Pediatric Neurosurgery

2020 ◽  
pp. 26-62
Keyword(s):  
Pediatric Neurosurgery ◽  
Shunt Infection ◽  
Genetic Alterations ◽  
Fibrinolytic Therapy ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Pediatric Medulloblastoma ◽  
Csf Shunt Infection ◽  
Childhood Hydrocephalus ◽  
Strip Craniectomy

This chapter focuses on pediatric neurosurgery. The first study compares the results of extended strip craniectomy versus subtotal calvarectomy with cranial vault remodeling for patients with sagittal craniosynostosis, while the second study tests the safety and efficacy of minimally invasive endoscopic strip craniectomy followed by helmet molding therapy in the treatment of infantile craniosynostosis. The next three studies determine the success of endoscopic third ventriculostomy (ETV) in the treatment of childhood hydrocephalus, evaluate the risk factors for cerebrospinal fluid (CSF) shunt infection following initial shunt replacement, and assess the efficacy of drainage, irrigation, and fibrinolytic therapy (DRIFT) for premature infants with posthemorrhagic ventricular dilatation. Meanwhile, the following set of studies identifies the genetic alterations related to the pathogenesis of pediatric medulloblastoma and discusses the effect of prolonged postoperative chemotherapy on the ability to delay the delivery of radiation in children younger than 3 years of age with malignant brain tumors. The following two studies investigate whether prenatal repair of myelomeningocele could result in better neurologic function compared with the standard postnatal repair and explore functional outcomes following selective posterior rhizotomy in children with cerebral palsy. The last study is of historical value and explore Cushing’s critical review of cerebellar medulloblastomas.

Prospective surveillance of complications in a pediatric neurosurgery unit

2010 ◽  
Vol 5 (6) ◽  
pp. 544-548 ◽  
Author(s):  
James M. Drake ◽  
Jay Riva-Cambrin ◽  
Andrew Jea ◽  
Kurtis Auguste ◽  
Mandeep Tamber ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Pediatric Neurosurgery ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Neurosurgical Procedures ◽  
Csf Leakage ◽  
Second Procedure ◽  
Shunt Infections ◽  
Csf Leaks

Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

scholarly journals How do we change practice?

2021 ◽  
Vol 3 (2(May-August)) ◽  
pp. e932021
Author(s):  
John Kestle
Keyword(s):  
Infection Rate ◽  
Infection Prevention ◽  
Shunt Infection ◽  
Current Data ◽  
Research Network ◽  
Csf Shunt ◽  
Prevention Measures ◽  
Skin Preparation ◽  
Prevention Protocol ◽  
Csf Shunt Infection

OBJECT: The goal of this video lecture was to show the importance to research group organizing protocols to reduce cerebrospinal fluid (CSF) shunt infection at Hydrocephalus Clinical Research Network (HCRN) centers (from 8.7% to 5.7%). Antibiotic-impregnated catheters (AICs) were not part of the protocol but were used off protocol by some surgeons. The authors therefore began using a new protocol that included AICs in an effort to reduce the infection rate further. The improvement of quality was related to reduce variation and improve outcome. METHODS The previous protocol was implemented at HCRN centers on January 1, 2012, for all shunt procedures (excluding external ventricular drains [EVDs], ventricular reservoirs, and subgaleal shunts). Compliance with the protocol and outcome events up to March 30, 2014, were recorded. The actual protocol is based on 7 points (HCRNq centers): intravenous antibiotics, skin preparation, hand scrub, double gloves, iodophoretic surgical field, catheter and antibiotics, and vancomycin irrigation RESULTS. Before protocol implementation in 30 participating centers, and 1318 subjects (1571 surgical cases) enrolled the overall infection rate was 6.0% (95% CI 5.1%-7.2%). The actual infection rate when using this new protocol has been analyzed. CONCLUSIONS CSF shunt procedures performed in compliance with a new infection prevention protocol at HCRNq centers had a lower infection rate than noncompliant procedures. Based on the current data, HCRNq centers the role of AICs compared with other infection prevention measures is still under analysis.

scholarly journals Patient and Treatment Characteristics by Infecting Organism in Cerebrospinal Fluid Shunt Infection

2018 ◽  
Vol 8 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Tamara D Simon ◽  
Matthew P Kronman ◽  
Kathryn B Whitlock ◽  
Samuel R Browd ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Research Network ◽  
Csf Shunt ◽  
Coagulase Negative Staphylococcus ◽  
Gram Negative ◽  
Treatment Characteristics ◽  
Infection Treatment ◽  
Csf Shunt Infection ◽  
Univariate Analyses

Abstract Background Previous studies of cerebrospinal fluid (CSF) shunt infection treatment have been limited in size and unable to compare patient and treatment characteristics by infecting organism. Our objective was to describe variation in patient and treatment characteristics for children with first CSF shunt infection, stratified by infecting organism subgroups outlined in the 2017 Infectious Disease Society of America’s (IDSA) guidelines. Methods We studied a prospective cohort of children <18 years of age undergoing treatment for first CSF shunt infection at one of 7 Hydrocephalus Clinical Research Network hospitals from April 2008 to December 2012. Differences between infecting organism subgroups were described using univariate analyses and Fisher’s exact tests. Results There were 145 children whose infections were diagnosed by CSF culture and addressed by IDSA guidelines, including 47 with Staphylococcus aureus, 52 with coagulase-negative Staphylococcus, 37 with Gram-negative bacilli, and 9 with Propionibacterium acnes. No differences in many patient and treatment characteristics were seen between infecting organism subgroups, including age at initial shunt, gender, race, insurance, indication for shunt, gastrostomy, tracheostomy, ultrasound, and/or endoscope use at all surgeries before infection, or numbers of revisions before infection. A larger proportion of infections were caused by Gram-negative bacilli when antibiotic-impregnated catheters were used at initial shunt placement (12 of 23, 52%) and/or subsequent revisions (11 of 23, 48%) compared with all other infections (9 of 68 [13%] and 13 of 68 [19%], respectively). No differences in reinfection were observed between infecting organism subgroups. Conclusions The organism profile encountered at infection differs when antibiotic-impregnated catheters are used, with a higher proportion of Gram-negative bacilli. This warrants further investigation given increasing adoption of antibiotic-impregnated catheters.

Multidisciplinary approach to cerebrospinal fluid shunt infection with an appeal for attention to details in assessment and standardization in reporting

2011 ◽  
Vol 7 (5) ◽  
pp. 452-461 ◽  
Author(s):  
Ken R. Winston ◽  
Susan A. Dolan
Keyword(s):  
At Risk ◽  
Multidisciplinary Approach ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Accurate Identification ◽  
Meaningful Information ◽  
Valid Data ◽  
Csf Shunt Infection ◽  
Criteria For Diagnosis ◽  
Shunt Infections

Object The goal of this study was to evaluate the problems encountered in monitoring CSF shunt infection, including the collection, analysis, and reporting of data. The authors propose a system that would produce more accurate, and hence more meaningful, information on shunt infection than do the methodologies and customs now in common use. Methods The authors reviewed and analyzed 19 years of quarterly records of a committee that has addressed CSF shunt infection in an ongoing manner. Results There are strong incentives, political and otherwise, to identify low rates of CSF shunt infection. Details of the composition and operation of a multidisciplinary approach to CSF shunt infection are summarized. Many factors affect the occurrence of shunt infection and its accurate assessment and reporting. Easily accessible sources for the identification of cases of shunt infections and for the assessment of an at-risk population often contain discrepancies in significant numbers. Conclusions Multidisciplinary oversight of the entire matter of CSF shunt infection enhances the chances for collecting accurate data, identifying causes of infection, and developing effective preventative strategies. Valid data require a mechanism for finding all individuals within the at-risk pool; the accurate identification of patients who had shunt infections; standard, pragmatic, and robust criteria for diagnosis of shunt infection; and multidisciplinary oversight of the entire process.

Operative Related Infection Rates for Ventriculoperitoneal Shunt Procedures in a Children's Hospital

1987 ◽  
Vol 8 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Janara J. Younger ◽  
James C.H. Simmons ◽  
Fred F. Barrett
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Infection Risk ◽  
Csf Shunt ◽  
Infection Rates ◽  
Surgical Infection ◽  
Shunt Procedure ◽  
Csf Shunt Infection

AbstractWe determined the operative related cerebrospinal fluid (CSF) shunt infection rates for our institution over a 3-year period (1982 to 1984) using strictly defined numerator and denominator data. The minimum post-operative follow-up period was 12 months. The average surgical infection risk for a CSF shunt procedure at our institution during the study period was 13.3%. Annual infection rates were relatively constant (13.8%, 13.2% and 12.9%), however both quarterly (5.7% to 23.3%) and surgeon-specific (5.7% to 22.8%) rates varied widely. Infection rates calculated by using “traditional” numerator and denominator data were considerably lower (6.5% to 9.2%).Operative related CSF shunt infection rates should be determined by utilizing strictly defined numerator and denominator values in order to allow valid comparisons of published rates.

Comparison of Two Methods of Prophylaxis Against CSF Shunt Infection

1984 ◽  
Vol 39 (S 2) ◽  
pp. 109-110 ◽  
Author(s):  
M. Lambert ◽  
A. MacKinnon ◽  
A. Vaishnav
Keyword(s):  
Shunt Infection ◽  
Csf Shunt ◽  
Csf Shunt Infection

scholarly journals Infection rates following initial cerebrospinal fluid shunt placement across pediatric hospitals in the United States

2009 ◽  
Vol 4 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Tamara D. Simon ◽  
Matthew Hall ◽  
Jay Riva-Cambrin ◽  
J. Elaine Albert ◽  
Howard E. Jeffries ◽  
...  
Keyword(s):  
The United States ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Infection Rates ◽  
Study Objective ◽  
Shunt Placement ◽  
Pediatric Hospitals ◽  
Csf Shunt Infection ◽  
Shunt Infections

Object Reported rates of CSF shunt infection vary widely across studies. The study objective was to determine the CSF shunt infection rates after initial shunt placement at multiple US pediatric hospitals. The authors hypothesized that infection rates between hospitals would vary widely even after adjustment for patient, hospital, and surgeon factors. Methods This retrospective cohort study included children 0–18 years of age with uncomplicated initial CSF shunt placement performed between January 1, 2001, and December 31, 2005, and recorded in the Pediatric Health Information System (PHIS) longitudinal administrative database from 41 children's hospitals. For each child with 24 months of follow-up, subsequent CSF shunt infections and procedures were determined. Results The PHIS database included 7071 children with uncomplicated initial CSF shunt placement during this time period. During the 24 months of follow-up, these patients had a total of 825 shunt infections and 4434 subsequent shunt procedures. Overall unadjusted 24-month CSF shunt infection rates were 11.7% per patient and 7.2% per procedure. Unadjusted 24-month cumulative incidence rates for each hospital ranged from 4.1 to 20.5% per patient and 2.5–12.3% per procedure. Factors significantly associated with infection (p < 0.05) included young age, female sex, African-American race, public insurance, etiology of intraventricular hemorrhage, respiratory complex chronic condition, subsequent revision procedures, hospital volume, and surgeon case volume. Malignant lesions and trauma as etiologies were protective. Infection rates for each hospital adjusted for these factors decreased to 8.8–12.8% per patient and 1.4–5.3% per procedure. Conclusions Infections developed in > 11% of children who underwent uncomplicated initial CSF shunt placements within 24 months. Patient, hospital, and surgeon factors contributed somewhat to the wide variation in CSF shunt infection rates across hospitals. Additional factors may contribute to variation in CSF shunt infection rates between centers, but further study is needed. Benchmarking and future prospective multicenter studies of CSF shunt infection will need to incorporate these and other patient, hospital, and surgeon factors.

CSF Shunt Infection by Unencapsulated Haemophilus influenzae

1993 ◽  
Vol 17 (3) ◽  
pp. 519-520 ◽  
Author(s):  
G. W. K. Wong ◽  
S. J. Oppenheimer ◽  
W. Vaudry
Keyword(s):  
Haemophilus Influenzae ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Csf Shunt Infection

Role of endoscopic third ventriculostomy at infected cerebrospinal fluid shunt removal

2012 ◽  
Vol 9 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Tomohisa Shimizu ◽  
Mark G. Luciano ◽  
Toru Fukuhara
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Shunt Infection ◽  
Secondary Outcome ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Cerebrospinal Fluid Shunt ◽  
Csf Shunts ◽  
Shunt Removal

Object Cerebrospinal fluid shunt infection is distressing, especially in the pediatric population. Usually, infected CSF shunts are removed, and after temporary external CSF drainage, reinsertion of the CSF shunt is necessary. Unfortunately, it is not rare to encounter CSF reinfection after shunt renewal, and furthermore, the reinserted CSF shunt is at a considerable risk of malfunction. Endoscopic third ventriculostomy (ETV) is a potent option in managing CSF shunt infection, although ETV failure may occur more frequently when it is used to remove an infected shunt. The authors retrospectively evaluated CSF reinfection after using ETV during removal of infected CSF shunts; then the longevity of ETV and of successive reinserted ventriculoperitoneal shunts (VPSs) after ETV failure were also examined. Methods Children with shunted hydrocephalus were retrospectively reviewed, and data on their initial CSF shunt infections were extracted. Thirty-six children underwent VPS reinsertion (the VPS group), and 9 underwent ETV after removal of the infected CSF shunt (the ETV group). As the primary outcome, ETV efficacy against CSF reinfection within 6 months was analyzed by comparing the reinfection rates, and the risk factors for CSF reinfection were analyzed by logistic regression. The longevity of the reinserted shunt in the VPS group was calculated using the Kaplan-Meier method, which was compared with ETV longevity as the secondary outcome, and also with the longevity of reinserted VPSs in the ETV group after ETV failure as the tertiary outcome. Results Reinfection of CSF was seen in 27.8% of children in the VPS group. Among 9 children in the ETV group, only 1 (11.1%) had CSF reinfection. However, logistic regression analysis failed to show that performing ETV was a significant factor protecting against CSF reinfection: the significant risk factors were younger age at reinsertion of VPS or ETV (p = 0.037) and a history of shunt revisions (p = 0.011). The longevity of reinserted VPSs in the VPS group was calculated to be 658 ± 166.3 days (mean ± SE). Longevity of ETV was compared in the analysis of the secondary outcome, which was 929.2 ± 511.1 days, and there were no significant differences between these durations. Only 2 ETVs stayed patent, and a VPS was eventually implanted in the other 7 children. The longevity of this reinserted VPS in the ETV group, calculated based on these 7 children, was 2011.1 ± 540.7 days, which was confirmed to be longer than that in the VPS group (p = 0.031). Conclusions Although the protective effect of using ETV during removal of an infected CSF shunt on reinfection is marginal, the ETV longevity can be considered equivalent to that of reinserted VPSs. Even if ETV failure occurs, the reinserted VPS has significantly better longevity than a VPS reinserted without using ETV, and use of ETV during infected CSF shunt removal can be considered a potent alternative or at least an adjunct to VPS reinsertion.

Effect of Antibiotic-Impregnated Shunts on Infection Rate in Adult Hydrocephalus: A Single Institution's Experience

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. 625-629 ◽  
Author(s):  
S Harrison Farber ◽  
Scott L Parker ◽  
Owoicho Adogwa ◽  
Matthew J McGirt ◽  
Daniele Rigamonti
Keyword(s):  
Normal Pressure ◽  
Pseudotumor Cerebri ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Communicating Hydrocephalus ◽  
Shunt Insertion ◽  
Oxacillin Resistance ◽  
Catheter Implantation ◽  
Csf Shunt Infection ◽  
The Mean

Abstract BACKGROUND: Cerebrospinal fluid (CSF) shunt infection remains a major cause of morbidity and mortality in the treatment of hydrocephalus. Studies have demonstrated the efficacy of antibiotic-impregnated shunt (AIS) systems in reducing CSF shunt infections in pediatric patients. Fewer studies evaluate the efficacy of AIS systems in adult hydrocephalus. OBJECTIVE: To determine whether categorical conversion to AIS shunt systems reduced the incidence of shunt infection in adults. METHODS: All adult patients undergoing CSF shunt insertion over a 7-year period were retrospectively reviewed (2004–2009). In 2006, a categorical switch to AIS catheters was made. Before 2006, standard nonimpregnated shunt catheters were used. We retrospectively reviewed the first 250 cases of AIS catheter implantation and compared them with the immediately preceding 250 non-AIS cases to assess 1-year incidence of CSF shunt infection. RESULTS: Five hundred shunt surgeries were performed for normal-pressure hydrocephalus in 378 patients (76%), pseudotumor cerebri in 83 patients (17%), and various obstructive/communicating hydrocephalus etiologies in 40 patients (8%). All patients were followed for 12 months. The mean age was 60 ± 18 years. Baseline characteristics were similar between AIS (n = 250) and non-AIS (n = 250) cohorts. Overall, 13 patients (2.6%) experienced CSF shunt infection, occurring a mean of 2 ± 2 months postoperatively. Shunt infection incidence was decreased in AIS (1.2%) vs non-AIS (4.0%) cohorts (P = .0492). Staphylococcus epidermidis was the most common pathogen in AIS and non-AIS cohorts. Oxacillin resistance was not increased in the AIS cohort. CONCLUSION: Categorical conversion to AIS catheters was associated with a reduced incidence of shunt infection. AIS catheters may be a reliable instrument for decreasing perioperative shunt colonization and subsequent infection in adults with hydrocephalus.

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