Şükriye Yılmaz

Aims: Congenital portosystemic shunts (CPSS) are rare vascular malformations diverting portal venous blood into the systemic circulation. Data describing their clinical spectrum, associated congenital anomalies, and natural history in children remain limited.Methods: We retrospectively evaluated nine pediatric patients diagnosed with CPSS at the Department of Pediatric Gastroenterology, Ankara Etlik City Hospital, between January 2023 and October 2025. Demographic, clinical, laboratory, radiological, and follow-up data were analyzed descriptively.Results: Seven patients (77.8%) had intrahepatic and two (22.2%) had extrahepatic (Abernethy type II) shunts. The most common presentations were neonatal hypoxemia/cyanosis (4/9), cholestasis (3/9), and hypoglycemia (2/9). Associated congenital anomalies, most frequently cardiovascular, hepatobiliary, and renal, were identified in eight of nine patients (88.9%). During follow-up (mean 21.6±14.1 months), complete spontaneous closure occurred in four of seven intrahepatic shunts (57.1%) and regression in two (28.6%), whereas both extrahepatic shunts remained patent.Conclusion: In this small series, intrahepatic CPSS diagnosed in infancy frequently demonstrated spontaneous closure or regression, whereas both extrahepatic shunts remained patent during follow-up, consistent with previous reports, although this finding should be interpreted cautiously given the small number of extrahepatic cases. Associated congenital anomalies were frequently observed, supporting consideration of multidisciplinary multisystem evaluation in children diagnosed with CPSS.

Aim: Pediatric intracranial abscesses and empyemas are neurosurgical emergencies associated with significant morbidity and mortality. This study evaluated the clinical, radiological, and microbiological characteristics of surgically treated pediatric intracranial suppurative infections, as well as surgical management strategies, functional outcomes, and prognostic factors.Material and Methods: Twenty-one pediatric patients who underwent surgery for intracranial abscess or empyema between November 2022 and 2025 were retrospectively reviewed. Demographic, clinical, radiological, laboratory, microbiological, and treatment-related data were analysed. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at 6 months and classified as favourable (GOS 5) or unfavourable (GOS ≤ 4). Neurological sequelae were evaluated separately. Non-parametric statistical methods were applied.Results: Subdural empyema was the most common diagnosis (66.7%), and most lesions were supratentorial (95.2%). The median age was 87 months, and 71.4% of patients were male. Craniotomy with drainage was performed in 95.2% of cases. Post-treatment C-reactive protein and white blood cell levels significantly decreased (p

Malformations of cortical development (MCDs) are heterogeneous neurodevelopmental disorders resulting from abnormalities in neuronal proliferation, migration, and post-migrational organization, and they represent an important cause of pediatric epilepsy. High-resolution magnetic resonance imaging (MRI), particularly three-dimensional fluid-attenuated inversion recovery (3D-FLAIR), improves the detection of subtle cortical abnormalities such as focal cortical dysplasia (FCD).This study aimed to describe the distribution, clinical characteristics, and epilepsy-related features of malformations of cortical development in children, and to evaluate the added value of 3D FLAIR MRI in the detection and characterization of focal cortical dysplasia. A total of 47 pediatric patients were included. Post-migrational abnormalities were the most common findings (74.4%), followed by migration disorders (21.2%) and abnormalities of proliferation or apoptosis (4.2%). Seizures were the most frequent presenting symptom, and FCD was the most common subtype. Among the 17 patients with FCD, four lesions not visible on routine imaging were detected using the 3D-FLAIR sequence. In conclusion, MCDs are an important cause of pediatric epilepsy. High-resolution MRI, particularly 3D FLAIR imaging, improves the detection of subtle cortical abnormalities, especially focal cortical dysplasia. Optimized MRI protocols using widely available 1.5-T systems may significantly enhance diagnostic accuracy and support therapeutic planning.

Aims: Pediatric non-traumatic intracranial hemorrhage (pNTIH) is an important cause of acute neurological morbidity with an etiological spectrum distinct from that of adults. This study aimed to evaluate the imaging findings, etiological distribution, and age-related characteristics of pNTIH in children.Methods: This retrospective, single-center study included 56 pediatric patients aged 0-18 years who were diagnosed with pNTIH between September 2022 and January 2026. Radiological evaluation included computed tomography (CT), magnetic resonance imaging (MRI), and advanced vascular imaging modalities, including CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA). Etiologies were determined using a combination of clinical, laboratory, and imaging findings.Results: Arteriovenous malformation (AVM) was the most common etiology (23.2%), followed by cerebral aneurysm (14.3%) and venous ischemia-related hemorrhage (12.5%). AVM, venous ischemia, and cavernoma-related hemorrhages were more common in older children, whereas treatment related hemorrhage was more frequent in infants. Increasing age was associated with a higher likelihood of AVM-related hemorrhage (OR=1.14; 95% CI, 1.01-1.29; p=0.032). CTA was performed in 71.4% of patients, MRA in 53.6%, and DSA in 26.8%. Early mortality occurred in 3 patients (5.4%).Conclusion: Non-traumatic intracranial hemorrhage in children demonstrates age-dependent etiological variation. Early multimodality imaging is essential for accurate etiological diagnosis and timely management.

Objective: This study evaluates neuroimaging findings in pediatric headache patients and identifies clinical predictors for imaging necessity. Methods: A retrospective analysis was performed on 1008 children aged 3-17 years presenting with headache between January 2023 and January 2025. Data on headache type, neurologic examination, and cranial magnetic resonance imaging (MRI) results were collected and classified per ICHD-3 criteria. Results: Of the patients, 62.7% were girls and the mean age was 12.4 years. Migraine (27.0%) and tension-type headache (18.6%) were the most common diagnoses. Neurologic examinations were normal in 96.2%. MRI was conducted in 908 patients; 26.7% showed abnormalities, although only 3.6% were clinically significant (eg, pseudotumor cerebri, Chiari malformation). Significant findings correlated with abnormal neurologic examinations and sleep-disrupting headaches ( P < .001, P = .0047). Headache duration was not predictive. Conclusion: Most pediatric headaches are benign. Imaging should be limited to cases with abnormal examinations or clinical red flags.

Objective: Chiari 1 malformation is a congenital anomaly characterized by downward displacement of the cerebellar tonsils through the foramen magnum. Surgical decision-making in Chiari 1 largely depends on clinical symptoms and imaging findings, particularly the presence of headache and syringohydromyelia. This study aimed to evaluate the radiological characteristics and postoperative imaging changes in pediatric patients with Chiari 1 and Chiari 1.5 malformations. Material and Methods: This retrospective study included 101 pediatric patients (age range; 1–18 years) diagnosed with Chiari 1 or Chiari 1.5 based on brain and cervical spine MRI findings between November 2022 and April 2025. Clinical and radiological data, including tonsillar descent, syringomyelia, craniovertebral junction anomalies, and basal angle measurements were analyzed. Twenty-one patients underwent posterior fossa decompression and postoperative MRIs were evaluated at 3 and 6 months. Statistical analyses were performed using chi-square, Mann–Whitney U, Wilcoxon signed-rank, and McNemar tests, with p <0.050 considered significant. Results: Among the 101 patients, 52 (51%) were female, and 49 (49%) were male (mean age; 11.1±4.9 years). Headache was significantly more frequent in operated patients (66.7% vs. 32.5%, p=0.014). Syringomyelia was also more common in the surgical group (33.3% vs. 3.8%, p <0.001), and tonsillar descent was greater (14.3±5.3 mm vs. 9.5±3.6 mm, p<0.001). No significant differences were found between the groups regarding age, sex, basal angle, or foramen magnum diameter. Postoperative follow-up revealed regression of syrinx dimensions and clinical improvement in all operated patients. Conclusion: Headache, syrinx formation, and greater tonsillar descent are key radiological and clinical predictors of surgical intervention in pediatric Chiari 1. While craniovertebral junction anomalies and hydrocephalus may coexist, they appear less predictive of surgical necessity. Posterior fossa decompression remains a safe and effective treatment in symptomatic pediatric patients, leading to both clinical and radiological improvement.

Purpose Idiopathic intracranial hypertension (IIH) in the pediatric population remains diagnostically challenging, particularly in the absence of papilledema, and increasingly depends on ancillary neuroimaging findings to support clinical assessment. The aim of this study was to systematically evaluate established magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) markers of elevated intracranial pressure in children and to investigate oculomotor nerve cistern (OMC) distention as a potential novel adjunctive imaging biomarker of pediatric IIH. Methods This retrospective study included patients aged 0–18 years who underwent brain MRI and contrast-enhanced MRV for suspected intracranial hypertension and had cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture. Patients with secondary causes of intracranial hypertension were excluded. MRI and MRV examinations were independently assessed by two blinded senior pediatric radiologists. Imaging parameters analyzed included pituitary gland height and superior contour, perioptic CSF distention with optic nerve sheath diameter (ONSD) measurements, optic nerve tortuosity, posterior globe flattening, Meckel’s cave dimensions, transverse sinus stenosis, jugular vein stenosis, and qualitative assessment of OMC distention. Patients were stratified according to CSF opening pressure, with values ≥28 cm H₂O considered elevated. Results Sixty-six patients met the inclusion criteria, of whom 44 demonstrated elevated CSF opening pressure. The mean ONSD was significantly greater in the elevated-pressure group compared with controls (5.60 ± 0.91 mm vs 5.04 ± 0.68 mm; p=0.012), and perioptic CSF distention exhibited the highest diagnostic sensitivity (90.9%). OMC distention was more frequently observed in patients with elevated CSF pressure (52.3% vs 27.3%), yielding moderate sensitivity (52.2%) and specificity (72.7%). Additionally, the anteroposterior diameter of Meckel’s cave was significantly increased in the elevated-pressure cohort. Conclusion Conventional MRI and MRV markers provide robust supportive evidence for the diagnosis of pediatric IIH. OMC distention appears to be a plausible adjunctive imaging biomarker that may enhance diagnostic confidence when interpreted in conjunction with established neuroimaging findings.

This study aimed to evaluate the clinical indications, imaging findings, and structural factors identified on pediatric lumbar MRI, with a specific focus on non-traumatic low back pain and lumbar disc herniation (LDH). A retrospective review was conducted of 1,253 lumbar MRI examinations performed in pediatric patients aged 0-18 years between November 2022 and March 2024. Clinical indications were documented for all patients. Imaging findings were systematically analyzed in children presenting with non-traumatic low back pain. In patients diagnosed with LDH, the presence of lumbosacral transitional vertebrae (LSTV), spondylolysis, and spondylolisthesis was reassessed. LSTVs were categorized using the Castellvi classification. Low back pain was the most common indication for MRI (n=650, 51.9%). Among these children, 62.3% had normal examinations. Disc protrusion (15.1%), degenerative disc or endplate changes (8.9%), spondylolysis (5.5%), and spondylolisthesis (2.8%) were the most frequent abnormalities. LDH predominantly occurred at the L5-S1 level. LSTVs were identified in 52 patients (8%) with LDH, and higher-grade Castellvi types were significantly associated with LDH (p<0.001). Lumbarization of S1 was observed in 10 LDH patients, typically showing squaring of S1 and prominence of the S1-2 disc space. Although most pediatric lumbar MRI examinations performed for low back pain are normal, MRI remains essential for identifying clinically relevant structural abnormalities. LDH is more common in older adolescents and is associated with anatomical variants such as LSTV and lumbarization. Recognition of these variations, combined with adherence to evidence-based imaging recommendations, is crucial for accurate diagnosis and appropriate clinical management in children with low back pain.