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Massimi L, Cinalli G, Frassanito P, Arcangeli V, Auer C, Baro V, Bartoli A, Bianchi F, Dietvorst S, Di Rocco F, Gallo P, Giordano F, Hinojosa J, Iglesias S, Jecko V, Kahilogullari G, Knerlich-Lukoschus F, Laera R, Locatelli D, Luglietto D, Luzi M, Messing-Jünger M, Mura R, Ragazzi P, Riffaud L, Roth J, Sagarribay A, Pinheiro MS, Spazzapan P, Spennato P, Syrmos N, Talamonti G, Valentini L, Van Veelen ML, Zucchelli M, Tamburrini G. Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era. Childs Nerv Syst 2024; 40:1221-1237. [PMID: 38456922 DOI: 10.1007/s00381-024-06332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
| | - G Cinalli
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - V Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Auer
- Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - V Baro
- Pediatric and Functional Neurosurgery, Department of Neurosciences, University of Padova, Padua, Italy
| | - A Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - F Bianchi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Dietvorst
- University Hospitals Leuven, Leuven, Belgium
| | - F Di Rocco
- Hôpital Femme-Mère-Enfant, Université de Lyon, Lyon, France
| | - P Gallo
- Birmingham Children's Hospital, Birmingham, UK
| | - F Giordano
- University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - J Hinojosa
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Iglesias
- Hospital Regional Universitario de Malaga, Malaga, Spain
| | - V Jecko
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - G Kahilogullari
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - F Knerlich-Lukoschus
- Division Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - R Laera
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - D Locatelli
- Neurosurgery Department, Università Dell'Insubria, Ospedale di Circolo e Macchi Foundation, Varese, Italy
| | - D Luglietto
- Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M Luzi
- Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | | | - R Mura
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - P Ragazzi
- Department of Pediatric Neurosurgery, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Turin, Italy
| | - L Riffaud
- Rennes University Hospital, Rennes, France
| | - J Roth
- Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Sagarribay
- Hospital Dona Estefânia-Centro Hospitalar Universitário, Lisboa, Portugal
- Hospital CUF Descobertas, Lisboa, Portugal
| | - M Santos Pinheiro
- Centro Hospitalar Lisboa Norte-Hospital Santa Maria, Lisboa, Portugal
| | - P Spazzapan
- University Medical Center-Ljubljana, Ljubljana, Slovenia
| | - P Spennato
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - N Syrmos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - L Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M L Van Veelen
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - M Zucchelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto Scienze Neurologiche Di Bologna, Boulogne, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
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Thomale UW, Auer C, Spennato P, Schaumann A, Behrens P, Gorelyshev S, Bogoslovskaia E, Shulaev A, Kabanian A, Seliverstov A, Alexeev A, Ozgural O, Kahilogullari G, Schuhmann M, Jimenez-Guerra R, Wittayanakorn N, Sukharev A, Marquez-Rivas J, Linsler S, Damaty AE, Vacek P, Lovha M, Guzman R, Stricker S, Beez T, Wiegand C, Azab M, Buis D, Sáez M, Fleck S, Dziugan C, Ferreira A, Radovnicky T, Bührer C, Lam S, Sgouros S, Roth J, Constantini S, Cavalheiro S, Cinalli G, Kulkarni AV, Bock HC. TROPHY registry - status report. Childs Nerv Syst 2021; 37:3549-3554. [PMID: 34184098 PMCID: PMC8578079 DOI: 10.1007/s00381-021-05258-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The TROPHY registry has been established to conduct an international multicenter prospective data collection on the surgical management of neonatal intraventricular hemorrhage (IVH)-related hydrocephalus to possibly contribute to future guidelines. The registry allows comparing the techniques established to treat hydrocephalus, such as external ventricular drainage (EVD), ventricular access device (VAD), ventricular subgaleal shunt (VSGS), and neuroendoscopic lavage (NEL). This first status report of the registry presents the results of the standard of care survey of participating centers assessed upon online registration. METHODS On the standard of treatment forms, each center indicated the institutional protocol of interventions performed for neonatal post-hemorrhagic hydrocephalus (nPHH) for a time period of 2 years (Y1 and Y2) before starting the active participation in the registry. In addition, the amount of patients enrolled so far and allocated to a treatment approach are reported. RESULTS According to the standard of treatment forms completed by 56 registered centers, fewer EVDs (Y1 55% Y2 46%) were used while more centers have implemented NEL (Y1 39%; Y2 52%) to treat nPHH. VAD (Y1 66%; Y2 66%) and VSGS (Y1 42%; Y2 41%) were used at a consistent rate during the 2 years. The majority of the centers used at least two different techniques to treat nPHH (43%), while 27% used only one technique, 21% used three, and 7% used even four different techniques. Patient data of 110 infants treated surgically between 9/2018 and 2/2021 (13% EVD, 15% VAD, 30% VSGS, and 43% NEL) were contributed by 29 centers. CONCLUSIONS Our results emphasize the varying strategies used for the treatment of nPHH. The international TROPHY registry has entered into a phase of growing patient recruitment. Further evaluation will be performed and published according to the registry protocol.
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Affiliation(s)
- U. W. Thomale
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Auer
- Division of Pediatric Neurosurgery, Kepler Universitätsklinikum, Linz, Austria
| | - P. Spennato
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. Schaumann
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - P. Behrens
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Gorelyshev
- Pediatric Neurosurgery, Moscow Bashlyaeva Pediatric Hospital, Moscow, Russia
| | - E. Bogoslovskaia
- Pediatric Neurosurgery, Surgut Clinical Perinatal Center, Surgut, Russia
| | - A. Shulaev
- Pediatric Neurosurgery, Children’s Republic Clinical Hospital, Kazan, Russia
| | - A. Kabanian
- Pediatric Neurosurgery, Children’s Regional Hospital, Krasnodar, Russia
| | - A. Seliverstov
- Pediatric Neurosurgery, Kemerovo Regional Pediatric Hospital, Kemerovo, Russia
| | - A. Alexeev
- Pediatric Neurosurgery, Chelyabinsk Regional Children’s Clinical Hospital, Chelyabinsk, Russia
| | - O. Ozgural
- Neurosurgery, Ankara University, Ankara, Turkey
| | | | - M. Schuhmann
- Pediatric Neurosurgery, University Hospital of Tübingen, Tubingen, Germany
| | - R. Jimenez-Guerra
- Neonatal Neurosurgery, National Institute of Perinatology, Mexico City, Mexico
| | - N. Wittayanakorn
- Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - A. Sukharev
- Pediatric Neurosurgery, Regional Children Hospital, Yekaterinburg, Russia
| | | | - S. Linsler
- Neurosurgery, Saarland University Hospital, Homburg, Saarland Germany
| | - A. El Damaty
- Pediatric Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - P. Vacek
- Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - M. Lovha
- Neurosurgery, Volyn Regional Pediatric Hospital, Lutsk, Ukraine
| | - R. Guzman
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - S. Stricker
- Neurosurgery, Universitätskinderspital Beider Basel, Basel, Switzerland
| | - T. Beez
- Neurosurgery, Heinrich-Heine-University, Duesseldorf, Germany
| | - C. Wiegand
- Neurosurgery, Marienhospital, Osnabrück, Germany
| | - M. Azab
- Neurosurgery, Damietta Specialized Hospital, Damietta, Egypt
| | - D. Buis
- Neurosurgery, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - M. Sáez
- Neurosurgery, Hospital La Paz, Madrid, Spain
| | - S. Fleck
- Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - C. Dziugan
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - A. Ferreira
- Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - T. Radovnicky
- Neurosurgery, Masaryk Hospital, Usti Nad Labem, Czech Republic
| | - C. Bührer
- Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin, Berlin Augustenburger Platz 1, 13353 Berlin, Germany
| | - S. Lam
- Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - S. Sgouros
- Pediatric Neurosurgery, Iaso Childrens Hospital, Athens, Greece
| | - J. Roth
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Constantini
- Pediatric Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - S. Cavalheiro
- Pediatric Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - G. Cinalli
- Pediatric Neurosurgery, AORN Santobono Pausilipon, Naples, Italy
| | - A. V. Kulkarni
- Pediatric Neurosurgery, Sick Children Hospital, University of Toronto, Toronto, Canada
| | - H. C. Bock
- Pediatric Neurosurgery, University Medical Center Göttingen, Gottingen, Germany
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