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OBJECTIVES: The presenting literature review aims to evaluate the efficacy and reliability of corpus callosotomy (CC) as a palliative treatment in pediatric patients with refractory epilepsy. METHODS: Relevant studies were searched in the databases Pubmed, Scopus, and Lilacs. For such, the keywords "corpus callosotomy" AND "epilepsy" AND "pediatric" OR "child" were used. The following eligibility criteria were taken into consideration in the selection: descriptive studies published in English in the last 5 years; = 20 patients from 0 to 19 years old presenting refractory epilepsy who underwent total or partial CC; and a minimum of 6 months of post-operative follow-up. The procedure's efficacy and safety, in addition to improvement in quality of life, were evaluated. RESULTS: In general, the most used surgical approach was total CC and the majority of patients presented more than one type of epilepsy. The percentage of seizure-free patients after CC was significant in two studies (21,7% and 35%) and more than half attained a reduction of at least 50% in epileptic crises. In one study, crisis reduction had a mean of 90% and 72,7% of patients reported improved quality of life. The number of direct complications in two studies was =10% and deaths due to CC were rare. Neurological deficits were relatively common in one study, mostly transitory. Conclusion: Corpus callosotomy is an efficient palliative resource in the treatment of refractory epilepsy in pediatric patients. Furthermore, the number of direct complications and deaths are rare and neurological deficits are mostly temporary. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Malignant neoplasms of the encephalon and other central nervous system structures (MNECNS) present significant prevalence in children. Due to scientific scarcity and the subject's importance, this study aims to epidemiologically analyze the number of hospitalizations and absolute mortality by MNECNS in children. METHODS: Descriptive retrospective study about the number of hospitalizations and absolute mortality by MNECNS in Brazil from 2010 to 2020 in children from 0-14 years old. Data were obtained through the Department of Informatics of the Brazilian National Health System (DATASUS). This system shows limitations, such as the underreporting and the nondifferentiation of the neoplasm's histologic types. The variables utilized were the number of absolute deaths, hospitalizations, age group, sex, race, and region. There was no need for approval of the Ethics Committee for data collection since this study uses publicly available data. FINDINGS: In Brazil, 5424 absolute deaths and 32,458 hospitalizations due to MNECNS were reported in children from 0-14 years old, from 2010 to 2020. Southeast region had highest numbers of absolute deaths (39,14%) and hospitalizations (45,17%). White children represented the majority of absolute deaths (51,07%) and hospitalizations (40,76%). The age with most cases of either absolute deaths (35,9%) and hospitalizations (35,96%) was 5-9 years old. Boys represented 52,64% of absolute deaths and 55,99% of hospitalizations CONCLUSION: Between 0-14 years old, the hospitalizations and absolute deaths caused by MNECNS were more common in children of 5-9 years old, white individuals, boys, and in the Southeast of Brazil (which presented a higher overall number of cases). [ABSTRACT FROM AUTHOR]

Objective: Hydrocephalus is a disorder in which an excessive quantity of cerebrospinal fluid accumulates inside the cerebral ventricles and/or subarachnoid space. Given its elevated morbimortality and this study aims to epidemiologically analyze the prevalence of hydrocephalus in live births (HLB) and absolute mortality in children under 1-year-old due to hydrocephalus in Brazil between 2010 and 2020. METHODS: A descriptive retrospective study was conducted using data from the Brazilian National Health System (DATASUS) to determine the number of HLB and absolute mortality in children under 1-year-old. Variables included HLB, mortality rate, sex, race, and region. RESULTS: In 11 years, Brazil reported 6,985 cases of HLB and 894 deaths in children under 1 year old due to hydrocephalus. The Southeast (36.93%) and Northeast (30.95%) regions had the highest HLB numbers, while the Northeast (41.61%) had the highest mortality rate. Male cases accounted for 53.99% of HLB and 53.57% of deaths. Brown children constituted the largest portion of HLB (54.20%), and white children had the highest mortality rate (45.41%). The mortality rate due to hydrocephalus was 12.79%, with the high rate in the Northeast. Conclusion: Between 2010 and 2020, Brazil experienced 6,985 cases of HLB and 894 deaths in children under 1 year old due to hydrocephalus, resulting in a mortality rate of 12.79%. The Southeast exhibited the highest HLB count, while the Northeast had a high mortality rate. Male patients and white children had the highest number of deaths. [ABSTRACT FROM AUTHOR]

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Study Design: systematic review., Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures of the subaxial cervical spine in neurologically intact patients., Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order to determine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxial cervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with the PRISMA Statement and registered on PROSPERO (CRD42023405699)., Results: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databases were included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, a serious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to less complex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operative management (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture height and non-operative treatment success [Fracture height (percentage) Mean Difference = -17.51 (-28.22, -6.79 95% CI); Absolute height Mean Difference: -0.46 (-0.60, -0.31 95% CI)]. Other risk factors were not included in the meta-analysis due to lack of data. The level of certainty was rated as "very low"., Conclusions: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute terms or as a percentage) are significant risk factors for failure of non-operative treatment., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Factors influencing the length of spinal instrumentation have been mostly evaluated in burst fractures, receiving more attention than other unstable thoracolumbar injuries. We aimed to evaluate clinical factors affecting surgical decision-making and associated complications., Methods: This was a multicentric retrospective cohort study. Outcomes of patients with AO Spine injury classification types B2, B3, and C operated through an open posterior-only approach were analyzed. Length of instrumentation was correlated with age, type of injury, comorbidities, level of injury, neurological status, and complications., Results: Among 439 patients, 30.3% underwent short-segment fixation (SSF) and 69.7% underwent long-segment fixation (LSF). Type C injuries were treated with LSF in 89.4% of cases ( P < 0.001). On multivariate analysis, age ≤39 years (OR: 2.06), AO spine type B2 (OR: 3.58), and type B3 (OR: 7.48) were statistically significant predictors for SSF, while hypertension (OR: 4.07), upper thoracic injury (OR: 9.48), midthoracic injury (OR: 6.06), and American Spinal Injury Association Impairment Scale A (OR: 3.14) were significantly associated with LSF. Patients with SSF had fewer overall complications (27.1% vs 50.9%, P < 0.001) and were less likely to develop pneumonia (6.0% vs 18.3%, P < 0.001) and urinary tract infections (6.8% vs 16.3%, P < 0.007)., Conclusions: Unstable thoracolumbar injuries were mostly treated by LSF. Length of instrumentation was affected by the type of spinal injury, location of the injury, and neurological status. SSF was associated with lower rates of early complications than LSF., Clinical Relevance: The decision on the length of fixation in the surgical treatment of unstable thoracolumbar injuries is affected by different factors, and it will impact the rate of postoperative complications., Competing Interests: Declaration of Conflicting Interests: The authors report no conflicts of interest in this work., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Background: Thoracic and lumbar spine injuries may require surgical management, particularly AO Spine types B and C injuries. Open reduction and fixation using pedicle screws, with or without fusion and/or decompression, is the gold standard surgical treatment for unstable injuries. Recent advances in instrumentation design have resulted in less-invasive surgeries. However, the literature is sparse about the effectiveness of these procedures for types B and C injuries. The objective is to compare the outcomes of conventional open surgery versus minimally invasive spine surgery (MISS) for the treatment of AO Spine types B and C thoracolumbar injuries., Methods: A systematic review of published literature in PubMed, Web of Science, and Scopus was performed to identify studies comparing outcomes achieved with open versus minimally invasive surgery in AO Spine types B and C thoracolumbar injury patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used., Results: Five retrospective case-control studies and 3 prospective studies met selection criteria. In general, most of the studies demonstrated that minimally invasive spine surgery is feasible for types B and C injuries, and associated with potential advantages like reduced blood loss, postoperative pain, and muscle injury, and shorter hospital stays. However, no differences were detected in major outcomes, like neurological status or disability., Conclusions: Published literature currently suggests that minimally invasive spine surgery is a valid alternative for treating types B and C thoracolumbar injuries. However, further comparative prospective randomized clinical trials are necessary to establish the superiority of one approach over the other., Level of Evidence: 3., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS.)

Pituitary carcinomas are rare neoplasms characterized by craniospinal and/or systemic metastases originated from the pituitary. Their histopathology is frequently indistinguishable from that of benign adenomas. The development of markers that better reflect their behavior is desirable. We present the case of a 47 year-old man with a prolactin-secreting macroadenoma who was submitted to surgeries, cranial radiation therapy, and bromocriptine treatment, but evolved to a fatal outcome after the disclosure of intracranial metastases. Tumor samples underwent p53 and Ki-67 immunohistochemical assessment. p53 was absent in all samples, a rare finding among pituitary carcinomas. Ki-67 proliferative index was 2.80% in the original tumor, 4.40% in the relapse, and 4.45% in the metastasis. The figure in the relapse is higher than the expected for a noninvasive adenoma. In conclusion, p53 staining is not positive in all pituitary carcinomas. A high Ki-67 proliferative index in a pituitary adenoma might indicate a more aggressive behavior.