- Describe your topic
- Pediatric hydrocephalus is the most common surgically correctable neurological problem in children from infancy through adolescence. While effective surgical interventions are available, these treatments are not without side effects and failures. The first evidence based guidelines for pediatric hydrocephalus were published in November 2014 . These guidelines systematically reviewed the medical evidence on nine hydrocephalus related topics. Significant literature has been produced in the interim since its publication. Updated guidelines based on systematic literature reviews with a focus on three new related hydrocephalus topics would help neurosurgeons better treat pediatric patients with hydrocephalus and improve the patients’ health outcomes. The nine topics previously reviewed include 1. Management of post-hemorrhagic hydrocephalus in premature infants, 2. Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement, 3. Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children, 4. Effect of valve type on cerebrospinal fluid shunt efficacy, 5. Preoperative antibiotics for shunt surgery in children with hydrocephalus, 6. Antibiotic-impregnated shunt systems versus conventional shunts in children, 7. Management of cerebrospinal fluid shunt infection, 8. Effect of ventricular catheter entry point and position, and 9. Change in ventricle size as a measurement of effective treatment of hydrocephalus. Significant literature is now available regarding endoscopic third ventriculostomy using a new technique, choroid plexus cauterization, that may improve the efficacy of the procedure. , Additional evidence is also available regarding programmable CSF shunt valves. , , In addition, two new hydrocephalus related topics, discussed in section 3 of this application, would benefit from a systematic literature review.
- Describe why this topic is important.
- Since the Congress of Neurological Surgeons (CNS) published the previous guidelines in 2014, new evidence is available regarding Endoscopic Third Ventriculostomy with choroid plexus cauterization.2,3 This new evidence could provide significant updates to the prior guidelines Chapter 1. Management of post-hemorrhagic hydrocephalus in premature infants and Chapter 3. Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. New evidence is available regarding programmable shunt valves.4,5,6 This could be incorporated into an update of Chapter 4, Effect of valve type on cerebrospinal fluid shunt efficacy. We also identified two new topics that could add value to an update of the hydrocephalus guidelines: 1. Evaluation and treatment of slit ventricle syndrome and 2. Evaluation and diagnosis of shunt malfunction. Slit ventricle syndrome is a condition produced when overdrainage of cerebrospinal fluid from a ventriculo-peritoneal shunt causes chronic headaches. This can be a debilitating condition to patients, and it can be difficult to diagnose and treat. No one has evaluated the literature or performed a meta-analysis on this topic. A chapter on the diagnosis and treatment of slit ventricle syndrome would be beneficial to physicians taking care of children with ventriculoperitoneal shunts.
- Tell us why you are suggesting this topic.
- There are no guidelines for the best way to evaluate and diagnose shunt malfunction in a child. Every year thousands of children with hydrocephalus present to emergency rooms with potential signs and symptoms of a shunt malfunction. A systematic review of the best way to evaluate and diagnose a shunt malfunction would be very helpful to both initial evaluators such as emergency room physicians as well as practicing pediatric neurosurgeons. We understand that limited funds may dictate a limited scope for the update, and we are happy to increase or decrease the scope of the update based on the available resources of AHRQ.
- Target date.
- The CNS would like to begin the guideline in 2019, but the timeline is flexible.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- This topic was initiated by the Section on Pediatric Neurosurgery of the American Academy of Neurological Surgeons (AANS)/CNS. The CNS also recruited from a variety of institutions and subspecialty disciplines in an effort to have as broad a representation of opinions and expertise as possible, including representatives from neurology and pediatrics. It is CNS’s goal to follow the IOM recommendations to be inclusive and inter-disciplinary when constructing our guidelines and subsequent recommendations. A conscientious effort will also be made to be sure that any conflict of interest is fully disclosed and avoided. Participants who have published extensively in certain areas will be asked to recuse themselves from voting and will be assigned to evaluate evidence in other topics. Every effort will be made to ensure that the guideline is accurate, reliable, and non-biased.
- How will you or your group use the information from a new evidence report?
- The Congress of Neurological Surgeons (CNS) will update the previously published guideline, continuing to aid clinicians and guide clinical practice on this important topic. The CNS maintains in-house infrastructure to lead, promote, and support the creation and methodological processes to produce evidence-based guidelines, which are critical tools to confront a rapidly changing health care environment. Using the CNS’s high quality, rigorous methodological process, a multidisciplinary task force will develop recommendations based on the available evidence provided by the Evidence Based Practice Center. Throughout development, the task force will use evidence-based methodologies and strictly adhere to a priori defined criteria as defined by the Institute of Medicine s (IOM) standards for conducting systematic reviews and clinical evidence-based guidelines.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The CNS guidelines attempt to provide essential information for clinicians, globally, helping to improve patient care and outcomes. In addition to developing high quality guidelines, CNS is also committed to dissemination of guidelines in multiple, open access formats, such as publication in peer-reviewed journals, publication on the CNS webpage, webinars, conference seminars and courses, engaging partnering organizations, translating guidelines (see the Neurosurgery Speaks program) as well as other promotional efforts.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- American Academy of Pediatrics* American Academy of Neurology American Association of Neurological Surgeons* American Society of Pediatric Neurosurgeons Child Neurology Society* American Neurological Association Hydrocephalus Association National Hydrocephalus Foundation *Indicates organizations that CNS has partnered with for other guideline projects.
- Information About You: (optional)
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- Provide a description of your role or perspective
- Professional Society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization
- Congress of Neurological Surgeons
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