Search Results

Object.先前的报道表明,调节阀门y improve the survival of cerebrospinal fluid shunts or relieve shunt-related symptoms. To evaluate these claims, the authors conducted a prospective multicenter cohort study of children who underwent placement of Strata valves.

Methods.Patients undergoing initial shunt placement (Group 1) or shunt revision (Group 2) were treated using Strata valve shunt systems. Valves were adjustable to five performance level settings by using an externally applied magnet. The performance levels were checked using an externally applied hand tool and radiography. Patients were followed for 1 year or until they underwent shunt revision surgery.

Between March 2000 and February 2002, 315 patients were enrolled in the study. In Group 1 (201 patients) the common causes of hydrocephalus were myelomeningocele (16%), aqueductal stenosis (14%), and hemorrhage (14%). The overall 1-year shunt survival was 67%. Causes of shunt failure were obstruction (17%), overdrainage (1.5%), loculated ventricles (2%), and infection (10.6%). Patients in Group 2 (114 patients) were older and the causes of hydrocephalus were similar. Among patients in Group 2 the 1-year shunt survival was 71%.

There were 256 valve adjustments. Symptoms completely resolved (26%) or improved (37%) after 63% of adjustments. When symptoms improved or resolved, they did so within 24 hours in 89% of adjustments. Hand-tool and radiographic readings of valve settings were the same in 234 (98%) of 238 assessments.

Conclusions.The 1-year shunt survival for the Strata valve shunt system when used in initial shunt insertion procedures or shunt revisions was similar to those demonstrated for other valves. Symptom relief or improvement following adjustment was observed in 63% of patients. Hand-tool assessment of performance level settings reliably predicted radiographic assessments.

✓The choice of outcome (or outcomes) and their measurement are critical for a sound clinical trial. Surgeons have traditionally measured simple outcomes such as death, duration of survival, or tumor recurrence but have recently developed more sophisticated measures of the effect of an intervention. Many outcome measures require a lengthy maturation process, which includes a determination of the instrument's validity, reliability, and sensitivity; thus, using established instruments rather than creating new ones is recommended. The authors illustrate several guidelines for the determination of appropriate outcome measures by using examples from their experience and describe several outcome measures that can be used in pediatric neurosurgery. These include general outcome measures such as the Pediatric Evaluation of Disability Inventory and the Functional Independence Measure for Children, which measure physical function and independence in chronically ill and disabled children as well as disease-specific measures for hydrocephalus (Hydrocephalus Outcome Questionnaire), cerebral palsy (gross motor function and performance measures), head injury (Pediatric Cerebral Performance Category and Children's Coma Scale), and oncology (Pediatric Cancer Quality-of-Life Inventory).

P Myxopapillary ependymomas (MPEs) have historically been thought to be benign tumors occurring most frequently in adults. Only 8 to 20% of these tumors occur in the first two decades of life, making this tumor a rarity in pediatric neurosurgery. Five patients with intraspinal MPEs were treated by the authors between 1992 and 2003. Four (80%) of these five patients suffered from disseminated disease of the central nervous system (CNS) at the time of presentation; this incidence is much higher than that reported in the combined adult and pediatric literature.

Combining five pediatric case series reported in the literature with the present series, the authors review a total of 26 cases of pediatric patients with intraspinal MPEs. In nine cases (35%) CNS metastases occurred. In those cases in which patients underwent screening for CNS tumor dissemination, however, the incidence of disseminated disease was 58% (seven of 12 patients).

In pediatric patients MPEs may spread throughout the CNS via cerebrospinal fluid pathways; therefore, MR imaging of the entire CNS axis is recommended at both presentation and follow-up review to detect tumor dissemination.