Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
-
Comparative Study
Lack of efficacy of antibiotic-impregnated shunt systems in preventing shunt infections in children.
Shunt infection is a common and serious complication of cerebrospinal fluid (CSF) shunting most commonly caused by skin flora contamination at surgery. Recent studies indicate that the use of antibiotic-impregnated (AI) shunt systems may reduce the risk of postoperative shunt infections. We evaluated the incidence of shunt infections associated with the use of AI shunt catheters and compared it with the incidence associated with standard non-AI catheters. ⋯ We reviewed 160 shunt procedures (80 per group). The infection rate was 5.0% among patients with AI catheters compared with 8.8% in the control group (P = 0.534, Fischer's exact). The average time to infection was similar between the two groups. Among the AI group, the shunt infection rate did not differ between ventricular catheter, distal catheter revisions, and revisions of ventricular and peritoneal tubing. In contrast with other reports, we found no significant reduction in the pediatric CSF shunt infection rate with the use of AI shunt systems. Any recommendation for or against the routine use of AI systems in children requires a prospective, blinded, randomized-controlled trial with adequate power.
-
The bones of the skull of the newborn and nursing infants, in general, possess great malleability. For this reason, the depressed fractures occurring at this age are called "Ping Pong" or "Green Stick" fractures. The treatment of these fractures is surgical according to different authors, although some of these fractures that happen in childbirth can elevate themselves spontaneously. ⋯ Finally, it has been demonstrated that this procedure is simple, inexpensive, and avoids surgical intervention.
-
The aim of this study is to retrospectively evaluate a series of consecutive patients affected by post-hemorrhagic hydrocephalus in prematurity, treated with an implant of an Ommaya reservoir followed by ventriculo-peritoneal (VP) shunt and/or endoscopic third ventriculostomy (ETV) to evaluate the safety and efficacy of these treatment options in the management of the condition. ⋯ The combination of Ommaya reservoir, VP shunt, and the aggressive use of ETV as a primary treatment or as an alternative to shunt revision allowed for a significant reduction of shunt dependency in a traditionally shunt-dependent population. Further studies are warranted to optimise the algorithm of treatment in these patients.