating condition with substantial rates of morbidity and mortality. Endovascular treatment is standard acute revascularization therapy for stroke in adults, but it is not well-studied in pediatrics. We report the successful treatment of two pediatric cases of anterior circulation stroke with primary mechanical thrombectomy. Case presentation Two Asian children, aged 13 and 8 years, presented to Dr. Soetomo General Academic Hospital in September 2020 and April 2021, respectively, with hemiplegia and significant Pediatric National Institutes of Health Stroke Scale (Ped NIHSS) scores. Head CT scans demonstrated hyperdense middle cerebral artery signs, suggesting large-vessel occlusion stroke. Both patients underwent emergent thrombectomy within 5 and 10 h after initial onset, and successful recanalization was achieved within an hour. Both demonstrated good neurological recovery and there was no recurrent stroke during follow-up. Clinical discussion Thrombectomy has appeal for childhood acute ischemic stroke (AIS) due to a longer post-stroke time window for intervention. As the short-term outcome, a significantly reduced Ped NIHSS score is achieved. Long-term outcomes are measured by modified Rankin Scale (mRS) scores. A literature review from 2016 to 2021 yielded 21 pediatric case reports of primary mechanical thrombectomy for anterior circulation stroke (including the present cases). We compare our cases with the published literature to discuss the short-term and long-term outcomes. Conclusion Mechanical thrombectomy holds promise as a treatment modality in pediatric AIS. These case reports described successful primary mechanical thrombectomy for AIS treatment in children.

Background: Glioblastoma is one of the most malignant types of primary central nervous system tumors with a high recurrence rate and dismal prognosis. Multifocal glioblastoma has been shown to have a poorer prognosis than solitary glioblastoma. Cancer patients are at risk of contracting COVID-19. It is hypothesized that COVID-19 may induce glioma tumorigenesis via angiotensin enzyme 2 receptor. We reported a rare pediatric multifocal glioblastoma in a twelve-year-old boy complicated with COVID-19. Case Presentation: The patient was a twelve-year-old boy with a new-onset unprovoked seizure and headache. Magnetic resonance imaging (MRI) showed a heterogeneous solid cystic mass in the left temporal region (2.1x2.1x2.8 cm) with an increased choline/creatinine ratio and choline/n-acetyl acetate aspartate (NAA) ratio suggestive for high-grade glioma. The patient was contracting COVID-19 shortly after the diagnosis of glioblastoma. Two weeks later, patients came with significant neurological deterioration, hemiparesis, headache, and vomiting. MRI showed an infiltrative mass in the temporal and parietal region (5.05x8.03x8.3 cm) with intratumoral hemorrhage, also causing midline shift deviation (11.9 mm). The patient underwent trepanation and total safe resection of the tumor. Histopathological findings showed neoplastic cells with abundant mitotic figures, necrotic foci and pseudopalisading necrosis. These findings confirmed the diagnosis of multifocal glioblastoma. Conclusion: Glioblastoma is a rare disease in the pediatric population with a poor prognosis due to its infiltrative nature and high recurrence rate. The patient had an acute deterioration of the neurological condition and rapid growth of the tumor after he contracted COVID-19, which may or may not be incidental. Further observation of similar cases will be required to determine the association between glioblastoma and COVID-19.

Tumour excision and laminoplasty are commonly performed as surgical treatment of extra vertebral extension of cervical schwannoma. It is worth knowing that the conventional technique of multilevel laminectomy may hinder younger patients in the long-term. This article reports a 30-year old man with an intradural-extramedullary tumour which extended from C4 to T1 that underwent modified laminoplasty.  This modified technique is preferable in maintaining the anteroposterior diameter of spinal canal as well as reducing the displacement of guttered laminae