Augmented reality in pediatric craniofacial surgery: clinical experience

增强现实技术在小儿颅面外科手术中的应用：临床经验

Augmented reality (AR) has recently gained a reputation in surgical applications, providing real-time integration of virtual information into the surgeon's field of view. The aim of this paper was to describe the authors' clinical experience with AR using the Microsoft HoloLens 2 head-mounted display (HMD) in pediatric craniofacial surgery, particularly for correcting single-suture craniosynostosis. The results indicate that AR performs similarly to traditional navigation methods in terms of accuracy. These findings suggest that AR-based HMDs hold significant potential to be a reliable method of intraoperative navigation. Further studies are recommended to implement the application of this technology and assess long-term outcomes.

增强现实（AR）最近在外科手术应用中声名鹊起，它能将虚拟信息实时整合到外科医生的视野中。本文旨在介绍作者在小儿颅面外科手术中使用微软HoloLens 2头戴式显示器（HMD）进行增强现实技术的临床经验，特别是在矫正单缝颅缝早闭方面的应用。结果表明，在准确性方面，增强现实技术的表现与传统导航方法相当。这些发现表明，基于增强现实技术的头戴式显示器有很大潜力成为一种可靠的术中导航方法。建议开展进一步研究以推广这项技术的应用并评估其长期效果。

REF: Ruggiero F, Cercenelli L, Tarsitano A, et al. Augmented reality in pediatric craniofacial surgery: clinical experience. J Neurosurg Pediatr. Published online August 29, 2025. doi:10.3171/2025.4.PEDS24587 PMID: 40882228

Phase 1 and expanded imaging study of tozuleristide in patients with pediatric primary central nervous system tumors

托珠来司他治疗儿童原发性中枢神经系统肿瘤患者的1期及扩展影像学研究

Fluorescence-guided surgery has been shown to increase the extent of resection in adult high-grade glioma. The peptide-dye conjugate tozuleristide is a fluorescence-guided surgical agent under development to aid in visualization of tumor tissue during CNS tumor resection. The goals of this study were to assess safety, pharmacokinetics, and the fluorescent signal of tozuleristide in primary CNS tumors in pediatric patients with CNS cancers and to determine a recommended dose for phase 2 studies. Tozuleristide was well tolerated. The data suggest that tozuleristide fluorescence may be applicable in a range of pediatric CNS tumors and clinical scenarios, providing a useful adjunct to neurosurgeon experience in distinguishing tumor from nontumor tissue.

荧光引导手术已被证明可提高成人高级别胶质瘤的切除范围。肽 - 染料偶联物托祖来司他是一种正在研发的荧光引导手术剂，用于在中枢神经系统（CNS）肿瘤切除过程中辅助可视化肿瘤组织。本研究的目的是评估托祖来司他在中枢神经系统癌症儿科患者原发性中枢神经系统肿瘤中的安全性、药代动力学和荧光信号，并确定 2 期研究的推荐剂量。托祖来司他耐受性良好。数据表明，托祖来司他荧光可能适用于一系列儿科中枢神经系统肿瘤和临床情况，为神经外科医生区分肿瘤组织和非肿瘤组织的经验提供了有用的辅助手段。

REF: Lee A, Cole BL, Ojemann J, et al. Phase 1 and expanded imaging study of tozuleristide in patients with pediatric primary central nervous system tumors. J Neurosurg Pediatr. Published online August 29, 2025. doi:10.3171/2025.5.PEDS24630 PMID: 40882241

Management of positive cerebrospinal fluid cultures from intraventricular reservoirs of neuronal ceroid lipofuscinosis type 2 patients: one institution’s experience

神经元蜡样脂褐质沉积症2型患者脑室内储液囊脑脊液培养阳性的处理：单中心经验

Enzyme replacement therapy (ERT) with cerliponase alfa (Brineura) has been shown to slow the progression of milestone deterioration in neuronal ceroid lipofuscinosis type 2 (CLN2), an inherited neurodegenerative lysosomal storage disorder. Cerliponase alfa must be administered intraventricularly every 2 weeks, necessitating the placement of ventricular reservoirs and requiring frequent access. Traditionally, positive cerebrospinal fluid (CSF) cultures obtained from implanted ventricular reservoirs are managed with device replacement and antibiotic treatment. The authors sought to establish which circumstances might allow for careful observation without device removal. In this study, the authors report their single-institution experience with the clinical outcomes of positive CSF cultures in 16 CLN2 patients with ventricular reservoirs over 6 years. At the authors' institution, we have found that in asymptomatic patients with frequently accessed ventricular reservoirs, positive CSF culture with low virulence skin flora was common. Rarely did positive cultures with common skin flora necessitate intervention. The authors' experience has shown that nonvirulent infection of ventricular reservoirs with low virulence skin flora can be monitored without intervention. This strategy reduces the risks of invasive surgery, prolonged antibiotic courses, and missed infusions.

使用西利庞酶α（布瑞纽拉）进行的酶替代疗法（ERT）已被证明可以减缓神经元蜡样脂褐质沉积症2型（CLN2）的里程碑式功能减退进程，CLN2是一种遗传性神经退行性溶酶体贮积症。西利庞酶α必须每2周进行一次脑室内给药，这就需要植入脑室储液囊且需要频繁穿刺。传统上，从植入的脑室储液囊中获取的脑脊液（CSF）培养呈阳性时，会采取更换装置并进行抗生素治疗的处理方式。作者试图确定在哪些情况下可以进行密切观察而无需移除装置。在这项研究中，作者报告了他们单机构在6年时间里对16例植入脑室储液囊的CLN2患者脑脊液培养阳性的临床结局经验。在作者所在的机构，他们发现对于频繁穿刺脑室储液囊的无症状患者，脑脊液培养出低毒力皮肤菌群呈阳性的情况很常见。由常见皮肤菌群导致的培养阳性很少需要进行干预。作者的经验表明，对于脑室储液囊被低毒力皮肤菌群感染的非致病性感染可以进行无干预监测。这一策略降低了侵入性手术、长期使用抗生素以及错过输注治疗的风险。

REF: Fote GM, Schafenacker A, Singh J, et al. Management of positive cerebrospinal fluid cultures from intraventricular reservoirs of neuronal ceroid lipofuscinosis type 2 patients: one institution's experience. J Neurosurg Pediatr. Published online August 22, 2025. doi:10.3171/2025.4.PEDS24452 PMID: 40845388

Outcomes of ventriculoperitoneal shunt surgery for hydrocephalus in children in low- and middle-income countries: a systematic review

中低收入国家儿童脑积水脑室腹腔分流术的结局：一项系统评价

Improving outcomes for pediatric patients with hydrocephalus in low- and middle-income countries (LMICs) requires research on ventriculoperitoneal shunt (VPS) complications and outcomes that may be comparable to studies conducted in high-income countries (HICs). The authors aimed to address this gap by conducting a systematic review to analyze VPS complications and outcomes among pediatric patients in LMICs. This review provides a comprehensive profile of VPS complications and outcomes in pediatric patients in LMICs. Despite a predominance of observational studies, these findings offer critical insights that may inform health policy and practice in LMICs. Future research should prioritize longitudinal studies to explore long-term outcomes, develop cost-effective approaches to reduce complications, and foster international collaborations to strengthen global neurosurgical capacity.

改善低收入和中等收入国家（LMICs）脑积水儿科患者的预后，需要开展关于脑室腹腔分流术（VPS）并发症和预后的研究，且研究结果应能与高收入国家（HICs）的研究相媲美。作者旨在通过开展系统综述来分析低收入和中等收入国家儿科患者的脑室腹腔分流术并发症和预后情况，以填补这一研究空白。该综述全面概述了低收入和中等收入国家儿科患者脑室腹腔分流术的并发症和预后情况。尽管以观察性研究为主，但这些研究结果提供了重要见解，可能为低收入和中等收入国家的卫生政策和实践提供参考。未来的研究应优先开展纵向研究，以探索长期预后，制定具有成本效益的方法来减少并发症，并促进国际合作以增强全球神经外科能力。

REF: Mukumbya B, Adeleye AO, Siddig AHE, et al. Outcomes of ventriculoperitoneal shunt surgery for hydrocephalus in children in low- and middle-income countries: a systematic review. J Neurosurg Pediatr. Published online August 15, 2025. doi:10.3171/2025.4.PEDS24598 PMID: 40815859

Robot-assisted intrathalamic infusion for gene therapy in young children: surgical considerations

机器人辅助丘脑内输注用于幼儿基因治疗：手术相关考量

Stereotactic gene therapy in children is challenging due to the fragility of the infant skull and long hours of infusion. The thalamus, an integrative hub for the entire cortex, has been shown to facilitate widespread gene/protein delivery via axonal transport. The aim of this study was to evaluate the safety and accuracy of bilateral thalamic convection-enhanced delivery (CED) of adeno-associated virus (AAV) vectors for GM2 gangliosidoses in children and to assess outcomes based on post-infusion imaging. In this study, the surgical technique used in the first in-human intrathalamic drug infusion gene therapy trial in young children with GM2 gangliosidosis was reviewed. The innovative stereotactic setup used robotic surgical assistance and ensured high-precision targeting and secure cannula placement during prolonged infusions, even in infants as young as 6 months of age. Post-infusion MRI confirmed that the infusate remained well contained within the thalamus. The mean Vd/Vi ratio of 2.0 is consistent with the literature. Overall, bilateral thalamic delivery of AAV transgene in children was safe and well tolerated.

由于婴儿颅骨脆弱且输注时间长，儿童的立体定向基因治疗具有挑战性。丘脑作为整个皮质的整合枢纽，已被证明可通过轴突运输促进广泛的基因/蛋白质递送。本研究的目的是评估双侧丘脑对流增强递送（CED）腺相关病毒（AAV）载体治疗儿童GM2神经节苷脂贮积症的安全性和准确性，并根据输注后影像评估治疗效果。在本研究中，对首次在患有GM2神经节苷脂贮积症的幼儿中开展的丘脑内药物输注基因治疗试验所采用的手术技术进行了回顾。创新的立体定向装置采用了机器人手术辅助，确保在长时间输注过程中实现高精度靶向和稳固的套管放置，即使是6个月大的婴儿也适用。输注后磁共振成像（MRI）证实，输注物很好地局限在丘脑内。平均分布容积/输注容积（Vd/Vi）比值为2.0，与文献报道一致。总体而言，儿童双侧丘脑递送AAV转基因是安全的，且耐受性良好。

REF: Daci R, Shazeeb MS, Owusu-Adjei B, et al. Robot-assisted intrathalamic infusion for gene therapy in young children: surgical considerations. J Neurosurg Pediatr. Published online August 15, 2025. doi:10.3171/2025.4.PEDS2569 PMID: 40815857

Short-term outcomes of endoscopic third ventriculostomy and choroid plexus cauterization in children with hydrocephalus at Arusha Lutheran Medical Centre in northern Tanzania: a retrospective study

坦桑尼亚北部阿鲁沙路德教会医疗中心脑积水患儿行内镜下第三脑室造瘘术和脉络丛烧灼术的短期结局：一项回顾性研究

Despite progress in building surgical infrastructure in East Africa, access to neurosurgical care remains challenging. More than 6000 new cases of pediatric hydrocephalus occur each year in sub-Saharan Africa, but only approximately 50 neurosurgeons are available to treat those cases. Treatment for pediatric hydrocephalus typically involves placement of a ventriculoperitoneal (VP) shunt, but recently the treatment focus has broadened to revisit endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC). However, it is unknown whether ETV with CPC (ETV/CPC) is safe and efficacious in low- and middle-income countries for infants younger than 1 year. This study investigated the implementation of ETV/CPC at a low-resource hospital in northern Tanzania. At this institution, ETV with or without CPC was found to be an alternative treatment option when compared to VP shunting. This study also found that these procedures can be safely performed in children younger than 1 year and can avoid the need for VP shunts in many patients. Further research is needed to evaluate the long-term outcomes of these patients.

尽管东非在建设外科基础设施方面取得了进展，但获得神经外科治疗仍面临挑战。撒哈拉以南非洲每年有超过6000例小儿脑积水新病例，但仅有约50名神经外科医生来治疗这些病例。小儿脑积水的治疗通常包括放置脑室腹腔（VP）分流管，但最近治疗重点已扩大到重新审视脉络丛 cauterization（CPC）联合内镜下第三脑室造瘘术（ETV）。然而，尚不清楚在中低收入国家，CPC联合ETV（ETV/CPC）对1岁以下婴儿是否安全有效。本研究调查了坦桑尼亚北部一家资源匮乏医院实施ETV/CPC的情况。在该机构，与VP分流术相比，有或无CPC的ETV被发现是一种替代治疗选择。本研究还发现，这些手术可以安全地在1岁以下儿童中进行，并且在许多患者中可以避免使用VP分流管。需要进一步研究来评估这些患者的长期预后。

REF: Mulla E, Rafka HE, Elahi C, et al. Short-term outcomes of endoscopic third ventriculostomy and choroid plexus cauterization in children with hydrocephalus at Arusha Lutheran Medical Centre in northern Tanzania: a retrospective study. J Neurosurg Pediatr. Published online August 15, 2025. doi:10.3171/2025.4.PEDS24549 PMID: 40815861

Incidence and clinical management of vertebral anomalies in myelomeningocele: a retrospective analysis of 422 cases

脊髓脊膜膨出患者脊柱畸形的发病率及临床处理：422例回顾性分析

Myelomeningocele (MMC) is a severe neural tube defect frequently associated with vertebral anomalies, including scoliosis and kyphosis, which can significantly impact mobility and quality of life. This study aimed to evaluate the incidence and clinical correlations of scoliosis and other vertebral anomalies in children with MMC. Scoliosis and other vertebral anomalies are highly prevalent in MMC patients, necessitating early diagnosis and multidisciplinary management. These findings underscore the importance of long-term monitoring and individualized treatment approaches to optimize spinal health and functional outcomes.

脊髓脊膜膨出（MMC）是一种严重的神经管缺陷，常与脊柱异常相关，包括脊柱侧凸和脊柱后凸，这会显著影响患者的活动能力和生活质量。本研究旨在评估脊髓脊膜膨出患儿中脊柱侧凸及其他脊柱异常的发生率及其临床相关性。脊柱侧凸和其他脊柱异常在脊髓脊膜膨出患者中高度流行，因此需要早期诊断和多学科管理。这些研究结果强调了长期监测和个体化治疗方案对于优化脊柱健康和功能结局的重要性。

REF: Sever C, Alatas I, Ay LA, et al. Incidence and clinical management of vertebral anomalies in myelomeningocele: a retrospective analysis of 422 cases. J Neurosurg Pediatr. Published online August 8, 2025. doi:10.3171/2025.5.PEDS24548 PMID: 40779802

Variation of demographic and socioeconomic factors associated with pediatric traumatic brain injury: a geospatial analysis

与儿童创伤性脑损伤相关的人口统计学和社会经济因素的差异：一项地理空间分析

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among children in the United States, with nearly a half million pediatric TBI-related emergency visits annually. The authors aimed to investigate geospatial disparities in pediatric TBI across ZIP Code Tabulation Areas (ZCTAs) and to assess the association of neighborhood sociodemographic factors with pediatric TBI incidence rate and outcomes. In this cross-sectional study, pediatric TBI rates clustered disproportionately in socioeconomically disadvantaged areas. These findings underscore the need for targeted, neighborhood-level prevention strategies and policies addressing social determinants to mitigate the rising burden of pediatric TBI.

创伤性脑损伤（TBI）是美国儿童死亡和发病的主要原因之一，每年有近50万例与儿童TBI相关的急诊就诊。作者旨在研究邮政编码统计区（ZCTA）内儿童TBI的地理空间差异，并评估社区社会人口学因素与儿童TBI发病率及预后的关联。在这项横断面研究中，儿童TBI发病率在社会经济条件不利的地区异常集中。这些研究结果强调，需要制定有针对性的社区层面预防策略和政策，以解决社会决定因素问题，从而减轻儿童TBI日益加重的负担。

REF: Kazemi F, Cohen AR. Variation of demographic and socioeconomic factors associated with pediatric traumatic brain injury: a geospatial analysis. J Neurosurg Pediatr. Published online August 8, 2025. doi:10.3171/2025.4.PEDS2572 PMID: 40779799

Comprehensive pediatric neurosurgical implant checklist to maintain low implant infection rates: lessons on compliance and institutional culture

维持低植入物感染率的综合儿科神经外科植入物清单：关于合规性和机构文化的经验教训

Implant infection is a significant contributor to morbidity and mortality for children with hydrocephalus and other neurosurgical conditions requiring shunts and other neurosurgical implants. To standardize pediatric neurosurgical care and minimize the risk of infections related to implanted shunts and neurosurgical devices, the authors introduced a 23-point checklist for all pediatric neurosurgical implant procedures at Stanford University in March 2019. This protocol minimizes operating room traffic and standardizes sterile technique, preparation, and antibiotic use. Adherence to a strict implant protocol can ensure very low rates of infections for pediatric shunts and neurosurgical implants. This study found a lower shunt infection rate than the national pediatric benchmark-the 5.1% infection rate observed within the Hydrocephalus Clinical Research Network (HCRN) and the 3.9% infection rate observed within the HCRN quality network, to which the authors' institution contributes data. Despite surgeon and staff turnover, high overall institutional checklist compliance and consistently low infection rates were observed over time.

植入物感染是导致脑积水及其他需要分流管和其他神经外科植入物的神经外科疾病患儿发病和死亡的重要原因。为了规范儿科神经外科护理并降低与植入分流管和神经外科装置相关的感染风险，作者于2019年3月在斯坦福大学为所有儿科神经外科植入手术引入了一份包含23项内容的核查清单。该方案可减少手术室人员流动，并规范无菌技术、术前准备和抗生素使用。严格遵守植入物操作规范可确保儿科分流管和神经外科植入物的感染率极低。本研究发现，分流管感染率低于美国全国儿科基准——脑积水临床研究网络（HCRN）观察到的5.1%的感染率，以及HCRN质量网络观察到的3.9%的感染率（作者所在机构为该网络提供数据）。尽管有外科医生和工作人员更替，但随着时间的推移，仍观察到机构整体对核查清单的高依从性和持续较低的感染率。

REF: Cheetham-West AO, Kumar KK, Kruger JF, et al. Comprehensive pediatric neurosurgical implant checklist to maintain low implant infection rates: lessons on compliance and institutional culture. J Neurosurg Pediatr. Published online August 1, 2025. doi:10.3171/2025.5.PEDS24335 PMID: 40749236