✓ Inadvertent adjustments and malfunctions of programmable valves have been reported in cases in which patients have encountered powerful electromagnetic fields such as those involved in magnetic resonance imaging, but the effects of small magnetic fields are not well known. The authors present a case in which a child playing with a collection of commercially available toy magnets altered the pressure setting of an implanted valve and may have caused its permanent malfunction.
Richard C. E. Anderson, Marion L. Walker, John M. Viner and John R. W. Kestle
Richard C. E. Anderson, Peter Kan, Paul Klimo, Douglas L. Brockmeyer, Marion L. Walker and John R. W. Kestle
Object. Intracranial pressure (ICP) monitoring has become routine in the management of patients with traumatic brain injury (TBI). Many surgeons prefer to use external ventricular drains (EVDs) over fiberoptic monitors to measure ICP because of the added benefit of cerebrospinal fluid drainage. The purpose of this study was to examine a consecutive series of children with TBI and compare the incidence of complications after placement of an EVD, a fiberoptic intraparencyhmal monitor, or both.
Methods. A retrospective chart review was conducted to identify children with TBI who met the criteria for insertion of an ICP monitor. All patients underwent head CT scanning on admission and after placement of an ICP monitor.
During a 5-year period 80 children met the criteria for inclusion in the study. Eighteen children (22.5%) underwent EVD placement only, 18 (22.5%) underwent placement of a fiberoptic device only, and 44 (55%) received both. A total of 62 fiberoptic devices (48%) were inserted, and 68 EVDs (52%) were placed. Overall, there was a fourfold increased risk of complications in children who received an EVD compared with those in whom a fiberoptic monitor was placed (p = 0.004). Hemorrhagic complications were detected in 12 (17.6%) of 62 patients who received an EVD compared with four (6.5%) of 62 patients who received a fiberoptic monitor (p = 0.025). Six (8.8%) of 68 EVDs were malpositioned and required replacement; in three (50%) of these cases a hemorrhagic complication occurred. Only one infection was noted in a patient with an EVD (1.5%).
Conclusions. In this retrospective cohort of pediatric patients with TBI, complication rates were significantly higher in those receiving EVDs than in those in whom fiberoptic monitors were placed. Although the majority of these complications did not entail clinical sequelae, surgeons should be aware of the different complication rates when choosing the most appropriate device for each patient.
John R. W. Kestle, Amy Lee, Richard C. E. Anderson, Barbu Gociman, Kamlesh B. Patel, Matthew D. Smyth, Craig Birgfeld, Ian F. Pollack, Jesse A. Goldstein, Mandeep Tamber, Thomas Imahiyerobo, Faizi A. Siddiqi and for the Synostosis Research Group
The authors created a collaborative network, the Synostosis Research Group (SynRG), to facilitate multicenter clinical research on craniosynostosis. To identify common and differing practice patterns within the network, they assessed the SynRG surgeons’ management preferences for sagittal synostosis. These results will be incorporated into planning cooperative studies.
The SynRG consists of 12 surgeons at 5 clinical sites. An email survey was distributed to SynRG surgeons in late 2016, and responses were collected through early 2017. Responses were collated and analyzed descriptively.
All of the surgeons—7 plastic/craniofacial surgeons and 5 neurosurgeons—completed the survey. They varied in both experience (1–24 years) and sagittal synostosis case volume in the preceding year (5–45 cases). Three sites routinely perform preoperative CT scans. The preferred surgical technique for children younger than 3 months is strip craniectomy (10/12 surgeons), whereas children older than 6 months are all treated with open cranial vault surgery. Pre-incision cefazolin, preoperative complete blood count panels, and an arterial line were used by most surgeons, but tranexamic acid was used routinely at 3 sites and never at the other 2 sites. Among surgeons performing endoscopic strip craniectomy surgery (SCS), most create a 5-cm-wide craniectomy, whereas 2 surgeons create a 2-cm strip. Four surgeons routinely send endoscopic SCS patients to the intensive care unit after surgery. Two of the 5 sites routinely obtain a CT scan within the 1st year after surgery.
The SynRG surgeons vary substantially in the use of imaging, the choice of surgical procedure and technique, and follow-up. A collaborative network will provide the opportunity to study different practice patterns, reduce variation, and contribute multicenter data on the management of children with craniosynostosis.