Superior Oblique Palsy: Characteristics and Treatment Outcomes.

Does spasticity affect outcomes in patients with cerebral palsy undergoing posterior spinal fusion?

Clinical characteristics and surgical outcomes in children with congenital laryngeal clefts.

Clinical characteristics and surgical outcomes in exotropic Duane retraction syndrome.

Facial Nerve Preservation in Hannover IV Vestibular Schwannomas. What Factors Can Predict Facial Outcome?

OBJECTIVE This article aims to analyze the multiple clinical, imaging, and perioperative factors that may contribute with postoperative facial nerve (FN) function in a series of Hannover IV Vestibular Schwannomas (VS) operated by a single surgeon at a third-level center in Argentina. MATERIALS AND METHODS Retrospective, single-center, analytical study of a cohort of 133 Hannover IV VS operated by the senior author between 2008 and 2023. RESULTS Mean follow-up was 14 months (12, 33). Gross total resection (GTR) was achieved in 55% and near total resection (NTR) in 23%. FN function was optimal (HB I and II) in 46% of patients immediately after surgery, which improved up to 66% during follow-up. Multivariate analysis revealed that factors linked to poorer early facial outcomes included preoperative gait instability, larger tumor size, and postoperative hemorrhagic complications. Regarding late facial status, factors associated with poorer outcomes included the facial grade at diagnosis and postoperatively, second surgery, and complications such as meningitis. CONCLUSIONS Surgery for Hannover IV VS remains a surgical challenge, even in experienced hands. There are individual factors that might contribute to FN results like revision surgery, size, ventral-superior FN displacement, and complications. A detailed analysis of the MRI, FN monitoring and a precise FN dissection could be crucial for a satisfactory result.

Long-Term Outcomes of Strabismus Surgery in Children with Cerebral Palsy: Focus on Consecutive Exotropia

Highlights What are the main findings? Long-term ocular alignment was successfully achieved in approximately two-thirds of children with cerebral palsy following individualized interventional treatment. Consecutive exotropia occurred exclusively after treatment of esotropia, whereas residual deviation was significantly more common after exotropia treatment. What are the implications of the main findings? Children with cerebral palsy require long-term postoperative follow-up because ocular alignment may change substantially over time. Individualized treatment strategies, including strabismus surgery with or without Botulinum toxin A, can provide satisfactory long-term outcomes, although postoperative alignment instability remains an important clinical challenge. Abstract Background/Objectives: To evaluate the long-term outcomes of strabismus treatment in children with cerebral palsy (CP) and to investigate factors associated with postoperative alignment success and the development of consecutive strabismus. Methods: The retrospective, single-center study included 73 children with CP and strabismus who were followed from January 2015 to December 2024. Demographic characteristics, ophthalmological findings, treatment methods, and postoperative outcomes were assessed. Ocular deviation was measured through prism and alternate cover testing or a modified Krimsky test, and surgical success was defined as a final deviation of ≤10 prism diopters (PD). Patients were assessed at the patient level. Comparisons between exotropic and esotropic patients and between patients who had consecutive exotropia and those who had successful alignment were made using appropriate statistical tests. Results: Study participants included 55 patients with esotropia (75.3%) and 18 patients with exotropia (24.7%). The mean follow-up period was 32.6 ± 7.18 months. A successful ocular alignment was achieved in 32 of 46 patients (69.6%) with esotropia and in 10 of 17 patients (58.8%) with exotropia following surgical treatment and/or BTA. Consecutive exotropia developed exclusively in patients initially treated for esotropia (39.1% vs. 0%, p = 0.001). Patients with consecutive exotropia underwent surgery at a younger age and had larger preoperative deviation angles than those who had successful alignment, but these differences were not statistically significant. Conclusions: Strabismus treatment provides satisfactory long-term motor alignment in many children with cerebral palsy. However, consecutive exotropia following esotropia surgery remains a common postoperative condition and is the principal source of alignment instability in this population. Younger surgical age and larger preoperative deviations were more common among patients with consecutive exotropia, but no statistically significant associations between the evaluated clinical variables and consecutive exotropia were identified in the exploratory univariate analyses.

Outcomes of Strabismus Procedures in Children with Perinatal Brain Injury.

PURPOSE To evaluate the long-term success rates of strabismus procedures in children with a history of perinatal intracranial injuries compared to matched controls. DESIGN Retrospective clinical cohort study. SUBJECTS 108 patients with strabismus (84 esotropia, 24 exotropia) and perinatal brain injury. Controls (108 without brain injuries) were matched 1:1 by horizontal deviation type, age at intervention, and preoperative deviation magnitude. METHODS Patients underwent incisional surgery, botulinum toxin injection, or botulinum toxin-augmented surgery with at least two years of follow-up. MAIN OUTCOME MEASURES Two-year motor success (horizontal deviation ≤10 prism diopters) and general motor-sensory success (motor success or fine stereopsis ≤100 arcseconds), without requiring retreatment. RESULTS At 3-6 months, success did not differ significantly (52.9% vs 67.3%; P=.098). At 2 years, motor success was lower in the brain-injury cohort overall (43.5% vs 65.7%; OR=0.31, 95% CI, 0.16-0.62; P=.0005) and the esotropia subgroup (45.2% vs 66.7%; OR=0.36, 95% CI, 0.17-0.74; P=.005). General motor-sensory success was likewise lower overall (47.2% vs 69.4%; OR=0.33, 95% CI, 0.17-0.64; P=.0007) and in esotropia (47.6% vs 70.2%; OR=0.34, 95% CI, 0.17-0.71; P=.0034). Postoperative drift was greater in the brain-injury cohort (P=.037), and failures were predominantly under-corrections. Among 60 matched esotropia pairs undergoing incisional surgery alone, surgical dosing was comparable (95.9% vs 96.6% of standard; P=.68). In the primary multiple-variable model, larger preoperative deviation was associated with lower general motor-sensory success in the combined cohort (OR=0.963 per prism diopter, 95% CI, 0.934-0.994; P=.019) and esotropia subgroup (OR=0.950, 95% CI, 0.912-0.989; P=.012). Treatment with botulinum toxin was not independently associated with success in a sensitivity model (adjusted OR=0.18; P=.126). Male sex was associated with motor failure in exotropia (OR=0.03; P=.015). CONCLUSIONS Children with perinatal brain injury had lower long-term strabismus treatment success, predominantly from undercorrection, despite comparable normalized surgical dosing. Larger preoperative deviation was associated with lower success, particularly among patients with esotropia. These findings support tailored preoperative counseling regarding secondary interventions and warrant prospective studies evaluating adjusted treatment dosing in this population.