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New evidence-based guidelines for treating hydrocephalus in children aim to improve current methods and help clear up confusion surrounding effective therapy for the condition.
The guidelines-developed by a volunteer physician task force-grew out of the realization that “current treatment methods are insufficient, and there is currently little agreement on the ‘best’ treatment, even among leading practitioners,” the task force writes. Hydrocephalus, which affects an estimated 1 in 500 infants, children, and adolescents, is the most common surgically correctable pediatric neurologic condition.
To develop evidence-based guidance, the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force, with support from the Pediatric Section of the American Association of Neurological Surgeons and Congress of Neurological Surgeons, examined peer-reviewed articles published between January 1966 and March 2012 that describe hydrocephalus treatments, related complications, and management of the complications in infants, children, and adolescents.
The task force evaluated each article and classified the evidence presented as Class I (strongest), Class II (moderate), or Class III (inconclusive or conflicting evidence or expert opinion). The resulting recommendations are based on the supporting evidence: Level I (high clinical certainty, Class I evidence), Level II (moderate clinical certainty, Class II evidence or strong consensus of Class III evidence), and Level III (clinical uncertainty, Class III evidence).
The guidelines address 8 topics in separate articles: posthemorrhagic hydrocephalus in premature infants; use of endoscopic computer-assisted electromagnetic navigation and ultrasound in shunt placement; treatment with cerebrospinal fluid shunt or endoscopic ventriculostomy; effect of valve type on cerebrospinal fluid shunt efficacy; preoperative antibiotics for shunt surgery; management of cerebrospinal fluid shunt infection; and effect of ventricular catheter entry point and position.
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