Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study
Comparison of shunt infection incidence in high-risk subgroups receiving antibiotic-impregnated versus standard shunts.
Shunt infection is a morbid complication of CSF shunting. Though antibiotic-impregnated shunt (AIS) systems decrease shunt infections by preventing bacterial colonization following device implantation, their effectiveness in populations at high risk for infection has recently been disputed. We set out to determine whether the categorical switch to AIS systems at our institution has resulted in a decreased incidence of shunt infection in high-risk pediatric patients. ⋯ The introduction of AIS catheters into our institutional practice has reduced the incidence of shunt infection in pediatric populations at highest risk for infection. AIS catheters are effective instruments to prevent peri-operative colonization of CSF shunt components.
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Optic nerve sheath diameter has been linked with intracranial pressure in previous studies. Measurement of sheath diameter using transorbital ultrasound is proposed as a clinical assessment indicator of developing hydrocephalus in the paediatric population. ⋯ Transorbital ultrasound is a reproducible, non-invasive technique for the assessment of optic nerve sheath diameter and is well tolerated in children. Our series revealed asymptomatic baseline value higher than in previous reports. Variation from individual case asymptomatic baseline was the most sensitive variable in the series in determining development of hydrocephalus. This technique is felt to be a useful adjunct in the assessment of hydrocephalus in the paediatric neurosurgical population.
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Ten to 40% of children operated on for a posterior fossa tumour require a further surgical procedure for the management of a persisting active ventricular dilation. The management of this kind of hydrocephalus is still controversial. ⋯ Post-operative ETV should be considered the best option to treat persistent hydrocephalus after the removal of posterior fossa tumours.
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Venous hypertension is emerging as a significant contributor to intracranial pressure in children with syndromic craniosysnostosis. This is associated with jugular foramen stenosis or atresia and with the development of collateral emissary veins. We demonstrate how computed tomography venography can document the prevalence of these emissary veins and how their visualisation plays an important role in operative planning. ⋯ Patients with syndromic craniosynostosis often demonstrate abnormal venous anatomy, which can have serious consequences on craniofacial surgery, especially when a posterior decompression is being considered. Based on these findings, the authors assert that those children with some syndromic craniosynostosis being considered for surgery should undergo venographic studies as part of their pre-operative evaluation.