Pediatric hydrocephalus: systematic literature review and evidence-based guidelines
Pediatric hydrocephalus guidelines were recently published in a Journal of Neurosurgery: Pediatrics supplement. This is the first systematic scientific literature review to develop clinical guidelines for treating pediatric hydrocephalus. Based on the strength of supporting evidence to indicate clinical certainty, a total of 20 recommendations (6 Level I, 5 Level II, and 9 Level III) were presented. Key highlights include these Level I recommendations: 1) Serial lumbar punctures, intraventricular thrombolytic agents, acetazolamide and furosemide should not be used to reduce the need for shunt placement in infants with post-hemorrhagic hydrocephalus; 2) There is no benefit to using endoscopes in routine ventricular catheter placement; 3) there is no advantage for one shunt hardware design over another; 4) Preoperative antibiotic use does not lower infection risk. These guidelines also highlight the need for more studies to develop high quality evidence for clinical management of pediatric hydrocephalus.