Pediatric hydrocephalus: systematic literature review and evidence-based guidelines

Journal of Neurosurgery: Pediatrics supplement

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.

Brandon G. Rocque, MD MS
Birmingham, AL