Search Results

You are looking at 1 - 2 of 2 items for

  • Author or Editor: Casey J. Madura x
  • Refine by Access: all x
Clear All Modify Search
Full access

Curtis J. Rozzelle, Casey Madura, and Ron W. Reeder

OBJECTIVE

Endoscopic third ventriculostomy with choroid plexus cauterization for the treatment of neonatal and infant hydrocephalus has gained popularity in the past decade. Identifying treatment failure is critically important. Results of a pilot study of 2 novel imaging markers seen on fast-sequence T2-weighted axial MRI showed potential clinical utility. However, the reliability of multiple raters detecting these markers must be established before a multicenter validation study can be performed.

METHODS

Two sets of de-identified single-shot T2-weighted turbo spin-echo axial images were prepared from scans of patients before and after they underwent endoscopic third ventriculostomy with choroid plexus cauterization between March 2013 and January 2016. The first set showed the lateral and third ventricles for visualization of turbulent CSF dynamics, and the second set showed the lateral ventricular atria for choroid plexus glomus detection. Three raters (Group 1) received written instructions before evaluating each image set once and then again 1 week later. Another 8 raters (Group 2) evaluated both image sets after oral instruction and group training on a pretest image set. Fleiss’ kappa coefficients with 95% CIs were calculated for intrarater and interrater reliability in Group 1 and interrater reliability in Group 2.

RESULTS

Intrarater reliability kappa coefficients for Group 1 were ≥ 0.74 for turbulence and ≥ 0.80 for choroid plexus; their interrater kappa coefficients at the initial assessment were 0.50 (95% CI 0.37–0.62) and 0.56 (95% CI 0.43–0.69), respectively. The Group 2 interrater kappa scores were 0.82 (95% CI 0.78–0.86) for turbulence and 0.62 (95% CI 0.58–0.66) for choroid plexus.

CONCLUSIONS

With minimal training, intrarater reliability on visualization of turbulence and the choroid plexus was substantial, but interrater reliability was only moderate. After modestly increasing training, interrater reliability improved to near perfect and to substantial reliability for visualization of turbulence and choroid plexus, respectively. Given adequately trained observers, a multicenter investigation into the validity and potential clinical utility of the imaging markers seems feasible.

Restricted access

David S. Hersh, Jonathan E. Martin, Ruth E. Bristol, Samuel R. Browd, Gerald Grant, Nalin Gupta, Todd C. Hankinson, Eric M. Jackson, John R. W. Kestle, Mark D. Krieger, Abhaya V. Kulkarni, Casey J. Madura, Jonathan Pindrik, Ian F. Pollack, Jeffrey S. Raskin, Jay Riva-Cambrin, Curtis J. Rozzelle, Jodi L. Smith, and John C. Wellons III

OBJECTIVE

Long-term follow-up is often recommended for patients with hydrocephalus, but the frequency of clinical follow-up, timing and modality of imaging, and duration of surveillance have not been clearly defined. Here, the authors used the modified Delphi method to identify areas of consensus regarding the modality, frequency, and duration of hydrocephalus surveillance following surgical treatment.

METHODS

Pediatric neurosurgeons serving as institutional liaisons to the Hydrocephalus Clinical Research Network (HCRN), or its implementation/quality improvement arm (HCRNq), were invited to participate in this modified Delphi study. Thirty-seven consensus statements were generated and distributed via an anonymous electronic survey, with responses structured as a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A subsequent, virtual meeting offered the opportunity for open discussion and modification of the statements in an effort to reach consensus (defined as ≥ 80% agreement or disagreement).

RESULTS

Nineteen pediatric neurosurgeons participated in the first round, after which 15 statements reached consensus. During the second round, 14 participants met virtually for review and discussion. Some statements were modified and 2 statements were combined, resulting in a total of 36 statements. At the conclusion of the session, consensus was achieved for 17 statements regarding the following: 1) the role of standardization; 2) preferred imaging modalities; 3) postoperative follow-up after shunt surgery (subdivided into immediate postoperative imaging, delayed postoperative imaging, routine clinical surveillance, and routine radiological surveillance); and 4) postoperative follow-up after an endoscopic third ventriculostomy. Consensus could not be achieved for 19 statements.

CONCLUSIONS

Using the modified Delphi method, 17 consensus statements were developed with respect to both clinical and radiological follow-up after a shunt or endoscopic third ventriculostomy. The frequency, modality, and duration of surveillance were addressed, highlighting areas in which no clear data exist to guide clinical practice. Although further studies are needed to evaluate the clinical utility and cost-effectiveness of hydrocephalus surveillance, the current study provides a framework to guide future efforts to develop standardized clinical protocols for the postoperative surveillance of patients with hydrocephalus. Ultimately, the standardization of hydrocephalus surveillance has the potential to improve patient care as well as optimize the use of healthcare resources.