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

    • This updated guideline is the result of a planned five-year review of medical literature conducted by the Congress of Neurological Surgeons. This update discusses new and previous recommendations from the 2014 guidelines on the treatment of pediatric hydrocephalus (HC).
    • There are 1 new Level III and 1 new Level I recommendations while the rest of the guidelines remain unchanged. These include:

    Level III – Management of post hemorrhagic HC in premature infants:

    1. NEW: Neuro-endoscopic lavage is a feasible and safe option for removal of intraventricular clots and may decrease rate of shunt placement.

    Level I - Antibiotic-impregnated shunt systems vs conventional shunts to prevent shunt infection in children:

    1. NEW: Antibiotic-impregnated shunt tubing reduces risks of infection compared to the conventional silicone hardware and should be used for children who require shunt placement

     Confirmation of previous recommendations:

    • Technical assistance devices for ventricular placement: ultrasound is an option
    • Ventriculoperitoneal shunt (VPS) placement vs endoscopic third ventriculostomy (ETV) for pediatric HC: VPS and ETV are both viable options
    • Different shunt components for pediatric VPS: Valve types do not influence risk of shunt failure
    • Preoperative antibiotics for VPS: Use of preoperative antibiotic is recommended
    • Treatment of VPS infection: Supplementation of antibiotic treatment with partial or complete shunt hardware removal is an option
    • Ventricular catheter entry point on shunt survival: frontal and occipital entry points are both options
    • Change in ventricle size as a measurement of effective treatment of HC: insufficient evidence to recommend specific change in ventricle size as a measurement of timing and success of HC treatments including VPS and ETV


    Academic OUP

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