Anorexia nervosa (AN) severely impacts individual’s mental and physical health as well as quality of life. In 21% of cases no durable response to conservative treatment can be obtained. The serious course of the disease in the most severely affected patients justifies invasive treatment options. One of the treatment methods increasingly used in recent years is deep brain stimulation (DBS). A 42-year-old woman suffering from chronic AN of the bulimic subtype shows a 46.9% weight gain and a subjective increase in quality of life, 12 months after bilateral nucleus accumbens (NAcc) DBS implantation. No improvement in comorbid depression could be achieved. DBS of the NAcc is a treatment option to be considered in severe AN when conventional treatment modalities recommended by evidence-based guidelines have not been able to bring lasting relief to the patient’s suffering.

Understanding and classifying inherent tumor heterogeneity is a multimodal approach, which can be undertaken at the genetic, biochemical, or morphological level, among others. Optical spectral methods such as Raman spectroscopy aim at rapid and non-destructive tissue analysis, where each spectrum generated reflects the individual molecular composition of an examined spot within a (heterogenous) tissue sample. Using a combination of supervised and unsupervised machine learning methods as well as a solid database of Raman spectra of native glioblastoma samples, we succeed not only in distinguishing explicit tumor areas—vital tumor tissue and necrotic tumor tissue can correctly be predicted with an accuracy of 76%—but also in determining and classifying different spectral entities within the histomorphologically distinct class of vital tumor tissue. Measurements of non-pathological, autoptic brain tissue hereby serve as a healthy control since their respective spectroscopic properties form an individual and reproducible cluster within the spectral heterogeneity of a vital tumor sample. The demonstrated decipherment of a spectral glioblastoma heterogeneity will be valuable, especially in the field of spectroscopically guided surgery to delineate tumor margins and to assist resection control.

Introduction: Spinal astroblastoma is a rare highly malignant tumor that mainly affects children. We review the few cases described in the literature and highlight the challenges of managing this neoplasm by illustrating a case recently treated at our institutions. To our knowledge, this is the first published case of EWSR1-BEND2 fused spinal astroblastoma with long-term follow-up. Case Presentation: An 8-year-old girl was transferred from her home country to Switzerland for treatment of a recurrent intramedullary tumor of the cervical spine extending from C2-C7. The tumor was primarily diagnosed as an ependymoma of the spinal cord. Prior to her transfer to our department, the patient had undergone subtotal resection of the lesion, radiation therapy, multiple chemotherapy regimens, and biopsy of the recurrent tumor. Clinically, the patient presented with tetraparesis and had recently experienced worsening upper extremity weakness with complete loss of hand function. We performed a near total resection of the recurrent tumor. Ultra-fast Nanopore seq® based DNA methylome profiling allowed confirmation of the molecular diagnosis of a high-grade neuroepithelial tumor (HGNET-MN1) consistent with astroblastoma in less than 2 h, with subsequent molecular workup revealing a EWSR1-BEND2 fusion. After surgery, the patient gradually regained function in her hands. She was sent to a specialized pediatric rehabilitation center, and while the tumor was being followed radiologically with no adjuvant treatment planned, the patient presented with a relapse of the tumor in only 3 months. Given the acute worsening of radiating pain and sudden respiratory failure, a cervical decompression was performed. MRI of the cervical spine showed infiltration of the lower aspects of the brainstem. The patient was offered palliative comfort care. Conclusion: Spinal astroblastoma is a rare and highly aggressive tumor affecting children and young adults with a high recurrence rate and thus far not well-defined prognosis. The molecular signature of astroblastoma needs to be further characterized to establish a treatment-relevant classification and to allow a better prognostication. Currently, gross-total resection combined with radiotherapy remains the mainstay of treatment for spinal astroblastoma.

OBJECTIVE: Transitional care in pediatric neurosurgery is challenging for patients and their parents. The specific needs of neurologically affected patients and the unique characteristics of the pathologies affecting pediatric neurosurgical patients compared with adults make a comprehensive, well-organized transition process essential for patient well-being and ensuring continuity of care. Little is known about patients’ preferences and opinions on this topic. This study aimed to assess the patients’ and parents’ expectations and perceptions of the transition process. METHODS: The authors retrospectively identified patients aged 16 to 30 years who underwent surgery in their pediatric neurosurgical department. The patients were divided into two groups: those about to transition and those who had already transitioned. Transition models were identified within the latter group. Parents of eligible patients were contacted for a telephone survey, and the patients themselves were included when possible. A modified version of the established Got Transition questionnaire from the National Alliance to Advance Adolescent Health was used. RESULTS: Thirty-four patients were included, and 44 telephone surveys were conducted with the patients and their parents. Three transition models were applied, with 7 patients (41.2%) transitioned using the continued caregiver model, 9 patients (52.9%) using the shared caregiver model, and 1 patient (5.9%) using the specialized clinic model. Patient and parent satisfaction was highest among the patients transitioned using the continued caregiver and specialized clinic models. CONCLUSIONS: Neurosurgical conditions in children differ significantly from those in adults, creating unique transitional care challenges. The continuing caregiver model has been shown to provide continuity of care and high patient and parent satisfaction. However, there are differences in the perspectives of parents and patients regarding transitional care, with parents typically expressing greater concern and need for detailed information. Implementing a well-structured and individualized transition process is essential to reduce the caregiving burden on families and healthcare institutions.

Objective: Cerebrospinal fluid (CSF) drainage via a ventriculoperitoneal shunt remains to be the most common treatment for infantile hydrocephalus. Since head growth is particularly dynamic and susceptible to intracranial pressure changes during the first months of life, shunting can have a considerable impact. This study aimed to examine changes in head circumference and ventricular width and evaluate their interdependence in children who underwent shunting during infancy with either of two different adjustable valve regimens. Methods: We conducted a retrospective analysis on synchronized patient databases at two tertiary pediatric neurosurgical centers. One center implanted a differential pressure (DP) adjustable valve with a fixed gravitational unit (aDP _G group). The other center used an adjustable gravitational assistance (GA) valve combined with a fixed DP unit (aG _DP group). We included infants less than 2 years of age at shunt implantation with a follow-up time of 3 years, respectively. Patient demographics, head circumferences ( z -scores), ventricular width and opening pressure settings of the shunt valves were collected and compared using statistical tests as appropriate. Results: A total of 155 infants ( n = 78 in aDP _G group and n = 77 in the aG _DP group) could be included in this study. Changes in head circumference z -scores across follow-up time were similar in both groups ( p = 0.99). In the aG _DP group, patients had more pronounced pathologically enlarged ventricles measured by fronto-occipital horn ratio (FOHR) at implantation compared to the aDP _G group ( p = 0.037). At the end of follow-up, in both groups, the proportion of patients showing a normal FOHR (0.37 ± 0.026) increased significantly, while reduction in ventricular size over time was more pronounced in the aG _DP group ( p < 0.01). The valve setting in the aG _DP group was significantly lower in standing and in lying position compared to the aDP _G group. Regression analysis revealed a significant association between the change in median FOHR and head circumference at the end of follow-up (slope (95%CI) = 3.46 (2.42–4.49), R ² = 0.22, p < 0.0001). Median change in FOHR, as well as head circumference at the end of follow-up, did correlate to valve settings at shunt implantation (p<0.01). Conclusions: The present study demonstrates a strong relation between changes in median FOHR and head circumference at the end of follow-up in shunted hydrocephalic infants. In addition, we identified a direct influence of initial valve setting on changes of ventricular width and head circumference at follow-up, underlining the importance of valve resistance for regulating CSF diversion and its anatomical consequences. Further investigations are needed to assess the influence of these parameters on long-term neurodevelopment and functional outcome.