Pre-operative imaging and post-operative appearance of standard paediatric neurosurgical approaches: a training guide for neuroradiologists

Abstract

A short-cut narrative review was conducted according to the SANRA guidelines to identify studies describing normal and abnormal postoperative radiological features of the most common paediatric neurosurgical procedures. Rather than focusing on the original pathology addressed by neurosurgical means, this review explored three main areas of operative neurosurgery: ventricular access, supratentorial & infratentorial craniotomies, and posterior fossa/craniocervical junction decompression. A total of twenty-three landmark papers were included for review based on their relevance to address the research question and serve as a practical guide for paediatric neuroradiology trainees and fellows. Accurate in text referencing of the ClinicalTrials.gov identifier, and weblink, has also been provided for all trials discussed in the results section. All the above is complemented by relevant iconography meant to describe a wide range of postoperative changes and early complications. Finally, the review is enriched by a discussion touching upon haemostatic agents, intentionally retained foreign bodies and the future of machine learning for neuroradiology reporting. Overall, the information presented in a systematic fashion will not only help trainees and fellows to deepen these topics and expand their knowledge in preparation for written and oral boards, but will also represent a useful resource for everyone including trained neuroradiologists and neurosurgeons themselves.

Pre-Operative CSF Analysis as a Prognostic Factor for Shunt Infection in Children

“…This conservative approach aligns with current surgical protocols, ensuring patient safety while the medical community awaits further research (21). Such studies should aim to encompass a larger, more diverse cohort and potentially extend the follow-up period to definitively ascertain the utility of intraoperative CSF sampling in pediatric neurosurgery (2,4,5,8,11,13,21,22).…”

“…In this study, we conducted a prospective analysis of 100 pediatric patients, all below the age of 16, who underwent ventriculoperitoneal (VP) shunt placement at Jinnah Post Graduate Medical Centre between June and December 2022. The cohort was carefully selected to include only those who had not undergone previous cranial surgeries, such as external ventricular drain placement or Ommaya reservoir insertion, ensuring a more homogenous study group and minimizing confounding factors (7,8). Patient demographics, the clinical condition necessitating the VP shunt procedure, shunt type, and the dates of VP shunt insertion and any subsequent infection or malfunction were meticulously recorded.…”

The incidence of VP shunt infection in a middle-income nation: a retrospective analysis of a pediatric population

“…At our institution, the preference is for Keen's point by senior neurosurgeons and the Chief of Neurosurgery, which is primarily used during the training of residents. This procedure is done by free hand, as image guidance [the gold standard as noted by Ganau et al ( 9 )] is not available to us. The success rate of freehand placement of ventricular catheter has been noted to be 44%–64% for Kocher's and 67%–71% with occipital and parieto-occipital approaches ( 8 ).…”

Bilateral fronto-orbital advancement combined with cranial vault release using a free-floating bone flap technique for nonsyndromic unilateral coronal synostosis

“…Of note, single-suture craniosynostosis may also result in a significant volumetric reduction of the skull cavity on the affected side with consequent functional impact due to potential increases in intracranial pressure (ICP) in about 15–20% of children ( 2 ). The goals of operative treatment are therefore to improve appearance and allow unrestricted brain growth while minimizing any detriment to brain development ( 3 ).…”