Background: Stereotactic biopsies for brainstem lesions are frequently performed to yield an accurate diagnosis and help guide subsequent management. In this study, we summarize our experience with different stereotactic approaches to brainstem lesions of different locations and discuss possible implications for safety and diagnostic yield. Methods: We retrospectively analyzed 23 adult patients who underwent a stereotactic biopsy for brainstem lesions between October 2011 and December 2019. Depending on the location supra- or infratentorial, trajectories were planned. We assessed the postoperative complications during the hospital stay as well as the diagnostic yield. Results: A supratentorial transfrontal approach was used in 16 (70%) cases, predominantly for lesions in the midbrain, upper pons, and medulla oblongata. An infratentorial, transcerebellar-transpeduncular approach was used in 7 (30%) cases mainly for lesions within the lower pons. All biopsies were confirmed to represent pathological tissue and a definitive diagnosis was achieved in 21 cases (91%). Three patients (13%) had transient weakness in the contralateral part of the body in the immediate postoperative period, which improved spontaneously. There was no permanent morbidity or mortality in this series of patients. Conclusion: Lesions of various locations within the brainstem can be successfully targeted via either a supratentorial transfrontal or an infratentorial transcerebellar transpeduncular approach. Our high diagnostic yield of over 90% and the low rate of complications underlines the diagnostic importance of this procedure in order to guide the medical management of these patients.

Severe traumatic brain injury (TBI) is a leading cause of mortality and disability in pediatric patients, especially in low- and middle-income countries. TBI significantly impacts child development and incurs substantial health care costs. Management of severe TBI includes evidence-based protocols to prevent and treat increased intracranial pressure (ICP), with decompressive craniectomy (DC) as a rescue measure. This study investigates the role of early DC in improving outcomes for children with severe TBI. A retrospective study was conducted from January 2003 to January 2023 at King Abdullah University Hospital, the main tertiary hospital in North Jordan. This study evaluated pediatric patients (under 16 years old) admitted with severe TBI who underwent early DC (within 24 hours). This study of 45 pediatric patients undergoing DC for severe TBI found a male predominance (75.6%) and a mean age of 4.3 years. Favorable outcomes (Glasgow Outcome Score 4-5) were achieved in 67% of cases. Pupillary abnormalities were significantly associated with prognosis (P = 0.004), but surgical timing (6 hours) was not (P = 0.661). The in-hospital mortality rate was 24%, with complications in 35.6% of patients. ICP monitoring was performed in 26.7% of patients. DC remains a crucial intervention for pediatric patients with severe TBI, primarily to control ICP. Our study found no significant difference in outcomes between early and late DC, aligning with prior research. However, pupillary abnormalities emerged as a key prognostic factor. Our findings highlight the need for further prospective multicenter studies to refine surgical timing for optimal outcomes.

Introduction: This article presents a rare case of idiopathic delayed brain edema (IDE) following successful stereotactic aspiration of a deeply seated brain abscess in a five-year-old child. Case Presentation: The patient underwent frameless stereotactic aspiration of a brain abscess. Despite successful abscess resolution and initial improvement, the child developed severe cerebral edema one month later, necessitating left decompressive craniectomy, additional interventions, and prolonged hospitalization. Conclusions: This paper outlines the clinical trajectory, diagnostic challenges, and management strategies employed, highlighting the unique presentation of delayed IDE in the pediatric population. The findings contribute to understanding IDE and its management after abscess resolution, particularly in young patients.

Background: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality worldwide. Ocular manifestations are common but often overlooked, despite their potential to cause long-term visual impairment. This study aimed to evaluate the prevalence and characteristics of ocular findings in pediatric TBI patients admitted to the intensive care unit (ICU). Method: We prospectively reviewed records of pediatric patients (≤16 years) with TBI admitted to the Neurosurgery ICU at King Abdullah University Hospital (January 2022–December 2024). TBI was defined using U.S. CDC criteria and confirmed by clinical and radiological findings. Ocular manifestations were identified from ophthalmology consultations, neurosurgical notes, and bedside examinations. Demographics, injury details, and clinical outcomes were recorded. Statistical analyses included Chi-square, Fisher’s exact, and Mann–Whitney U tests, with significance set at p ≤ 0.05. Results: Thirty-eight patients (median age: 8 years; 55.3% male) were included. Ocular findings were present in 20 patients (52.6%). These patients were significantly older (median age 10 vs. 6 years, p = 0.007) and had lower admission GCS scores (11 vs. 14, p = 0.016). Male predominance was higher in the ocular group (75.0% vs. 33.3%, p = 0.030). Ocular findings were significantly associated with surgical intervention (60.0% vs. 22.2%, p = 0.025), orbital fractures (40.0% vs. 5.6%, p = 0.021), basal skull fracture signs (p = 0.036), and extraocular muscle limitation (p = 0.048). On multivariable analysis, orbital fracture remained the only independent predictor of ocular findings (aOR 2.22, 95% CI 1.17–3.57, p = 0.02). Conclusion: Over half of pediatric ICU TBI patients demonstrated ocular manifestations, closely linked to greater injury severity and craniofacial trauma. Routine, comprehensive ophthalmological evaluation should be integrated into the multidisciplinary management of severe pediatric TBI to optimize visual and functional outcomes.