scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 30-34 ◽  
Author(s):  
David D. Limbrick ◽  
Lissa C. Baird ◽  
Paul Klimo ◽  
Jay Riva-Cambrin ◽  
Ann Marie Flannery
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Task Force ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Class Iii ◽  
Csf Shunts ◽  
Pediatric Hydrocephalus ◽  
Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature comparing CSF shunts and endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus and to make evidence-based recommendations regarding the selection of surgical technique for this condition. Methods Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts and ETV for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been determined a priori were examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider treatment recommendations based on the evidence. Results Of the 122 articles identified using optimized search parameters, 52 were recalled for full-text review. One additional article, originally not retrieved in the search, was also reviewed. Fourteen articles met all study criteria and contained comparative data on CSF shunts and ETV. In total, 6 articles (1 Class II and 5 Class III) were accepted for inclusion in the evidentiary table; 8 articles were excluded for various reasons. The tabulated evidence supported the evaluation of CSF shunts versus ETV. Conclusions Cerebrospinal fluid shunts and ETV demonstrated equivalent outcomes in the clinical etiologies studied. Recommendation: Both CSF shunts and ETV are options in the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate clinical certainty.

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 35-43 ◽  
Author(s):  
Lissa C. Baird ◽  
Catherine A. Mazzola ◽  
Kurtis I. Auguste ◽  
Paul Klimo ◽  
Ann Marie Flannery
Keyword(s):  
Systematic Review ◽  
Task Force ◽  
Treatment Options ◽  
Evidence Based ◽  
Moderate Degree ◽  
Class Iii ◽  
Insufficient Evidence ◽  
Pediatric Hydrocephalus ◽  
Programmable Valve ◽  
Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts. Methods Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded. Conclusions An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another. Recommendation: There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate degree of clinical certainty.

scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 3: Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 24-29 ◽  
Author(s):  
Ann Marie Flannery ◽  
Ann-Christine Duhaime ◽  
Mandeep S. Tamber ◽  
Joanna Kemp
Keyword(s):  
Systematic Review ◽  
Task Force ◽  
Catheter Placement ◽  
Computer Assisted ◽  
Ventricular Catheter ◽  
Evidence Based ◽  
Electromagnetic Navigation ◽  
Shunt Placement ◽  
Pediatric Hydrocephalus ◽  
Evidence Based Guidelines

Object This systematic review was undertaken to answer the following question: Do technical adjuvants such as ventricular endoscopic placement, computer-assisted electromagnetic guidance, or ultrasound guidance improve ventricular shunt function and survival? Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of cerebrospinal fluid shunts for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been delineated a priori were then examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results The search yielded 163 abstracts, which were screened for potential relevance to the application of technical adjuvants in shunt placement. Fourteen articles were selected for full-text review. One additional article was selected during a review of literature citations. Eight of these articles were included in the final recommendations concerning the use of endoscopy, ultrasonography, and electromagnetic image guidance during shunt placement, whereas the remaining articles were excluded due to poor evidence or lack of relevance. The evidence included 1 Class I, 1 Class II, and 6 Class III papers. An evidentiary table of relevant articles was created. Conclusions Recommendation: There is insufficient evidence to recommend the use of endoscopic guidance for routine ventricular catheter placement. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: The routine use of ultrasound-assisted catheter placement is an option. Strength of Recommendation: Level III, unclear clinical certainty. Recommendation: The routine use of computer-assisted electromagnetic (EM) navigation is an option. Strength of Recommendation: Level III, unclear clinical certainty.

scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 3-7 ◽  
Author(s):  
Ann Marie Flannery ◽  
Laura Mitchell
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Task Force ◽  
Clinical Information ◽  
Evidence Based ◽  
Educational Tool ◽  
Pediatric Hydrocephalus ◽  
Appropriate Treatment ◽  
Evidence Based Guidelines

This clinical systematic review of and evidence-based guidelines for the treatment of pediatric hydrocephalus were developed by a physician volunteer task force. They are provided as an educational tool based on an assessment of current scientific and clinical information as well as accepted approaches to treatment. They are not intended to be a fixed protocol, because some patients may require more or less treatment. In Part 1, the authors introduce the reader to the complex topic of hydrocephalus and the lack of consensus on its appropriate treatment. The authors describe the development of the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force charged with reviewing the literature and recommending treatments for hydrocephalus, and they set out the basic methodology used throughout the specific topics covered in later chapters.

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.

Comparison of endoscopic third ventriculostomy with or without choroid plexus cauterization in pediatric hydrocephalus: a systematic review and meta-analysis

2020 ◽  
Vol 26 (4) ◽  
pp. 371-378
Author(s):  
Yosef Ellenbogen ◽  
Karanbir Brar ◽  
Kaiyun Yang ◽  
Yung Lee ◽  
Olufemi Ajani
Keyword(s):  
Systematic Review ◽  
Choroid Plexus ◽  
Subgroup Analysis ◽  
Endoscopic Third Ventriculostomy ◽  
Meta Analysis ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Pediatric Hydrocephalus ◽  
Csf Diversion ◽  
Choroid Plexus Cauterization

OBJECTIVEPediatric hydrocephalus is a significant contributor to infant morbidity and mortality, particularly in developing countries. The mainstay of treatment has long been shunt placement for CSF diversion, but recent years have seen the rise of alternative procedures such as endoscopic third ventriculostomy (ETV), which provides similar efficacy in selected patients. The addition of choroid plexus cauterization (CPC) to ETV has been proposed to increase efficacy, but the evidence of its utility is limited. This systematic review and meta-analysis aimed to determine the efficacy and safety of ETV+CPC in comparison to ETV alone for the treatment of pediatric all-cause hydrocephalus.METHODSMEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, and ICRCTN databases were searched from conception through to October 2018 for comparative studies including both ETV+CPC and ETV in a pediatric population. The primary outcome was success rate, defined as no secondary procedure required for CSF diversion; secondary outcomes included time to failure, mortality, and complications. Data were pooled using random-effects models of meta-analysis, and relative risk (RR) was calculated.RESULTSFive studies were included for final qualitative and quantitative analysis, including 2 prospective and 3 retrospective studies representing a total of 963 patients. Overall, there was no significant difference in success rates between ETV and ETV+CPC (RR 1.24, 95% CI 0.88–1.75, p = 0.21). However, a subgroup analysis including the 4 studies focusing on African cohorts demonstrated a significant benefit of ETV+CPC (RR 1.38, 95% CI 1.08–1.78, p = 0.01). There were no notable differences in complication rates among studies.CONCLUSIONSThis systematic review and meta-analysis failed to find an overall benefit to the addition of CPC to ETV; however, a subgroup analysis showed efficacy in sub-Saharan African populations. This points to the need for future randomized clinical trials investigating the efficacy of ETV+CPC versus ETV in varied patient populations and geographic locales.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines

Neurosurgery ◽  
2020 ◽  
Vol 87 (6) ◽  
pp. 1071-1075
Author(s):  
David F Bauer ◽  
Lissa C Baird ◽  
Paul Klimo ◽  
Catherine A Mazzola ◽  
Dimitrios C Nikas ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Full Text ◽  
Best Practice ◽  
Medical Literature ◽  
Task Force ◽  
Relevant Literature ◽  
Evidence Based ◽  
Pediatric Hydrocephalus ◽  
Evidence Based Guidelines

ABSTRACT BACKGROUND The Congress of Neurological Surgeons reviews its guidelines according to the Institute of Medicine's recommended best practice of reviewing guidelines every 5 yrs. The authors performed a planned 5-yr review of the medical literature used to develop the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines” and determined the need for an update to the original guideline based on new available evidence. OBJECTIVE To perform an update to include the current medical literature for the “Pediatric hydrocephalus: systematic literature review and evidence-based guidelines”, originally published in 2014. METHODS The Guidelines Task Force used the search terms and strategies consistent with the original guidelines to search PubMed and Cochrane Central for relevant literature published between March 2012 and November 2019. The same inclusion/exclusion criteria were also used to screen abstracts and to perform the full-text review. Full text articles were then reviewed and when appropriate, included as evidence and recommendations were added or changed accordingly. RESULTS A total of 41 studies yielded by the updated search met inclusion criteria and were included in this update. CONCLUSION New literature resulting from the update yielded a new recommendation in Part 2, which states that neuro-endoscopic lavage is a feasible and safe option for the removal of intraventricular clots and may lower the rate of shunt placement (Level III). Additionally a recommendation in part 7 of the guideline now states that antibiotic-impregnated shunt tubing reduces the risk of shunt infection compared with conventional silicone hardware and should be used for children who require placement of a shunt (Level I). <https://www.cns.org/guidelines/browse-guidelines-detail/pediatric-hydrocephalus-guideline>

A lesson in history: the evolution of endoscopic third ventriculostomy

2012 ◽  
Vol 33 (2) ◽  
pp. E11 ◽  
Author(s):  
Paul J. Schmitt ◽  
John A. Jane
Keyword(s):  
Patient Selection ◽  
Endoscopic Third Ventriculostomy ◽  
Lessons Learned ◽  
New Technique ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Success Rates ◽  
Effective Implementation ◽  
Remarkable Improvement ◽  
History Of

The history of endoscopic third ventriculostomy (ETV) demonstrates the importance of studying neurosurgery's history. A story that began with numerous technological advancements started to fizzle as neurosurgeons were stymied by problems encountered during the infancy of the technology they were still developing. The new technique, although sound in theory, failed to deliver a realistic solution for managing hydrocephalus; it lost the battle to the valved shunt. Over the last 15–20 years, a clearer understanding of pathophysiological mechanisms underlying various forms of hydrocephalus, along with effective implementation of evidence-based practice, has allowed for optimization of patient selection and a remarkable improvement in ETV success rates. Neurosurgeons would be wise to take the lessons learned in modernizing the ETV procedure and reassure themselves that these lessons do not apply to other methods that are tempting to dismiss as antiquated or archaic.

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