OBJECTIVEResection of posterior fossa tumors in children may be associated with persistent neurological deficits. It is unclear if these neurological deficits are associated with persistent structural damage to the cerebellar pathways. The purpose of this research was to define longitudinal changes in diffusion tensor imaging (DTI) metrics in white matter cerebellar tracts and the clinical correlates of these metrics in children undergoing resection of posterior fossa tumors.METHODSLongitudinal brain DTI was performed in a cohort of pediatric patients who underwent resection of posterior fossa tumors. Fractional anisotropy (FA) of the superior cerebellar peduncles (SCPs) and middle cerebellar peduncles (MCPs) was measured on preoperative, postoperative, and follow-up DTI. Early postoperative (< 48 hours) and longer-term follow-up neurological deficits (mutism, ataxia, and extraocular movement dysfunction) were documented. Statistical analysis was performed to determine differences in FA values based on presence or absence of neurological deficits. Statistical significance was set at p < 0.05.RESULTSTwenty children (mean age 6.1 ± 4.1 years [SD], 12 males and 8 females) were included in this study. Follow-up DTI was performed at a median duration of 14.3 months after surgery, and the median duration of follow-up was 19.7 months. FA of the left SCP was significantly reduced on postoperative DTI in comparison with preoperative DTI (0.44 ± 0.07 vs 0.53 ± 0.1, p = 0.003). Presence of ataxia at follow-up was associated with a persistent reduction in the left SCP FA on follow-up DTI (0.43 ± 0.1 vs 0.55 ± 0.1, p = 0.016). Patients with early postoperative mutism who did not recover at follow-up had significantly decreased FA of the left SCP on early postoperative DTI in comparison with those who recovered (0.38 ± 0.05 vs 0.48 ± 0.06, p = 0.04).CONCLUSIONSDTI after resection of posterior fossa tumors in children shows that persistent reduction of SCP FA is associated with ataxia at follow-up.

Background: Trigeminal schwannomas are rare tumors of the trigeminal nerve. Depending on the location, from which they arise along the trigeminal nerve, these tumors can present with a variety of symptoms that include, but are not limited to, changes in facial sensation, weakness of the masticatory muscles, and facial pain. Case Description: We present a case of a 16-year-old boy with an atypical presentation of a large trigeminal schwannoma: painless malocclusion and unilateral masticatory weakness. This case is the first documented instance; to the best of our knowledge, in which a trigeminal schwannoma has led to underbite malocclusion; it is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology. We discuss this case as a unique presentation of this pathology, and the relevant anatomy implicated in clinical examination aid in further understanding trigeminal nerve pathology. Conclusion: We believe our patient’s underbite malocclusion occurred secondary to his trigeminal schwannoma, resulting in associated atrophy and weakness of the muscles innervated by the mandibular branch of the trigeminal nerve. Furthermore, understanding the trigeminal nerve anatomy is crucial in localizing lesions of the trigeminal nerve.

Objective With the increasing interest in fetal repair of myelomeningoceles (MMCs) over the last decade, it is reasonable to anticipate the need for high quality and accessible educational materials for patients. Patients often look to the internet for details regarding medical topics and specifically to YouTube for informative health-related videos. This study aims to analyze the content and shortcomings of currently available videos on YouTube regarding prenatal repair of MMCs. Study Design A YouTube search was performed on December 15, 2018, using the terms “fetoscopic surgery for neural tube defect” and “fetal surgery for neural tube defect.” The first 50 videos from each search were sorted by relevance and evaluated for video source (i.e., professional, personal, or other), target audience (medical professionals or general public), general descriptive statistics (i.e., video length, number of views, number of comments), and for five areas of content determined by the authors to constitute basic patient information regarding a surgical procedure: (1) procedure details, (2) eligibility criteria, (3) alternatives to surgery, (4) surgical risks, and (5) success rate. Accuracy of videos was not assessed. Results Of the 16 videos that met inclusion criteria, only 1 discussed fetoscopic surgery. The majority (62.5%) of videos were produced by a professional source and 81.3% were targeted toward the general public rather than medical professionals. Of the 16 videos, 10 (62.5%) included details regarding the surgery, 3 (18.8%) discussed eligibility criteria, and 8 (50.0%) mentioned alternatives to surgery. Additionally, seven videos (43.8%) discussed risks of the procedure and six (37.5%) included surgical success rate. Conclusion Only 2 of the 16 videos included all five areas of content that were evaluated, and both were in regard to open fetal repair. This study not only calls attention to the initial shortcomings of YouTube videos regarding fetal surgery for neural tube defects but also demonstrates the need for further investigation and more comprehensive analysis.

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INTRODUCTION Persistent neurological deficits are seen in over 60% of children after resection of posterior fossa tumors. The goal of this study was to determine if these deficits are associated with persistent structural injury to white matter tracts. METHODS Demographic, clinical, and imaging data were reviewed for children undergoing resection of posterior fossa tumors at a tertiary care pediatric hospital. Preoperative, early postoperative (within 48 h of injury) and follow-up diffusion tensor imaging (DTI) were analyzed. Fractional anisotropy (FA) of the middle and superior cerebellar peduncles (SCP) were measured using manual regions of interest. Mean FA values before and after surgery were compared using paired sample T-test. Preoperative, postoperative and follow-up FA values were compared between patients with and without persistent neurological deficits. Statistical significance was set at P < .05. RESULTS A toal of 20 patients (12 male, mean age 6.1 ± 4.1 yr) were included in this study. A total of Twelve patients (60%) underwent a trans-vermian approach and 15 patients (75%) underwent gross total resection. All patients had preoperative DTI scans, and follow-up DTI scans were available for 18 patients at a median duration of 19.7 mo (range 4-57.9 mo). Compared to preoperative DTI, FA of the left SCP was significantly reduced on early postoperative DTI scans (0.44 ± 0.07 vs 0.53 ± 0.1, P = .003). Significant reduction in left SCP FA on follow-up DTI was seen in patients with persistent ataxia at follow-up (0.43 ± 0.1 vs 0.55 ± 0.1, P = .016). Patients with persistent ataxia at follow-up (n = 10) had significantly lower FA of the left SCP at follow-up compared to patients who recovered from early postoperative ataxia (n = 4) (0.43 ± 0.1 vs 0.55 ± 0.04, P = .04). CONCLUSION Reduced FA of the SCP is associated with persistent ataxia at follow-up in children undergoing resection of posterior fossa tumors.

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An epidermoid cyst is lined with stratified squamous epithelium with a lumen filled with fluid, in most cases. Such cysts can occur anywhere in the body; however, they are rarely found on the epiglottis (0.54%). Herein, we describe to our knowledge, the first cadaveric case of a regular, circular, and soft mass extending out from the tip of the epiglottis with consistent histological characteristics of an epidermoid cyst. Epiglottic cysts are rare and mostly asymptomatic. However, through this case report, we aimed to highlight the clinical-surgical applications presented mainly when they grow large enough, to cause issues with ventilation or obstruct endotracheal tubes, thus interfering with airway management. Additionally, such cysts can affect swallowing or speaking.