Guest post from Ann Marie Flannery, MD, FAANS, FACS
Childrens Multi Specialty Clinic
Womens and Childrens Hospital
Hydrocephalus is one of the most common birth defects, impacting one out of every 500 births in the U.S. Fortunately, neurosurgeons can effectively treat this problem. In an effort to assure the highest quality of care to the smallest of neurosurgical patients, evidence based guidelines for the care of infants and children with hydrocephalus have been developed and published in a special supplement to the Journal of Neurosurgery: Pediatrics. These guidelines were created by a task force led by pediatric neurosurgeons with critical input also solicited from neonatologists and patient’s families.
This series of articles are an essential resource not only for pediatric neurosurgeons but also anyone who takes care of children with this common and complex disorder. Pediatricians, neonatologists, infectious disease specialists, and pediatric surgeons will all find something of value in this document.
Consider the following facts about hydrocephalus:
- Hydrocephalus is the leading pediatric neurosurgical diagnosis affecting up to one in 500 infants and children
- An additional 6,000 children annually develop hydrocephalus by age two
- Effective treatment of hydrocephalus can result in significant improvement in neurological function
- While the surgical treatment of hydrocephalus is often thought of as being simple, the complications and long-term implications of the diagnosis and treatment can be difficult
- Re-admission after VP shunt surgery is common
For all these reasons, evidence based improvement in care is especially important.
These guidelines are ambitious, covering the wide spectrum of causes, interventions, and complications associated with hydrocephalus. The evidence presented in these guidelines was culled from almost 2000 abstracts. Diverse topics covered include:
- Treatment of post hemorrhagic hydrocephalus in premature infants
- Evidence for the use of preoperative antibiotics
- Use of antibiotic impregnated catheters
- Effectiveness of technology such as computer-assisted navigation, ventricular ultrasound and ventricular endoscopy
- Evidence for selection of shunt valves
- Effectiveness of a third ventriculostomy when compared to a shunt
- The usefulness of using ventricular size as a judgment for treatment effectiveness
As with any evidence based guidelines, the quality of evidence strongly influences the quality of the recommendation. The pediatric neurosurgeons continue to elevate the quality of care delivery through development of this set of guidelines. In addition, pediatric neurosurgery is committed to ongoing improvement in quality of care and plan to direct their next efforts toward management of plagiocephaly, the acquired skull shape problem frequently seen in the era of “back to sleep.”