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A proposed preintervention framework for neurosurgery in children with medically refractory hypertonia: a scoping

Sunny Abdelmageed1,2, Riya Parikh3, Maryam N Shahin4

  • 11Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago.

Journal of Neurosurgery. Pediatrics
|February 6, 2026
PubMed

Insights

This study reviews preintervention screening for pediatric movement disorders (PMDs) and proposes a framework for neurosurgical candidates. Developing standardized presurgical algorithms can improve care for children with PMDs.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatrics

Background:

  • Pediatric movement disorders (PMDs) often necessitate advanced neurosurgical interventions.
  • Current preintervention evaluations are institution-specific, lacking international consensus.
  • A structured approach is needed for children with PMDs considered for neurosurgery.

Purpose of the Study:

  • To review current preintervention screening practices for PMDs.
  • To develop a suggested preintervention framework for pediatric neurosurgery candidates.

Main Methods:

  • A scoping review was conducted following PRISMA-ScR and JBI guidelines.
  • Information on preoperative evaluations for PMDs was compiled from 21 studies.
  • Data synthesis informed the development of a preintervention framework.

Main Results:

  • Presurgical evaluations commonly included multidisciplinary assessments, imaging, and various therapies (physical, occupational, gait, nutritional, genetic).
  • Presurgical algorithms were developed for pediatric hypertonia (dystonia, spasticity, mixed).
  • Diagnosis-specific algorithms guide clinical evaluation and neurosurgical recommendations.

Conclusions:

  • An evidence-based, structured, diagnosis-related presurgical algorithm for PMDs can enhance patient care through standardization.
  • This review highlights gaps in the presurgical workup of PMDs and surgical planning.
  • Standardized algorithms could improve indications, workup, and recommendations for pediatric neurosurgery.
Abstract

Keywords:
dystoniafunctional neurosurgeryhypertoniapediatricpresurgical evaluationspasticity

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