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Sheila L. Ryan, Anish Sen, Kristen Staggers, Thomas G. Luerssen and Andrew Jea

P erioperative surgical site infections (SSIs) after pediatric spine fusion are well-described complications with rates ranging from 0.5% to 1.6% in idiopathic scoliosis to 3.7% to 8.5% in combined idiopathic and nonidiopathic scoliosis series. 4 , 12 , 14–16 , 21 Some patient cohorts are at an increased risk for SSIs after spinal fusion; SSI rates for patients with spinal dysraphism range from 8% to 41.7%, and for those with cerebral palsy range from 6.1% to 15.2%. 1 , 2 , 6 , 9 , 17 , 19 , 20 Surgical site infections impart a tremendous burden on the

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John R. W. Kestle, Jay Riva-Cambrin, John C. Wellons III, Abhaya V. Kulkarni, William E. Whitehead, Marion L. Walker, W. Jerry Oakes, James M. Drake, Thomas G. Luerssen, Tamara D. Simon and Richard Holubkov

I nfection of ventriculoperitoneal shunts continues to be a source of morbidity for children with hydrocephalus and a frustrating problem for clinicians. In large databases the procedural infection rate has been reported as approximately 8%–10%. 7 , 8 , 14 Shunt infection is an important contributor to the cost of care in pediatric hydrocephalus. 2 Treatment of infection requires hospital admission, surgical removal of the device, inpatient intravenous antibiotic therapy for a variable period of time, 1 , 16 and implantation of a new shunt system

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Tamara D. Simon, Matthew P. Kronman, Kathryn B. Whitlock, Nancy E. Gove, Nicole Mayer-Hamblett, Samuel R. Browd, D. Douglas Cochrane, Richard Holubkov, Abhaya V. Kulkarni, Marcie Langley, David D. Limbrick Jr., Thomas G. Luerssen, W. Jerry Oakes, Jay Riva-Cambrin, Curtis Rozzelle, Chevis Shannon, Mandeep Tamber, John C. Wellons III, William E. Whitehead and John R. W. Kestle

W hile lifesaving and the mainstay of hydrocephalus treatment, 15 CSF shunts can cause new and chronic surgical and medical problems in children with hydrocephalus. Mechanical malfunction is frequent, with 40% of shunts requiring surgical revision within 2 years. 22 With each additional CSF shunt surgery, the risk of CSF shunt infection increases. 2 , 25 , 49 CSF shunt infection rates range from 0% to 35% per surgery, 5 , 12 , 20 , 24 , 25 , 28 , 30 , 31 , 33 , 34 , 36 , 56 with an average of 6%–8%. 18 , 19 CSF shunt reinfection after an initial infection

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Tamara D. Simon, Matthew P. Kronman, Kathryn B. Whitlock, Samuel R. Browd, Richard Holubkov, John R. W. Kestle, Abhaya V. Kulkarni, Marcie Langley, David D. Limbrick Jr., Thomas G. Luerssen, W. Jerry Oakes, Jay Riva-Cambrin, Curtis Rozzelle, Chevis N. Shannon, Mandeep Tamber, John C. Wellons III, William E. Whitehead and Nicole Mayer-Hamblett

W hile CSF shunts are life-saving and the mainstay of hydrocephalus treatment, 6 they are associated with new and chronic surgical and medical problems for children with hydrocephalus. These problems include mechanical malfunction requiring surgical revision 11 as well as CSF shunt infection. 1 , 12 , 23 While numerous review articles have been written, 3–6 , 18 until recently no organization in the US or elsewhere had published guidelines for CSF shunt infection management. However, the Infectious Diseases Society of America (IDSA), within the 2004

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I-Wen Pan, Grace M. Kuo, Thomas G. Luerssen and Sandi K. Lam

T he intrathecal baclofen pump (ITBP) was first introduced for treatment of spasticity of spinal origin. 13 The surgery involves the implantation of a permanent intrathecal catheter, reservoir, and pump mechanism to allow instillation of medication. Infections are not uncommon with these surgeries, which involve the presence of implants in a patient population with complex medical conditions. Infection rates were reported in some studies to be 4.5%-9% or even higher in children (9%-12%). 3 , 5 A collaborative study among European countries for consensus

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John R. W. Kestle, Richard Holubkov, D. Douglas Cochrane, Abhaya V. Kulkarni, David D. Limbrick Jr., Thomas G. Luerssen, W. Jerry Oakes, Jay Riva-Cambrin, Curtis Rozzelle, Tamara D. Simon, Marion L. Walker, John C. Wellons III, Samuel R. Browd, James M. Drake, Chevis N. Shannon, Mandeep S. Tamber, William E. Whitehead and The Hydrocephalus Clinical Research Network

I nfection continues to be a common complication of CSF shunts for children with hydrocephalus, and there are ongoing efforts to identify methods or devices that may reduce this risk. Quality-improvement research has suggested that standardized protocols may reduce device-related infection in a number of areas. 1 , 3 , 11 The Hydrocephalus Clinical Research Network (HCRN) has used this approach to minimize shunt infection rates since 2007. A protocol was developed using the available literature that included 11 steps aimed at reducing infection, such as

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Richard C. Ostrup, Thomas G. Luerssen, Lawrence F. Marshall and Mark H. Zornow

I ntracranial pressure (ICP) monitors that are currently in use include ventricular catheters, sub-arachnoid screws, and various subdural and epidural monitors. All of these devices have recognized advantages and problems. Ventricular catheters are accurate but are occasionally difficult to place in the presence of brain swelling and shift; they may be affected by obstruction or infection as well. 1 Subarachnoid devices are easily placed but can malfunction if they become loose or are not absolutely coplanar to the brain surface. Some authors indicate that

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injection); and 3) there exist gradients of BTP at different sites along a peritumoral edema depending on the type of tumor involved. We found Staphylococcus albus at the catheter tip in 18 of our patients and Enterococcus bacteria in one patient, but no clinical signs of infections. We use the same catheter several times in the same patient, with an initial cost of about $80. We have used catheters as many as 18 times in some patients. Reference 1. Piek J , Kosub B , Küch F , et al : A practical technique for continuous

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Jonathan N. Sellin, Aditya Vedantam, Thomas G. Luerssen and Andrew Jea

topical agents [e.g., morphine and vancomycin powder] in the epidural space, concurrent fusion, and intraoperative complications [e.g., unintended durotomy]); outcomes (e.g., infection, pain, CSF leak/pseudomeningocele, and reoperation for CSF leak/pseudomeningocele); timing of presentation with delayed CSF leak/pseudomeningocele; and length of follow-up. Pain was classified in a binary manner as either “resolved” or “persistent” based on the clinician's impression at the time of follow-up. Unfortunately, health-related QOL (HRQOL) outcome instruments, such as the 36

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Sandi K. Lam, Visish M. Srinivasan, Thomas G. Luerssen and I-Wen Pan

P lacement of ventriculoperitoneal shunts is one of the most common procedures in pediatric neurosurgery and is a significant health care burden. Shunt failure and shunt infections are common reasons for readmissions and revision surgeries. 5 Total hospital charges for treatment of pediatric hydrocephalus in the US are estimated to be between $1.4 and $2.0 billion each year. 35 Shunt admissions account for 0.6% of all pediatric hospital admissions, but consist of 3.1% of all pediatric hospital charges, 35 suggesting that children with hydrocephalus use