Background and Purpose: The efficacy of cerebrospinal fluid shunting to reduce intracranial hypertension and prevent fatal brain herniation in acute cerebral venous thrombosis (CVT) is unknown. Method: From the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) and a systematic literature review, we retrieved acute CVT patients treated only with shunting (external ventricular drain, ventriculoperitoneal or ventriculojugular shunt). Outcome was classified at 6 months and final follow-up by the modified Rankin Scale (mRS). Results: 15 patients were collected (9 from the ISCVT and 6 from the review) who were treated with a shunt (external ventricular drain in 6 patients, a ventriculoperitoneal shunt in 8 patients or an unspecified type of shunt in another one). Eight patients (53.3%) regained independence (mRS 0-2), while 2 patients (13.3%) were left with a severe handicap (mRS 4-6) and 4 (26.7%) died despite treatment. Five patients with parenchymal lesions were shunted within 48 h from admission deterioration, 4 with an external ventricular drain: 2 (40%) recovered to independence, 2 (40%) had a severe handicap and 1 (20%) died. In contrast, all 3 patients with intracranial hypertension and no parenchymal lesions receiving a ventriculoperitoneal shunt later than 48 h regained independence. Conclusion and Implications: A quarter of acute CVT patients treated with a shunt died, and only half regained independence. With the limitation of the small number of subjects, this review suggests that shunting does not appear to be effective in preventing death from brain herniation in acute CVT. We cannot exclude that shunting may benefit patients with sustained intracranial hypertension and no parenchymal lesions.

Background: Conservative surgery (CS) brachytherapy (BT) techniques for local therapy in bladder-prostate rhabdomyosarcoma (BP-RMS) seek to retain organ function. We report bladder function after high-dose rate (HDR) BT combined with targeted CS for any vesical component of BP-RMS. Procedure:Prospective cohort of all BP-RMS patients between 2014 and 2019 receiving HDR-BT (iridium-192, 27.5 Gy in five fractions) with/without percutaneous endoscopic polypectomy (PEP) or partial cystectomy (PC). Functional assessment included frequency-volume chart, voided volumes, post-void residual, flow studies, continence status and ultrasound scanning; abnormalities triggered video urodynamics.Results: Thirteen patients (10 male), aged 9 months to 4 years (median 23 months), presented with localised fusion-negative embryonal BP-RMS measuring 23-140 mm (median 43 mm) in cranio-caudal extent. After induction chemotherapy, local treatment consisted of PC+BT in three, PEP+BT in four and BT alone in six. At a median 3.5 years (range 21 months to 7 years) follow-up, all were alive without relapse. At a median age of 6 years (4-9 years), the median bladder capacity was 86% (47%-144%) of that expected for age, including 75% (74%-114%) after PC. Radiation dose to the bladder was associated with urinary urgency, but not bladder capacity or nocturnal enuresis. Complications occurred in two: one urethral stricture and one vesical decompensation in a patient with pre-existing high-grade vesico-ureteric reflux (VUR). The remaining patients were dry by day; five with anticholinergic medication for urinary urgency. Three patients are enuretic.Conclusions: Day-time dryness at a median 3.5 years after CS-HDR-BT was achieved in 92%, with 85% voiding urethrally, and 62% attaining day-and-night continence aged 4-9 years. We report reduced open surgery with minimally invasive percutaneous surgery, with HDR-BT or BT alone being suitable for many.Abbreviations: BP-RMS, bladder-prostate rhabdomyosarcoma; BT, brachytherapy; CS, conservative surgery; CT, computed tomography; CTV, clinical target volume; D 0.1 cm3 , minimum dose received by 0.1 cm 3 of tissue that receives the highest dose; D 2 cm3 , minimum dose received by the 2 cm 3 of tissue that receives the highest dose; D90, minimum dose to 90% of the volume; EBCA, expected bladder capacity for age; EBR, external beam radiotherapy; EFS, event-free survival; EpSSG, European paediatric Soft tissue sarcoma Study Group; EQD 2 , dosimetric equivalent if the radiation is delivered in 2-Gy fractions and is based on the radiosensitivity of the tissue, quantified by the tissue alpha beta ratio; Fr, French; HDR, high-dose rate; LDR, low-dose rate; MRI, magnetic resonance imaging; OAR, organ at risk; PC, partial cystectomy; PDR, pulsed-dose rate; PEP, percutaneous endoscopic polypectomy; PVR, post-void residual; VUR, vesico-ureteric reflux.

Background: Conservative-surgery (CS) brachytherapy (BT) techniques for local therapy in bladder-prostate rhabdomyosarcoma (BP-RMS) seeks to retain organ function. We report bladder function after high-dose-rate (HDR) BT combined with targeted CS for any vesical component of BP-RMS. Procedure: Prospective cohort of all BP-RMS patients between 2014-19 receiving HDR-BT (Iridium-192, 27.5Gy in 5 fractions) with/without percutaneous endoscopic-polypectomy (PEP) or partial cystectomy (PC). Functional assessment included frequency-volume-chart, voided volumes, post-void residual, flow studies, continence status and ultrasound scanning; abnormalities triggered video-urodynamics. Results: Thirteen patients (10 male), aged 9 months to 4 years (median 23 months), presented with localised fusion-negative embryonal BP-RMS measuring 23-140mm (median 43mm) in cranio-caudal extent. After induction chemotherapy, local treatment consisted of PC+BT in three, PEP+BT in four and BT alone in six. At a median 3½ years (range 1¾-7 years) follow up, all were alive without relapse. At a median age of 6 years (4-9 years), the median bladder capacity was 86% (47%-144%) of that expected for age, including 75% (74-114%) after PC. There was no relation to radiation dose to the bladder. Complications occurred in two: one urethral stricture and one vesical decompensation in a patient with pre-existing high-grade VUR. The remaining patients are dry by day; five with anticholinergic medication for urinary urgency. Three patients are enuretic. Conclusions: Day-time dryness at a median 3½ years after CS-HDR-BT was achieved in 92%, with 85% voiding urethrally, and 62% attaining day-and-night continence aged 4-9 years. We report reduced open surgery, with minimally-invasive percutaneous surgery with HDR-BT or brachytherapy alone being suitable for many.

Purpose: Road traffic injuries are the leading cause of death under 30 years, causing over a million deaths every year. Helmets, seat-belts and child-restraints have an important role in death and injury prevention. Our purpose was to analyze how safety measures relate to pediatric polytrauma severity in road traffic injury. Methods: A retrospective observational study was conducted, including polytraumatized pediatric patients, hospitalized after road traffic accidents, from January 2011 to December 2015. Comparison groups were classified according to protective equipment use. Logistic regression and generalized liner models describe the probability of safety equipment use, head trauma, higher injury severity score and permanent sequelae. Results: Of a total of 149 inpatients, 63.8% were male with a median age of 11 years. Absence of personal protective equipment was predictive for head trauma (p-value=0.014) and diffuse axonal injury associated with neurologic sequelae and death (p-value<0.01). Multivariate analysis confirmed a higher risk of protective equipment misuse in unsupervised children and in two-wheel accidents (p-value<0.05). Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) were inversely proportional (p-value<0.001). Sequelae were more frequent with lower GCS (p<0.001) and diffuse axonal lesion (p<0.001). Conclusions: Despite increasing alertness, helmet use in road accidents remains limited, reflecting on head trauma severity and subsequent neurological impairment. Absence of protective equipment on car collisions provoked more severe injury scores and prolonged hospital stay. In the "Decade of Action for Road Safety" we still find important handicaps in road safety measures, demanding more effective laws and alerting campaigns.