✓ A technique is described for closure of lumbosacral myelomeningoceles. The pathological anatomy of these lesions is examined, and the junction of the skin and dura is identified as the “junctional zone.” This zone permits maximal preservation of the available dura for watertight closure after operative dissection. The junctional zone also serves as an anchor for traction sutures, permitting skin closure without tension. Seventy consecutive repairs have been completed by the authors without significant complications. There have been no instances of cerebrospinal fluid leaks, meningitis, or wound dehiscence. In all cases the repair was carried out rapidly and in a single stage.
William R. Cheek, John P. Laurent, and David A. Cech
Franz E. Babl, Mark D. Lyttle, Natalie Phillips, Amit Kochar, Sarah Dalton, John A. Cheek, Jeremy Furyk, Jocelyn Neutze, Silvia Bressan, Amanda Williams, Stephen J. C. Hearps, MBiostat, Ed Oakley, Gavin A. Davis, Stuart R. Dalziel, and Meredith L. Borland
Current clinical decision rules (CDRs) guiding the use of CT scanning in pediatric traumatic brain injury (TBI) assessment generally exclude children with ventricular shunts (VSs). There is limited evidence as to the risk of abnormalities found on CT scans or clinically important TBI (ciTBI) in this population. The authors sought to determine the frequency of these outcomes and the presence of CDR predictor variables in children with VSs.
The authors undertook a planned secondary analysis on children with VSs included in a prospective external validation of 3 CDRs for TBI in children presenting to 10 emergency departments in Australia and New Zealand. They analyzed differences in presenting features, management and acute outcomes (TBI on CT and ciTBI) between groups with and without VSs, and assessed the presence of CDR predictors in children with a VS.
A total of 35 of 20,137 children (0.2%) with TBI had a VS; only 2 had a Glasgow Coma Scale score < 15. Overall, 49% of patients with a VS underwent CT scanning compared with 10% of those without a VS. One patient had a finding of TBI on CT scanning, with positive predictor variables on CDRs. This patient had a ciTBI. No patient required neurosurgery. For children with and without a VS, the frequency of ciTBI was 2.9% (95% CI 0.1%–14.9%) compared with 1.4% (95% CI 1.2%–1.6%) (difference 1.5% [95% CI −4.0% to 7.0%]), and TBI on CT 2.9% (95% CI 0.1%–14.9%) compared with 2.0% (95% CI 1.8%–2.2%) (difference 0.9%, 95% CI −4.6% to 6.4%).
The authors’ data provide further support that the risk of TBI is similar for children with and without a VS.