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The first edition of the Archives of Pediatric Neurosurgery (APN) was released in September 2019. Since then we have completed the 10th edition. There were 108 submissions receives (44/year), with a rejection rate of 20%. Archives of Pediatric Neurosurgery is the first open access electronic-only journal in pediatric neurosurgery, and also we are on social media as Facebook, Instagram and Tweeter. APN is the only journal specialized in Pediatric Neurosurgery in Latin America and Mexico. We have different types of publication highlighted the original papers, review, clinical case, video clinical case, and clinical video lecture. The Archives of Pediatric Neurosurgery is a triannual peer-reviewed medical online journal and was recognized in September 2020 as the official publication of the Brazilian Society for Pediatric Neurosurgery. In addition, the internal regulation (by-laws) was approved during the 2021 SBNPed Business Meeting. Some statistics related to APN (2019-2022): MOST DOWNLOADED PDF ARTICLE: Dezena et al. Anatomy of the ventricular system: Historical and morphological aspects MOST READ ABSTRACT: De Paula et al. Shaken Baby Syndrome: literature review in the last 5 years MOST CITED ARTICLE: de Oliveira RS, Ballestero MFM. The Covid-19 Outbreak and Pediatric Neurosurgery guidelines All articles are available online and free license to open access and download. All the papers were peer-reviewed (Figure 1). During this period, we included a specialized consultancy and we were able to index the APN in several indexing bases: DOAJ, Google Scholar, Cengage, REDIB, Crossref, Dimensions, J-Gate, and BASE. DOAJ is the most important community-driven, open access service in the world and has a reputation for advocating best practices and standards in open access. DOAJ indexing has brought recognition of a correct and well-structured work On this special occasion the editorial office would like to extend their greatest appreciation to all editors, and reviewers who have been supportive, and devoted much of their time and effort in nurturing APN. The journal, in particular, would like to thank the authors for submitting their papers to APN. We organized two editions in 2022 focusing on craniofacial and arachnoid cysts. Based on data from Google Analytics, APN is gaining momentum and attracting interest from readers. The number of accesses to abstracts has been increasing progressively since 2019 (Figure 1). The editorial board thanks you and the work continues so that we can reach new indexing bases and consolidate as a reference in pediatric neurosurgery. Recently, the Brazilian Neurosurgery Society recognized the importance of APN by supporting the project. Happy Birthday Archives of Pediatric Neurosurgery! A long life for everyone!

ABSTRACT A systematic review of the literature was performed in order to organize, evaluate, and select evidences available about the safety and efficacy of minimally invasive percutaneous arthrodesis with percutaneous pedicle screws in the treatment of patients with degenerative disc disease (and other spinal pathologies) as compared to conventional arthrodesis. PubMed, EMBASE and Cochrane Library databases were consulted to locate clinical trials and case reports/case series published in English between 2014 and 2019. After selection according to the inclusion/exclusion criteria, 21 of the 197 articles identified were chosen for a complete reading and used for the present review. Although the level of evidence of most of the studies included made the demonstration of efficacy and superiority among the surgical techniques reviewed difficult, the findings related to the minimally invasive procedure indicate a safe and reliable approach for the treatment of lumbar diseases. Level of evidence II; Systematic review of literature.

Much controversy remains on the current management of Chiari I deformity (CID) in children, with many clinical, surgical and ethic-legal implications. The Brazilian Society of Pediatric Neurosurgery (SBNPed, in the Portuguese acronym) has put together a panel of experts to analyze updated published data on the medical literature about this matter and come up with several recommendations for pediatric neurosurgeons and allied health professionals when dealing with CID. Their conclusions are reported herein, along with the respective scientific background.

A scientific journal’s greatest responsibility is to ensure that all contributions accepted for publications 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 maintain 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 2021.

An unlikely idea became a reality in June 2019 when we gathered an enthusiastic group and started testing the platform & workflow by OJS/PKP thus turning an idea into something concrete. The next step would be choosing the name of the journal and creating the website. Finally, the choice of the national and international editorial board based on academic and scientific criteria. Archives of Pediatric Neurosurgery (APN) was born. We published the very first issue of the APN in September 2019. The decision was to use of the Internet and related technologies as an enabler and infrastructure for health innovations. The use of information and communication technologies and the web helps to empower patients (not least through peer-to-peer communications), provides a platform for communication, clinical information and telemedicine (these days often through mobile devices), and revolutionizes information access and medical education [1]. We were not only innovating on content, but also on form. We were the first open access electronic-only journal in pediatric neurosurgery, and also, we are on social media as Facebook, Instagram and tweeter. We have different types of publication highlighted the clinical case, video clinical case, and clinical video lecture. Our YouTube channel, together with SBNPed, has a total of 48 videos and more than a thousand inscriptions. The Archives of Pediatric Neurosurgery is a triannual peer-reviewed medical online journal and was recognized in September 2020 as the official publication of the Brazilian Society for Pediatric Neurosurgery. We believe APN will contribute in furthering efforts to make our dream a reality getting a pediatric neurosurgery medical journal to be recognize in the world as option to publish original papers, clinical case, video clinical case, and others. Some statistics related to APN: MOST DOWNLOADED PDF ARTICLE: Dezena et al. Anatomy of the ventricular system: Historical and morphological aspects MOST READ ABSTRACT: Furlanetti et al. Shunt Technology in Pediatric Neurosurgery: Current options and Scientific Evidence MOST CITED ARTICLE: de Oliveira RS, Ballestero MFM. The Covid-19 Outbreak and Pediatric Neurosurgery guidelines Submissions Received 112 In two years, APN has published 62 international peer-review medical journals in 5 issues from September, 2019 to August, 2021. All articles are available online and free license to open access and download. All the papers were peer-reviewed (Figure 1). During this period, we included a specialized consultancy and we were able to index the APN in several indexing bases: Google Scholar, Cengage, REDIB, Crossref, Dimensions, and the most recent J-Gate. On this special occasion the editorial office would like to extend their greatest appreciation to all editors, and reviewers who have been supportive, and devoted much of their time and effort in nurturing APN. The journal, in particular, would like to thank the authors for placing their faith in this new, bold journal when it was still in its beginning stages. This continuous support has been pivotal to the development of the journal. In the times to come, APN will remain committed to publishing novel, high-quality, and valuable content. APN endeavors to bring readers the most up-to-date information in a wide variety of fields in the hopes of ultimately benefiting patients, all while ensuring the largest possible readership for all articles published in the journal. In our modern globalized academic community, APN recognizes the importance of international collaborations, and seeks to promote itself as an international journal. We have organized a series of articles focusing on important topics in various fields, and invited international prominent experts to co-author. Based on data from Google Analytics, APN is gaining momentum and attracting interest from readers. The number of accesses to abstracts has been increasing progressively since 2019 (Figure 2). As Section Editors, they keep track of the latest and significant research in their areas and recommend international key opinion leaders to review and write editorial comments on those important topics. We will pursue the serious work and include the APN in more indexing databases, expanding its importance in pediatric neurosurgery. Yes, it's time to celebrate this incredible achievement! but continue the professional work. Happy Birthday Archives of Pediatric Neurosurgery! A long life for everyone!

A scientific journal’s greatest responsibility is to ensure that all contributions accepted for publications 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 maintain 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 2020.

Introduction: Dandy Walker malformation (DWM) is characterized by agenesis or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle leading to an increase of the posterior fossa and superior dislocation of the lateral sinus, tentorium and torcula. Although it is the commonest posterior fossa malformation, its pathogenesis is still not fully understood, making the differential diagnosis with other posterior fossa malformations difficult and as a result the choice of therapeutic strategy. Material and methods: An extensive review of the literature relating to Dandy Walker malformation was performed. Historical, genetic, embryologic, epidemiologic, clinical and radiological presentation, treatment and prognosis were revised. Conclusion: The correct diagnosis of Dandy Walker malformation can be made through careful interpretation of magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) flow studies. The choice of hydrocephalus treatment depends on whether there is aqueduct stenosis. And, although ventriculoperitoneal (VP) shunts have been the treatment of choice for many years, neuroendoscopic techniques such as endoscopic thirdventriculostomy and stent placement are being frequently performed lately.

Dear Reader, You are receiving the second volume of Archives of Pediatric Neurosurgery. This is an electronic journal from the Brazilian Society of Pediatric Neurosurgery, which is published quarterly. We are dedicating this volume to hydrocephalus-related topics. Hydrocephalus is one of the most important topics in pediatric neurosurgery and is related to up to 40% of the activities performed in many specialized services. With its multiple etiologies and variety of proposed treatment modalities, this disease presents a huge challenge, and many questions have not been answered. When focusing on fetal hydrocephalus, we still cannot determine which fetuses will benefit from treatment during the fetal period. The answers are also unclear as to why surgery for myelomeningocele correction performed under 27 weeks of gestation decreases the prevalence of hydrocephalus. What is the best treatment for intraventricular hemorrhage in premature infants: Brain Washing, external ventricular drainage, ventriculosubgaleal shunt, reservoir placement and repeated punctures or lumbar punctures? Furthermore, what is the best treatment for hydrocephalus in cases of posterior fossa tumor: Placing an external ventricular drain and resecting the tumor, performing a third ventriculostomy or placing a ventriculoperitoneal shunt, considering that in cases of giant tumors in each of these situations, ascending herniations can occur? Of course, the procedure selected will be related to the dynamics, volume and expertise of the treatment center. Regarding valves, we know that the number of shunts implanted annually is enormous and that the market for valves is divided among several companies that manufacture these prostheses. Which valve is the best? An anti-gravitational one, a programmable one, one with an anti-siphon mechanism? Fixed-pressure valves, valves that produce fewer MRI artifacts, those that do not experience pressure changes due to MRI, or those impregnated with antibiotics? How can a simple valve work as well as a valve with a complex system? Why does a valve system cost $1,000 in one country but costs ten times more in another country? Why are some types of valves sold only in underdeveloped countries? How can we avoid or minimize biological and mechanical complications after valve placement? Even neuroendoscopic procedures that have been performed for more than 25 years in Brazil are not free of complications such as bleeding, infection and technical incapacity of the professional. Nevertheless, we believe that all services that treat children with hydrocephalus should be able to provide neuroendoscopic procedures, thus decreasing the number of shunts placed. We hope that this volume can answer some of these questions. I invite you to participate in Archives of Pediatric Neurosurgery by contributing scientific articles focusing on pediatric neurosurgery. This volume was compiled during the coronavirus (COVID-19) pandemic. We hope that this disease will be controlled quickly, allowing us to return to our normal activities. We also hope that pregnant women will not transmit the disease to their fetuses, causing hydrocephalus, as was observed in the last Zika virus epidemic. Sincerely, Sergio Cavalheiro Editor-in-chief, Archives of Pediatric Neurosurgery

ABSTRACTThe central sulcus region is an eloquent area situated between the frontal and parietal lobes. During neurosurgical procedures, it is sometimes difficult to understand the cortical anatomy of this region.Objective Find alternative ways to anatomically navigate in this region during neurosurgical procedures.Method We analyzed eighty two human hemispheres using a surgical microscope and completed a review of the literature about central sulcus region.Results In 68/82 hemispheres, the central sulcus did not reach the posterior ramus of the lateral sulcus. A knob on the second curve of the precentral gyrus was reliably identified in only 64/82 hemispheres.Conclusion The morphometric data presented in this article can be useful as supplementary method to identify the central sulcus region landmarks.

The anatomical characterization of the orbitofrontal cortex in human is limited in literature instead of many functional and clinical studies involving it. Objective Anatomically define the orbitofrontal region aiming to possible neurosurgical treatments and unify the scientific nomenclature as well. Method We analyze eighty four human hemispheres using a surgical microscope. Then we chose four hemispheres and dissect them according to Klinger’ technique. Results We found five main sulcus: olfatory sulcus, orbital medial sulcus, orbital lateral sulcus, orbital transverse sulcus and orbital intermediate sulcus. These sulcus, excluding the intermediate sulcus, delimit five gyrus: rectus gurys, orbital medial gyrus, orbital anterior gyrus, orbital lateral gyrus and orbital posterior gyrus. The main sulcal configuration can be divided on four more frequently patterns. Conclusion Orbitofrontal cortex is associated with many psychiatric disorders. Better anatomical and functional characterization of the orbitofrontal cortex and its connections will improve our knowledge about these diseases.

Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p

OBJECTIVE: Blake's pouch cyst (BPC) is a midline cystic malformation of the posterior fossa, within Dandy-Walker's complex (DWC), often associated with hydrocephalus. Endoscopic third ventriculostomy (ETV) has been an alternative to conventional methods for BPC treatment. This study aimed at reporting our experience with ETV in a series of patients with BPC. METHODS: Of 33 patients diagnosed with midline posterior fossa cyst, 26 met the protocol criteria for DWC, and eight subjects with BPC were selected (aged one month to two years old). All cases were treated with ETV. RESULTS: Five patients were male; and three were prenatally diagnosed. They had hydrocephalus and motor deficiencies. Motor assessment at a five-year follow-up yielded normal findings. All patients improved, and only one had residual cognitive dysfunction, despite overall neurological improvement. There were no complications. CONCLUSIONS: ETV was a safe and effective procedure, reducing risks and morbidity associated with open surgery and shunt-related problems.

Decompressive craniectomy (DC) has demonstrated efficacy in reducing mortality in hemispheric infarction of the middle cerebral artery. The aim of our study was to compare the outcome of patients submitted to DC to patients treated in a conservative way. Eighteen patients were submitted to DC and 14 received conservative treatment. Neurological status was assessed by the Glasgow Coma Score and National Institutes of Health Stroke Scale score. Mortality, modified Rankin Scale and Barthel Index scores were assessed at 90 days to evaluate outcome. We did not observe reduction in overall mortality and functional outcome in patients submitted to DC. The differences between our group and previously published series are probably related to the neurological status of the patients at the time of therapeutic decision.Craniectomia descompressiva (CD) tem demonstrado eficácia em reduzir a mortalidade em pacientes com infarto hemisférico (IH) da artéria cerebral média. Este estudo avaliou o prognóstico dos pacientes submetidos a CD comparando a pacientes com IH tratados de maneira conservadora. Dezoito pacientes foram submetidos a CD e 14 receberam tratamento conservador. Escala de Coma de Glasgow e Escala de AVC do National Institutes of Health foram utilizadas para graduar o déficit neurológico. A mortalidade, bem como os escores obtidos na escala modificada de Rankin e índice de Barthel foram avaliados em 90 dias. Não foi observada redução de mortalidade nos pacientes submetidos a CD. Essa diferença entre os nossos resultados e os estudos publicados previamente se deve, provavelmente, à decisão cirúrgica tardia em pacientes com sinais clínicos de herniação cerebral.

Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.

Abstract Background Although germ cell tumors and pineal cell tumors account for most of the histologic tumor subtypes, > 17 different tumors can arise in this location. We report a rare case of a low-grade oligodendroglioma that arose in the pineal region. Clinical Presentation A young woman complaining of a headache underwent magnetic resonance imaging that showed a mass in the pineal region and mild hydrocephalus. A ventriculoperitoneal shunt was performed followed by a near-total tumor removal, due to tumor invasion of the tectal plate and thalamus. The histologic examination confirmed the diagnosis of a low-grade oligodendroglioma. The patient then underwent chemotherapy and radiotherapy as adjuvant therapies. Conclusion Although the pineal region is a common place for a large number of tumoral lesions, low-grade oligodendrogliomas are extremely rare in this location. This case is only the second account of a benign oligodendroglioma of the pineal region reported in the literature.

ABSTRACT Objective This study aims to analyze the characteristics of patients with acute lumbar/sciatic disc herniation who underwent conservative, pain block procedures and surgical treatment, in order to better understand the natural history of herniations and their surgical indications, as well as the impact of hernia volume. Methods We analyzed 150 patients with a diagnosis of acute lumbar disc herniation. The treatments considered were: conservative, infiltration/pain block procedures and microdiscectomy. For seven patients who were surgically treated, the lumbar sequestrectomy volume was submitted to pathological analysis. Results Of the 150 patients, 80% were treated conservatively; 15.31% were treated with pain block procedures and 4.66% underwent microdiscectomy. The mean age of the surgical group was 42.5 years, and 57.1% of the patients were men. Most of the hernias were at L5-S1 (55.5%), and 77.7% were on the left side. All patients had presented significant lumbar pain or sciatica for a long period prior to the surgery. The Lasègue sign was present in all patients. Of the total number of patients, 85.7% presented hypoesthesia and 42.8% presented focal motor deficits, among other findings. The mean hernia volume was 9.6 cm3. Conclusions Unresponsiveness to conservative treatment is an important indication for surgery. The clinical manifestations in patients with a lumbar/sciatic hernia can be very diverse, as can the disc herniation volume, so these are not good indicators for surgery. Level of evidence IV; Case series

ABSTRACT Objective To analyze cases of recurrent glioblastoma subjected to reoperation at a Brazilian public healthcare service. Methods A total of 39 patients subjected to reoperation for recurrent glioblastoma at the Department of Neurosurgery, São Paulo Hospital, Federal University of São Paulo, from January 2000 to December 2013 were retrospectively analyzed. Results The median overall survival was 20 months (95% confidence interval – CI = 14.9–25.2), and the median survival after reoperation was 9.1 months (95%CI: 2.8–15.4). The performance of adjuvant treatment after the first operation was the single factor associated with overall survival on multivariate analysis (relative risk – RR = 0.3; 95%CI = 0.2–0.7); p = 0.005). Conclusion The length of survival of patients subjected to reoperation for glioblastoma at a Brazilian public healthcare service was similar to the length reported in the literature. Reoperation should be considered as a therapeutic option for selected patients.