Introduction: Central nervous system (CNS) infections represent some of the most critical pediatric health challenges, characterized by high mortality rates and a notable risk of long-term complications. Despite their significance, standardized guidelines for endocrinological follow-up of CNS infection survivors are lacking, leading to reliance on the expertise of individual centers and clinicians. Materials and Methods: Prospective monocentric observational study conducted at the Fondazione Policlinico Universitario Agostino Gemelli in Rome, Italy. It included patients with a history of CNS infection, admitted to various pediatric departments of the hospital. The participants were selected based on a coded diagnosis of CNS infection and had completed their follow-up at the Pediatric Endocrinology Day Hospital after October 2019. Results: Eighty participants were included, comprising 53 patients with a prior CNS infection and 27 healthy controls, with a median age of 7.4 years (range 3.6–12.3 years). Endocrinologic alterations were detected in 13 patients, with 8 cases in those who had meningitis, 4 in encephalitis survivors, and 1 in a patient with a cerebral abscess. Patients with a history of CNS infections were shorter compared with healthy controls (P = 0.027). Moreover, those who had meningitis exhibited an increased risk of developing epilepsy (P = 0.01), neurosensory disabilities (P = 0.034) and the need for ventriculoperitoneal shunt insertion (P = 0.006). Patients with bacterial CNS infections were more prone to neurosensory and endocrine dysfunctions compared to those with viral or other infections. Significant differences were observed in hormone levels between previously infected patients and controls, specifically in TSH (P < 0.001), ACTH (P = <0.001), and cortisol (P = 0.019). IGF-1 levels were considerably lower in the infection group, both in absolute terms and when adjusted for sex and age (P < 0.001). The regression analysis suggested that the reduction in IGF-1 was more pronounced the earlier the CNS infection occurred, irrespective of infection type. Conclusions: Our study found several endocrinologic imbalances in children who survived CNS infections.

Background/Objectives: Medulloblastoma is a rare tumor that represents almost two-thirds of all embryonal pediatric brain tumor cases. Current treatments, including surgery, radiation, and chemotherapy, are often associated with adverse effects, such as toxicity, resistance, and lack of specificity. According to multiple bulk and single-cell omics-based approaches, it is now clear that each molecular subgroup of medulloblastoma possesses intrinsic genetic and molecular features that could drive the definition of distinct therapeutic targets, and of markers that have the potential to improve diagnosis. Nanomedicine offers a promising approach to overcome these challenges through precision-targeted therapies and theranostic platforms that merge diagnosis and treatment. This review explores the role of nanomedicine in medulloblastoma. Here, possible theranostic nanoplatforms combining targeted drug delivery and simultaneous imaging are reviewed, highlighting their potential as tools for personalized medicine. Methods: We performed a chronological analysis of the literature by using the major web-based research platforms, focusing on molecular targets, and the potential application of nanomedicine to overcome conventional treatment limitations. Results: Advances in nanoparticle-based drug delivery systems enable selective targeting of key molecular pathways, improving therapeutic efficacy while minimizing off-target effects. Additionally, nanotechnology-based imaging agents, including MRI contrast agents and fluorescent probes, improve diagnostic accuracy and treatment monitoring. Despite these advantages, some significant challenges remain, including overcoming the blood–brain barrier, ensuring biocompatibility, and addressing regulatory pathways for clinical translation. Conclusions: In conclusion, we sought to identify the current knowledge on the topic and hope to inspire future research to obtain new nanoplatforms for personalized medicine.

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or “real SCIWORA”), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating “real” SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children.

Introduction: Cerebellopontine angle (CPA) tumors are rare in children. As a result, knowledge on them is still limited, often concerning old series. The goal of this study is to provide an update on these challenging neoplasms by presenting a large series compared with those available in the literature and focusing on tumor characteristics, molecular pattern, extent of tumor removal, surgical complications, and outcome. Methods: All children with CPA tumors consecutively operated on between 2010 and 2020 (minimum follow-up: 5 years) and with complete follow-up data were considered. Retro-sigmoid approach was used for tumors arising from CPA (group A) while a midline sub-occipital was used for those extending into CPA (Group B). Intraoperative neuronavigation, neuro-monitoring, and ultrasounds were routinely utilized. Results: 48 children (54 tumors) were included (mean age at surgery: 6.9 years, 38% infants, M/F ratio 1.1). Hydrocephalus was present at diagnosis in 27% of cases. Gross total resection of the tumor was obtained in 59% of cases, and subtotal and partial resection in 24% and 17%, respectively. Complications occurred in 25% of cases. Group A was composed of 23 children: the most common tumor was schwannoma (43%) followed by ependymomas, medulloblastoma, AT/RT (13% each), and less common histotypes. Group B was composed of 25 children: ependymomas (60%), AT/RT (20%), medulloblastoma (12%), others (8%). All but one ependymomas belonged to PF-A molecular group, while medulloblastomas were equally divided between WNT and Sonic-Hedgehog. The overall survival rate after a mean 7.2-year follow-up is 71%. A total of 14 patients died because of tumor or disease progression. No statistical differences between the two groups were detected as far as demographic data, tumor growing pattern, extent of tumor removal, complication rate, and overall survival were concerned. Only the mean tumor diameter was significantly longer in group B (3.9 cm vs. 3.3 cm). Apart from some differences in the demography, the extent of tumor removal and complications, no relevant differences were noticed among the series analyzed. Conclusions: Pediatric CPA tumors are uncommon but not rare and present significant management challenges. Surgery is demanding. The long-term survival is poorly improved compared with the past and compared with other posterior fossa tumors, the prognosis is mainly related to the biological tumor characteristics and the adjuvant treatments rather than the surgical excision.

Background/Objectives: to compare and characterize the frequency and severity of treatment-related adverse events (TRAEs) experienced by pediatric and adult patients with medulloblastoma receiving the same pediatric-based treatments. Methods: a retrospective comparative study of TRAEs was conducted on 18 adult patients and 45 pediatric patients with medulloblastoma treated at the same institution with craniospinal/local radiotherapy and chemotherapy delivered according to pediatric regimens (i.e., PNET3, PNET4, PNET5 or high-risk protocols). Results: Grade ≥ 3 hematological TRAEs were significantly more frequent in adults (61.1% vs. 33.3%, p = 0.038). Adults also more frequently suffered from weight loss > 10% than children (72.2% vs. 40%, p = 0.018). The incidence of chemotherapy-induced peripheral neuropathy did not differ significantly between the two groups (27.7% in adults versus 22.2% in children, p = 0.65). These findings suggest that adult patients treated with pediatric-derived protocols may benefit from more proactive hematologic and nutritional supportive care to safely maintain treatment intensity. Objective severe ototoxicity was 22.2% and 17.8% in adults and children (p = 0.69), respectively. There were significantly more adults than children who needed a dose reduction (55.6% vs. 28.9% in children, p = 0.042) and who stopped treatment prematurely (44.4% vs. 20.1% in children, p = 0.048). There was no difference in 5-year overall survival between adults and the pediatric population (88.8% vs. 86.7%, p = 0.82). Conclusions: Adults are at an increased risk of hematological and nutritional toxicities when treated for medulloblastoma with identical treatment regimens. These age-related patterns of sensitivity demand protocol modifications (such as more supportive care, nutritional support, and possibly lower dose intensities). Although there were more treatment modifications due to more severe toxicity, adults had the same survival rates as children, suggesting pediatric-based protocols should still be employed with modifications to supportive care.