Archives of Pediatric Neurosurgery

Full-Endoscopic Decompression for Congenital Spinal Stenosis Caused by Diastrophic Dysplasia in a 13-year-old Pediatric Patient: A Case Report

Emilson Camapum — 2025-05-12

Introduction: Diastrophic dysplasia (DTD) is a rare disorder that affects the development of cartilage and bone. It is an autosomal recessive skeletal dysplasia that results in short stature with limb shortening, contractures of large joints, spinal deformities, cleft palate, clubfoot, cystic swelling of the external ear, and deformities of the hands. The spine frequently develops excessive lumbar lordosis, cervical and thoracolumbar kyphosis, and scoliosis. Spinal stenosis can also be found, but it is less commonly reported.

Case presentation: This study aims to present a case of congenital spinal stenosis caused by DTD causing conus medullaris syndrome in a pediatric patient, which was treated with a full endoscopic bilateral over-the-top interlaminar technique. The patient achieved complete symptomatic recovery without any perioperative complications from the procedure.

Conclusion: This is the first report of a full endoscopic decompression for spinal stenosis caused by DTD in the literature. Also, this is the first report of full endoscopic decompression for congenital spinal stenosis in a pediatric patient. Level of evidence IV; Case Series.

Temporalis Muscle Cavernous Hemangioma in a Pediatric Patient

Asmaa Kebbe — 2025-05-12

Background: Temporalis muscle hemangiomas are an uncommon entity, even among the rare incidences of intramuscular hemangiomas. They are frequently identified as round, painless, soft lesions beneath the skin that have been growing slowly over time. A preliminary diagnosis can be made based on magnetic resonance imaging, but it is confirmed by pathology of the surgically excised lesion. The safest practice is to resect all of the hemangioma plus a safe margin of normal muscle so as to prevent recurrence as much as possible. Watchful waiting is also a reasonable alternative when surgery is not indicated.

Case presentation: Because of the apparent paucity of this lesion, especially in the pediatric population, we report this case of a temporalis muscle cavernous hemangioma in a male under 18 years of age who presented for a growing, painful temporalis lesion 4 years after being managed conservatively.

Conclusion: Temporalis hemangiomas are among the rarest intramuscular hemangiomas (IMHs) reported in the pediatrics population. They are often misdiagnosed, with MRIs being the preferred imaging for preoperative diagnosis, and a CT can determine bony involvement. The superior method of treatment when not simply observing its progress is wide surgical excision with normal muscle borders preceded by embolization for better bleeding control. IMHs do not have very high recurrence rates, but re-operation is feasible and none was shown to metastasize.

The Benefits of Epilepsy Surgery in Tuberous Sclerosis: A Case Report

Eduardo Trejo Olguin — 2025-05-12

Introduction/Background: Epilepsy affects millions worldwide, with about one-third of patients remaining drug-resistant despite optimal medical therapy. In tuberous sclerosis complex (TSC), refractory epilepsy is common and severely impacts quality of life. Surgery targeting epileptogenic tubers offers a potential curative approach, contrasting with palliative options like callosotomy.

Case Presentation: A 6-year-old girl with TSC presented with daily drug-resistant focal and generalized seizures. MRI revealed multiple cerebral tubers, with EEG identifying a dominant epileptogenic focus in the left temporal lobe. After multidisciplinary evaluation, the patient underwent left temporal craniotomy and lesionectomy, guided by intraoperative electrocorticography. Postoperative monitoring showed no epileptiform activity. Seizure frequency reduced by 50% immediately postoperatively, reaching remission by one month. At one year, she remained seizure-free with reduced antiepileptic therapy and showed cognitive improvements.

Conclusions: Targeted tuber resection effectively controlled seizures and enhanced quality of life, avoiding more invasive palliative procedures. Careful preoperative evaluation to identify dominant epileptogenic foci is critical. Lesionectomy offers superior long-term outcomes over palliative options like callosotomy in selected TSC patients, supporting a tailored surgical approach based on detailed neuroimaging and electrophysiological data.

Reduction Of Mortality In Children And Youth Due To Central Nervous System Tumors In Brazil

Thamara Bitencourt — 2025-05-12

Introduction: Mortality due to central nervous system (CNS) neoplasms is one of the leading causes of death in the pediatric population. Although Brazil has experienced a general decline in pediatric mortality from CNS neoplasms over the past decade, this trend has not been consistent across all regions of the country.

Methods: This study analyzed trends and regional variations in pediatric mortality from CNS neoplasms using data from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE). Mortality rates among individuals aged 0 to 19 were examined and stratified by sex, race, and federal unit.

Results: CNS neoplasms accounted for 27.3% of all deaths from neoplasms in the pediatric population. An overall reduction in mortality was observed, with the Southeast and Midwest regions showing the most significant declines, while the South experienced a less pronounced reduction. Mortality was more prevalent among males, individuals of white race, and the 5 to 9-year age group—contrasting with international findings that report higher mortality in children under 5 years of age. The data also revealed a trend of decreasing mortality with increasing age.

Conclusion: Regional disparities in mortality may be associated with differences in diagnostic capabilities and access to treatment. The age-related discrepancies between Brazilian and international data may reflect regional demographic dynamics. These findings highlight the ongoing need for improvements in early diagnosis, specialized care, and health education to further reduce CNS neoplasm mortality rates in Brazil.

Access to Pediatric Neurosurgery in Peru: A Call to Action

Christian Alexander Yataco Wilcas — 2025-04-15

One of the most significant challenges facing pediatric neurosurgery in Peru is the scarcity of subspecialists in this field. With a total of 6,546,000 children under 12 years old in the country, there is a clear need to address these issues through the training of more subspecialists, improvements in infrastructure, and collaboration between the government and healthcare institutions (1,2). In the context of pediatric healthcare, it's crucial to highlight that ninety-three out of every one hundred girls and boys under 12 years old have health insurance regardless of gender. Furthermore, the distribution of health insurance coverage shows differences based on geographical location, reaching 91.7% in urban areas and 95.3% in rural zones (1).

However, even though these data reflect a high level of coverage, it's important to note that possessing health insurance does not automatically guarantee complete and timely access to subspecialized medical care, such as pediatric neurosurgery. In Peru, it is common for patients to face long waiting lists in nationally recognized institutes (3); this situation can have severe consequences for the health and quality of life of children.

According to the Peruvian Medical College, the country has only four specialists accredited in pediatric neurosurgery subspecialty, while twenty specialists have the same recognition in pediatric neurology (4). In terms of the availability of specialists certified by the Peruvian Medical College, a pediatric neurosurgeon can provide care to approximately one million six hundred thousand children, while a pediatric neurologist can attend to around three hundred thousand children. The lack of specialists is alarming as it does not reflect the necessary coverage that specialized pediatric institutes should offer; in the long run, a negative impact on the quality of care required for specialized medical-surgical treatment is expected. It is essential to take steps to increase the training and education of specialists in pediatric neurology in our country, thus ensuring adequate access to medical care for children in need.

Moreover, in many regions of Peru, especially in rural and remote areas, hospitals and medical centers lack the necessary resources to perform highly complex pediatric neurosurgery procedures, necessitating humanitarian aid such as assistance and/or training (5). This lack of resources can significantly limit children's access to proper medical care, often leading to increased suffering and a poorer prognosis for patients.

Access to healthcare in Peru is often linked to geographical location and the economic resources of families (6). Children living in rural areas or coming from low-income families may face significant challenges in accessing quality pediatric neurosurgery services. This creates a disparity in healthcare, where some children may receive timely and high-quality care while others may go unattended.

Another issue affecting pediatric neurosurgery in Peru is the lack of public awareness regarding the importance of this specialty and neurological conditions in children (7,8). The lack of knowledge about warning signs of neurological problems in children can lead to delayed diagnoses and, ultimately, less effective treatment. It is essential to increase public awareness about these issues so that parents and caregivers can seek early medical attention when necessary.

To improve the situation of pediatric neurosurgery in Peru, it is crucial to continue training doctors and specialists in this field. Medicine is constantly evolving, and healthcare professionals must stay at the forefront of the latest techniques and advancements in the field. Continuous training and updating are fundamental to ensure that patients, especially children, receive the most up-to-date and high-quality care (9).

The coordination of healthcare is another critical aspect in managing pediatric neurological conditions. Children requiring neurosurgical care often need long-term follow-up and may require collaboration from different medical specialties. The lack of a well-coordinated care network can hinder the treatment and follow-up process, resulting in fragmented and less effective care.

Pediatric neurosurgery is an essential medical discipline for the well-being of children in Peru. However, it faces significant challenges, including the shortage of specialists, lack of resources in certain areas, unequal access to healthcare, lack of public awareness, and the need for constant training. To enhance care for children with neurosurgical conditions, it is fundamental to address these issues and work collaboratively with authorities to ensure equitable access and quality care throughout the country.

Announcement of the Latin American Congress in Pediatric Neurosurgery - CLANPED 2025

Javier Gonzalez Ramos — 2025-05-19

Dear Editor,

I am writing to inform you and the readership of the Archives of Pediatric Neurosurgery about the upcoming Latin American Congress in Pediatric Neurosurgery, organized by ASOLANPED. The event will take place in São Paulo, Brazil, from August 12 to 16, 2025.

This prestigious congress will bring together leading experts, researchers, and practitioners from across Latin America to discuss the latest advances and challenges in the field of pediatric neurosurgery. The congress will provide a unique opportunity for knowledge exchange and professional collaboration.

Among the scientific highlights, there will be two specialized courses focusing on Oncology, Hydrodynamics, and new technologies, designed to enhance the skills and expertise of the participants in these critical areas. Additionally, a dedicated microsurgery course, organized by Professor Feres Chaddad, will be held at the Federal University of São Paulo (Unifesp), providing hands-on training and practical insights from renowned specialists.

We believe that the congress will significantly contribute to the advancement of pediatric neurosurgery in the region and foster valuable interactions among professionals. We kindly invite the readership of the Archives of Pediatric Neurosurgery to participate and gain from this enriching experience.

Thank you for considering this announcement. We look forward to welcoming participants from around the globe to São Paulo this August.

Sincerely,

Javier Gonzalez Ramos – President of ASOLANPED

Ricardo Santos de Oliveira – President of CLANPED 2025

Giant tumor in an infant: How I do it

Rodrigo Inácio Pongeluppi — 2025-05-12

Giant tumors in infants present numerous surgical challenges. Even experienced surgeons may encounter difficulties in achieving total resection, controlling intraoperative bleeding, and preventing postoperative complications in these cases.

In this clinical video, we present the case of a 9-year-old boy who arrived at the emergency room with progressive headache and papilledema. Imaging revealed a giant hemispheric brain tumor. The video highlights the key surgical steps involved in its resection.

This case demonstrates the surgical approach to removing a large hemispheric tumor in a pediatric patient, emphasizing technique, strategy, and intraoperative decision-making.

Response to: Access to Pediatric Neurosurgery in Peru: A Call to Action

Artur Henrique Galvao Bruno Da Cunha — 2025-05-12

Practicing medicine in South American countries presents significant challenges due to limited budgets and high population demand. I have visited Peru multiple times, and on several occasions, I had the privilege of accompanying Dr. Zopfi, Dr. Posadas, and others on hospital visits and surgeries. I witnessed the struggles families face in seeking funds to purchase shunts for patients with hydrocephalus, as well as the need for essential medications like antibiotics. Over the last 24 years, the situation appears to have improved slightly, but there is still a shortage of medical supplies necessary to effectively serve the population.

In Peru, there are several types of health insurance plans available. Private health insurance plans are offered to a small percentage of the population. E-Salud is available for registered workers, while the Seguro Integral de Salud (SIS) provides coverage to approximately 70% of the population, similar to Brazil's SUS system.

Additionally, I believe that the claim stating there are only four pediatric neurosurgeons in Peru is outdated. Currently, more than 20 pediatric neurosurgeons are practicing at various institutions, including Hospital Del Niño, Centro Medico Del Niño, and Hospital Rebagliatti, among others.

Since 2000, the Pediatric Chapter of FLANC, now known as ASOLANPED, has organized several courses in various cities, including Lima, Trujillo, Cuzco, and Cajamarca, often with support from GLEN and ISPN.

In 2003, the International Association of Child Neurosurgery (INCA) was established as a US foundation to support pediatric neurosurgery in Peru. Their missions in Lima at the Hospital María Auxiliadora have resulted in numerous brain surgeries for children. Between 2004 and 2006, INCA provided training and equipment to develop a program in microsurgical techniques, neuroendoscopy, and minimally invasive neurosurgery. This support has contributed to a reduction in the number of shunt implants by implementing neuroendoscopic surgeries for treating hydrocephalus.

The Peruvian Society of Neurosurgery engages in exchanges with various societies worldwide. In South America, Peruvian professionals participate as both students and instructors in the Latin American Course of Pediatric Neurosurgery, which is organized annually by ASOLANPED and SBNPed.

In conclusion, the field of pediatric neurosurgery in Peru consists of well-trained and competent professionals who strive to perform their duties to the best of their abilities, despite facing challenges related to modern supplies and equipment.

From Hands to Holograms: The Evolution of Teaching Methods in Neurosurgery

Ricardo Santos de Oliveira — 2025-05-12

Editorial

The art and science of neurosurgery have always required a unique blend of cognitive rigor, manual dexterity, and decisive action. Over the centuries, the methods used to transmit this complex skillset from one generation to the next have transformed dramatically. From master-apprentice relationships in antiquity to the era of artificial intelligence (AI) and extended reality, the teaching of neurosurgery mirrors the broader technological and cultural shifts of human history.

In ancient times, surgical learning was deeply rooted in observation and repetition. Hippocratic and Galenic texts provided the earliest frameworks for understanding the nervous system, but it was through hands-on apprenticeship that technical knowledge was transmitted. This master-apprentice model, though limited in scalability and standardization, fostered deep mentorship and experiential learning.

The Renaissance brought with it the first formal anatomical studies, and by the late 19th and early 20th centuries, pioneers like Harvey Cushing had established neurosurgery as a distinct discipline. The advent of medical schools, dedicated neurosurgical residencies, and anatomical dissection labs allowed for a more structured and evidence-based approach to surgical education. In pediatric neurosurgery, groundbreaking innovations in the understanding of congenital anomalies and cerebrospinal fluid dynamics prompted subspecialized training and curricula.

The second half of the 20th century witnessed the introduction of audiovisual aids, operative atlases, and cadaveric simulation, marking a pedagogical shift towards multimodal learning. Microsurgical techniques and imaging advances demanded refined motor skills and spatial understanding, further emphasizing the need for simulation and repetition beyond the operating room.

Today, neurosurgical education is undergoing yet another revolution—one driven by the integration of artificial intelligence, virtual reality (VR), augmented reality (AR), and machine learning. AI-driven platforms now offer adaptive learning experiences, predictive analytics for surgical outcomes, and real-time feedback during simulations. Immersive VR/AR environments allow trainees to rehearse complex procedures in risk-free, anatomically accurate settings. These technologies are particularly transformative in pediatric neurosurgery, where surgical approaches must be tailored to the dynamic anatomy of the developing brain.

Furthermore, the use of AI in evaluating surgical performance, customizing educational content, and even in preoperative planning is not only enhancing the learner's journey but also democratizing access to high-quality training across regions and institutions. However, while these tools are powerful, they must augment—not replace—the foundational human elements of neurosurgical education: mentorship, ethics, empathy, and clinical judgment.

As we stand at the frontier of AI-integrated neurosurgical education, we must also reflect on the enduring values of our field. The future neurosurgeon must not only master emerging technologies but also cultivate the humility to learn from patients, the discipline to continually self-assess, and the wisdom to balance innovation with tradition.

The evolution of teaching methods in neurosurgery—from scalpels to simulations, from skulls to systems—has been remarkable. In pediatric neurosurgery, where the stakes are exceptionally high and the margin for error exceptionally low, embracing both the art and the algorithm will ensure that we continue to serve the youngest and most vulnerable patients with excellence and compassion.