Archives of Pediatric Neurosurgery

Chronic Cervicothoracic Extradural Hematoma Presenting With Progressive Neck Flexion Deformity in an Adolescent: A Rare Case Report

Prakash S Mahantshetti — 2026-01-19

Background: Spinal epidural hematomas (SEHs) are rare but potentially a fatal cause of spinal cord compression. This report describes a case of chronic cervicothoracic SEH presenting with progressive neck flexion deformity.

Case presentation: We present a 16-year-old girl with a 5-month history of progressive neck pain, flexion deformity, and features of myeloradiculopathy. Neurologic examination revealed hyperreflexia (3+), bilateral extensor plantar responses, diminished right grip strength, right-sided limb weakness (4/5 power) and spastic gait. Magnetic resonance imaging (MRI) showed a C6-D1 epidural collection with T1 hypointensity and T2 hyperintensity causing spinal cord compression. She underwent C5–D1 laminectomy with complete hematoma evacuation. Following complete evacuation of the hematoma and excision of this sac-like epidural layer, a second true dural mater was visualized. Histopathology confirmed chronic hematoma with sac like epidural layer with neovascularization and fibrous membrane formation. Postoperatively, the patient achieved complete neurological recovery (5/5 power and normal bilateral grip strength) with no recurrence at six months follow up.

Conclusion: Chronic cervicothoracic SEH should be considered in adolescents presenting with progressive neck pain, deformity, and myeloradiculopathy, even without trauma. Identification of a hematoma membrane resembling dual dura suggests chronic SEH features and is important for achieving complete evacuation. Prompt MRI evaluation, and timely surgical decompression can achieve complete neurological recovery.

Symptomatic Choroidal Fissure Arachnoid Cyst: Treatment by Endoscopic Fenestration

Alejandra Arévalo Sáenz — 2026-01-19

Introduction:
Choroidal fissure cysts are usually incidental findings on imaging studies. They are typically benign lesions, although in some cases they may cause morbidity due to intracranial hypertension. The formation of cysts in this location is related to abnormal development of the choroid tela and the choroidal fissure. Fewer than ten cases have been reported in the literature.

Case description: A 3-month-old patient with a small choroidal fissure cyst at birth presented with acute symptoms of intracranial hypertension, nausea, and vomiting. Imaging revealed a rapid and severe enlargement of the arachnoid cyst within just two weeks, reaching a preoperative size of 50 × 35 × 30 mm. The patient underwent endoscopic fenestration of the cyst, resulting in complete resolution of clinical symptoms in the early postoperative period and marked reduction in cyst size on imaging (36 × 21 × 24 mm) one day after surgery.
At two-month follow-up, the cyst measured 28 × 21 × 19 mm. Symptomatic choroidal fissure cysts are exceptionally rare, with only eight clinical cases reported to date in the literature. Traditionally, treatment has consisted of cystoperitoneal shunting. We currently believe that endoscopic treatment can be offered as a first-line option, achieving complete clinical resolution without evidence of complications.

Conclusion:
Symptomatic choroidal fissure cysts are an exceptionally rare pathology. Treatment by endoscopic fenestration provides excellent clinical and radiological resolution without additional short-term complications.

Aseptic Ascites: A Rare and Challenging Complication of Ventriculoperitoneal Shunting

Renato Colenci — 2026-01-19

Introduction: Ventriculoperitoneal (VP) shunts are widely used to manage hydrocephalus providing significant relief from cerebrospinal fluid (CSF) accumulation. However, abdominal complications, such as aseptic ascites, can occur, albeit rarely. This condition is characterized by the diffuse accumulation of CSF in the peritoneal cavity without evidence of infection, often requiring specific interventions.

Case presentation: We present the case of a 3-year-old child with abdominal distension for the past 15 days, without other abnormalities. The child was in the late postoperative period for optic pathway pilocytic astrocytoma, with surgeries performed at 1 year and 7 months of age and VP shunt (VPS) placement at 1 year and 10 months of age. Abdominal ultrasound, computed tomography, and magnetic resonance imaging revealed large-volume ascites without additional findings. Diagnostic paracentesis showed a serum-ascites albumin gradient (SAAG) of 3.1. Biochemical and microbiological analyses showed no signs of infection, and liver, cardiac, and renal function markers were within normal ranges. Cytological analysis revealed no neoplastic cells. A ventriculoatrial shunt was placed, resolving the ascites.

Conclusions: Aseptic ascites is a rare dysfunction of VPS, with limited cases reported. Most cases of peritoneal fluid accumulation are associated with shunt infections resulting in peritonitis. In aseptic ascites, however, microbiological analysis of ascitic fluid was negative. Intracranial hypertension symptoms are not usual - typically, the main symptom is abdominal distension without signs of peritonitis. Owing to the high protein accumulation and CSF production in certain conditions, ventriculoatrial shunting is commonly chosen as an alternative.

Recurrence Of Pilocytic Astrocytoma Of The Sellar Region With Intraventricular Growth: Clinical Case And Improvement Of Objective Vision

Uygun Altibayev — 2026-01-19

Introduction/Background: Pilocytic astrocytoma (PA) rarely originates in the sellar region. Tumor recurrence with intraventricular extension represents a complex neurosurgical scenario because of the proximity to the optic apparatus and the risk of persistent or progressive visual dysfunction.

Case presentation: An 11-year-old patient with a history of subtotal resection of a sellar pilocytic astrocytoma presented with tumor recurrence three years after the initial surgery, with intraventricular growth on magnetic resonance imaging (MRI). After the first procedure, the patient developed severe visual impairment and diabetes insipidus. Preoperative functional assessment included visual evoked potentials (VEP), which demonstrated delayed conduction along the visual pathways, suggesting compromised but potentially reversible pathway function. The patient underwent repeat surgical treatment via craniotomy with transcortical transventricular tumor resection, aiming at decompression of the visual pathways and maximal safe removal of the recurrent lesion. Postoperatively, gradual functional improvement was observed, including recovery of objective vision characterized by improved ability to perceive details and to discriminate the shape and movement of objects. However, limitations in recognition of fine details persisted, consistent with residual pathway injury.

Conclusions: In recurrent sellar pilocytic astrocytoma with intraventricular extension, surgical reintervention and decompression may lead to meaningful visual functional recovery even after prolonged deficits. VEP constitutes a valuable adjunct for documenting visual pathway dysfunction and may help estimate the potential for postoperative visual improvement.

When Conservative Management Fails: Pediatric Type III Odontoid Fracture With Delayed Instability

João Paulo Sant Ana Santos de Souza — 2026-01-19

Introduction/Background: Pediatric cervical spine trauma is rare, with most injuries involving the upper cervical region. Type III odontoid fractures are commonly managed with external immobilization when atlantoaxial stability is preserved; however, radiographic progression and occult spinal cord compromise may still occur.

Case presentation: A 7-year-old boy sustained high-energy cervical trauma after a fall from a three-story building. He reported mild, transient neck pain and had no neurological deficits. Cervical CT demonstrated a type III odontoid fracture extending to the right superior articular facet, associated with a single-line fracture of the left anterior arch of C1. Initial deformity was minimal (1 mm anterior translation and 6° anterior angulation), and he was treated with a rigid cervical collar. The patient was lost to follow-up and returned 3 months after injury; repeat CT showed marked deformity progression (42.5° anterior angulation and 4 mm translation). MRI revealed anterior spinal cord compression with intramedullary T2/STIR hyperintensity consistent with early radiological myelopathy, despite an unchanged and normal neurological examination. Given progressive instability and occult cord compromise, posterior C1–C2 stabilization with C1 decompression was performed under intraoperative neurophysiological monitoring. Postoperative recovery was uneventful. At 13 months, he remained neurologically intact, with solid fusion on CT and improvement of the intramedullary signal abnormality on MRI.

Conclusions: Pediatric type III odontoid fractures may worsen during conservative management, and clinically silent cord compression with MRI evidence of myelopathy can occur. Timely, structured follow-up imaging is essential, and prompt stabilization should be considered when progression, instability, and/or cord compression is identified.

Does the Incidency Duraplasty with Synthetic Dural Graft or Standard Primary Dural Closure reduce the risk of retethering? A comparative analysis of 36 pediatric patients

Nazar S. Annanepesov — 2026-01-19

Abstract

Bacground; Spinal lipomas in pediatric patients pose a significant risk of neurological deterioration due to the potential for retethering after surgical excision. This study aims to assess the efficacy of duraplasty in mitigating the risk of retethering following spinal lipoma excision in pediatric patients. We compared outcomes between two groups: one treated with duraplasty using synthetic dura and another with primary dural closure.

Methods

A retrospective analysis was performed on 36 pediatric patients who underwent spinal lipoma excision between 2019 and 2024. Group 1 (n=15) received duraplasty with synthetic dura, while Group 2 (n=21) underwent primary dural closure. The primary outcome was the incidence of retethering, defined by clinical and radiological criteria, over a follow-up period averaging 2.6 years (range: 2 – 5 years).

Results

A total of 36 pediatric patients with spinal lipomas were included in this retrospective analysis. The mean age of the study cohort was 9 years and 3 months, ranging from 25 days to 18 years Group 1 demonstrated a significantly lower incidence of retethering (13.3%) compared to Group 2 (38.1%), with a p-value of 0.02. The mean time to retethering was also significantly longer in Group 1 (3.5 years) versus Group 2 (2.1 years), with a p-value of 0.045.

Conclusion

Duraplasty with synthetic dura may reduce the risk of retethering in pediatric patients undergoing spinal lipoma excision. However, further prospective studies with larger sample sizes are required to validate these findings.

Stereotactic Brainstem Biopsy in Children: A Multicentric Case Series of 88 Patients

Walter Fagundes — 2026-01-19

Introduction:
Brainstem tumors pose a significant challenge in pediatric neurosurgery. Although MRI has advanced non-invasive diagnostics, up to 20% of cases show radiologic-histologic discordance, making stereotactic biopsy an important diagnostic option. This study aimed to assess the safety, diagnostic effectiveness, and clinical significance of stereotactic brainstem biopsy in a large pediatric cohort.

Methods:
We conducted a multicentric retrospective review of 88 children with intrinsic, non-resectable brainstem lesions who underwent stereotactic biopsy (frame-based or robot-assisted). Demographic data, surgical technique, histopathological diagnosis, and complications were analyzed.

Results:
Eighty-eight pediatric patients (median age 7 years, range 1.5–17; 54% male) underwent stereotactic brainstem biopsy. The most common presenting symptom was cranial nerve dysfunction, with the pons affected in 76% of cases. Stereotactic frame-based, robot-assisted, and Talairach techniques were used in 10%, 31%, and 59% of cases, respectively. The initial diagnostic yield was 97.7%. The most common diagnoses were high-grade glioma, including diffuse midline glioma (44%), followed by low-grade glioma (41%). The overall complication rate was 9.2%, primarily transient neurological deficits. No procedure-related deaths occurred. The mean follow-up period was 32 months.

Conclusion:
Stereotactic brainstem biopsy is a safe and effective diagnostic tool in children, offering high diagnostic yield with low morbidity. Continued advances in technique and molecular analysis further enhance its clinical value.

Challenges of Myelomeningocele care in sub-Saharan Africa: A Nigerian centre experience

Babagana Usman — 2026-01-19

Introduction: To study the challenges of myelomeningocele care in sub-Saharan Africa (a resource-poor setting). Reviewed the peculiarities of presentation and the management outcomes of patients with myelomeningocoele in our setting. Method: A 3-year retrospective review of all the myelomeningoceles that were managed in our centre from January 2021 to December 2023.
Results: A total of 53 patients were made up of 18 boys and 35 girls, with a male-to-female ratio of 1:2. Ages ranged from 1 hour to 16 years. Spinal levels were 1.9% cervical, 5.7% thoracic, 22.6% lumbar, and 37 (69.8%) in lumbosacral junctions. Circumferences ranged between 10.7 cm and 41 cm. All mothers knew about folic acid, but most (52, 98%) were postconceptional users. Associations include hydrocephalus (40, 75.5%), foot deformities (22.6%), and imperforate anus (1.9%). Surgeries were closure only (18.9%), flap closure (5.7%), closure with VP shunt in the same sitting (2 in 1’) in 36 (67.9%), and post-excision VP shunt in 4(7.5%). Postoperative complications (in 12 patients) were hydrocephalus (4, 33.3%), wound infection/dehiscence (5, 41.7%), and pseudomeningocele (3, 25%). Five (9.4%) patients were lost to follow-up. We had 2 mortalities (3.8%), and both were infection related.

Conclusion: Myelomeningocoele is common among females, and many presentations are late (days to years). Mothers knew about folic acid but lacked basic knowledge about its importance and appropriate usage (timing). We advocate for further public awareness of its preventive measures.

The “Open Science” promise vs the Author-pays reality. The Hidden Costs of Open Access: Equity, Quality, and Trust

Ricardo Santos de Oliveira — 2026-01-19

The movement toward open science was born from a simple and powerful ethical premise: knowledge should circulate freely. In pediatric neurosurgery, where evidence is often limited by rare diseases, small cohorts, and difficult-to-standardize outcomes, open access can be a genuine accelerator. It allows clinicians in resource-limited settings, trainees, and even families to access information that may shape decisions for children with life-altering conditions.

The “publish or perish” culture in academic science can be dangerous because it rewards quantity of publications more than quality, rigor, and truth. That pressure can quietly push individuals, labs, and whole fields toward behaviors that harm science and sometimes harm patients (1).

Yet the current form of “open access” frequently comes with an uncomfortable contradiction. Much of what is now called “open” is not free; rather, the cost has shifted from the reader to the author. The result is a model in which publication is increasingly tied to the capacity to pay. In practice, these risks transforming an ethical project—open science—into a financial gatekeeping system.

A recent analysis discussed in the international press highlights how the four largest commercial scientific publishers—Elsevier, Springer Nature, Wiley, and Taylor & Francis—earned more than $7 billion in 2024, with reported profit margins above 30% (2). These numbers are not merely financial details; they reveal how publishing has become a high-margin industry in which output volume is economically rewarded. In the transition from subscription-based access to the “author-pays” model, the incentives have changed. The new system risks rewarding the quantity of publications rather than the strength of evidence (3).

The consequences extend beyond cost and equity. When the volume of manuscripts becomes the engine of revenue, the stress on peer review increases. Editors and reviewers are overwhelmed. Rapid publication becomes a marketing advantage. “Speed” begins to compete with scrutiny. And the literature becomes vulnerable—not only to error, but also to manipulation.

Predatory journals represent the most visible expression of this environment. There are 2,780 predatoty journals that can be checked in the website (https://www.predatoryjournals.org/the-list/journals).

They imitate legitimate publications, charge fees, promise rapid acceptance, and frequently provide minimal review. They capture authors under pressure, especially those early in their careers or those without institutional guidance. But focusing only on predatory journals can be misleading, because the incentive problem is not limited to fringe actors. Even established journals can be affected when systems are stretched or exploited (4).

This concern was underscored by the recent withdrawal by Elsevier of the article titled “Fragments SARS-Cov-2 in aquatic organism represent an additional environmental risk concern: Urgent need for research” (5). The retraction notice states that the editorial process was compromised due to a breach affecting peer review, and the editors could no longer trust the integrity of the work. The details belong to another discipline, but the message is universal: peer review is not a guarantee; it is a process that depends on integrity, time, and safeguards.

Beyond journals and metrics, fake science is increasingly amplified by social media, where attention rewards dramatic conclusions over careful evidence. Low-quality or even fabricated studies—often from predatory journals or manipulated peer-review pipelines—can spread rapidly as screenshots, short videos, and influencer threads, stripped of context and methodological limitations. Once viral, these claims are hard to correct: retractions rarely travel as far as the original post, and algorithmic feeds can repeatedly surface the same misinformation to clinicians, patients, and families. In medicine, this creates a real safety issue, because shaky findings can shape public perception, pressure clinicians, and even influence treatment decisions long before the scientific community has time to verify the results.

Retractions should not automatically be viewed as scandals. They can also be understood as warning lights on the dashboard of science. They indicate that quality control has failed somewhere in the chain. If retractions increase, it may reflect not only misconduct but also the pressure of speed, the overload of editorial systems, and an ecosystem that favors output.

Pediatric neurosurgery is not immune. Our literature includes small studies, heterogeneous populations, and outcomes that can be difficult to measure. Under these conditions, even honest methodological limitations can be amplified into overstated conclusions. When weak evidence multiplies, it does not simply “add knowledge.” It increases noise, confuses clinical decision-making, and ultimately threatens trust. In a field where interventions shape the entire life trajectory of a child, the tolerance for unreliable science should be minimal.

The author-pays model creates an additional ethical tension for pediatric neurosurgery. Many clinicians and researchers work in settings where APCs represent an impossible barrier. When the ability to publish becomes tied to institutional wealth, the global scientific conversation becomes distorted. Low- and middle-income countries contribute disproportionately to the clinical burden of pediatric neurosurgical disease, yet may be excluded from authorship and visibility. This is not open science; it is open to read, but closed to contribute.

The solution is not to reject open access. Open access remains a worthy goal. The problem lies in confusing openness with payment and dissemination with quality. The model must evolve so that scientific publishing is financially sustainable without turning “open” into a synonym for “pay-to-publish.”

The quality of medical journals depends on several factors involving 3 groups of people; namely: the authors, the reviewers and the editors. Archives of Pediatric Neurosurgery (APN) formulated its essential requirements for the manuscripts submitted for possible publication. (6)

What should change? First, journals must strengthen transparency: APCs should be clearly justified, waiver policies should be functional rather than symbolic, and editorial safeguards against peer-review manipulation should be treated as essential infrastructure. Second, academic institutions should reform incentives. If promotion and prestige depend mainly on publication counts, the system will inevitably reward volume. Rigor, reproducibility, clinical relevance, and ethical conduct must carry more weight than raw productivity. Third, as authors and reviewers, we must be deliberate. Journal selection should be based not only on impact or visibility but also on transparency, editorial governance, and the credibility of peer review.

Open science should mean more than access to PDFs. It should mean openness of methods, openness of data when ethically possible, and openness to critique and replication. Above all, it should mean openness that does not exclude participation based on resources. Pediatric neurosurgery, because of its ethical burden and its high clinical stakes, should be at the forefront of defending a publishing culture where trust matters more than throughput.

If open science becomes merely an invoice attached to publication, we risk building a literature that is widely accessible but progressively less reliable. A truly open scientific ecosystem must be open to read, open to verify, and open to contribute—without sacrificing integrity on the altar of volume.

Acknowledgement to Editors and Scientific Referees 2025

Matheus Ballestero — 2026-01-19

A scientific journal’s greatest responsibility is to ensure that all contributions accepted for publication are rigorously but fairly reviewed. The Editor-in-Chief and Archives of Pediatric Neurosurgery gratefully acknowledge the qualified and regular collaboration of renowned medical doctors and scientists who kindly devoted their time to constructively review the submitted articles. Their expertise and invaluable assistance contributed to maintaining a high scientific standard for APN. We are thus indebted to the Editorial Board members and the following experts who reviewed papers and completed the peer-reviewing process within 2025.

Adrián Cáceres

Alexandre Varella Giannetti

Aline Saré de Melo

Andrei Fernandes Joaquim

Angelo Silva Neto

Breno Barbosa

Brigida Schembida de Oliveira

Bruno Fernandes

Carlos Umberto Pereira

Cassio Raposo-Amaral

Cleiton Formentin

Enrico Ghizoni

Javier Gonzalez Ramos

Jéssica Luchi Ferreira

João Gustavo Rocha Peixoto dos Santos

João Pedro Leite Pereira

Leopoldo Mandic Furtado

Leyzeane Marques do Nascimento

Luciano Furlanetti

Manuell Segredo

Marcelo Volpon Santos

Marcelo Amato

Marcos Devanir Silva da Costa

Matheus Fernando Manzolli Ballestero

Paulo Ronaldo Jubé Ribeiro

Pedro Tadao Hamamoto Filho

Raissa Mansilla

Ricardo Gepp

Rodrigo Inácio Pongeluppi

Sebastian Gastón Jaimovich

Stephanie Naomi Funo de Souza

Tatiana Protzenko

Tiago Cavalcante

Usman Daibu

Walter Fagundes