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  • Author or Editor: Michelle Kameda-Smithx
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Rurality index score and pediatric neuro-oncological outcome in Ontario

Michelle Masayo Kameda-Smith, Gregory R. Pond, and Hsien Seow

OBJECTIVE

Rapid access to neurosurgical decisions and definitive management are vital for the outcome of neurocritical patients. There are unique challenges associated with the provision of services required to maintain critical infrastructure for rural citizens. Given that a relationship between rurality, marginalization, and health outcomes has been identified as associated with higher mortality rates and higher rates of many diseases, the authors studied whether worse clinical outcomes were associated with rurality in pediatric neuro-oncological disease.

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Using linked administrative databases, the authors retrospectively analyzed a population-based cohort of patients diagnosed with a pediatric brain tumor between 1996 and 2017 in Ontario, Canada. The main variable of interest was the Rurality Index for Ontario (RIO; larger value denotes more rural); the main outcome was survival, while controlling for surgery and tumor type.

RESULTS

Of the 1428 patients included, 53.9% were male. Overall survival of all the children (controlling for surgery and tumor type) at 1, 5, and 10 years was 84.7%, 65.1%, and 58.4%, respectively. A total of 11.5% were classified as living in a rural area of Ontario. The distance to the nearest pediatric neurosurgical hospital ranged from 25.6 to 167.4 km. The RIO score was 0 in 38.7% of children, and the majority of patients had a RIO score < 40. A higher RIO score was not a significant factor (continuous p = 0.12/ordinal p = 0.18) associated with length of follow-up, indicating that rurality was not significantly linked to compliance with clinical follow-up.

CONCLUSIONS

Rurality of the region in which pediatric neuro-oncological patients reside was not associated with patient outcome (HR 0.83, p = 0.39).

In开云手机版app下载安装最新版神经外科杂志:儿科开云体育app官方网站下载入口Volume 31: Issue 4 (Apr 2023)

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A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications

Ayoub Dakson, Michelle Kameda-Smith, Michael D. Staudt, Pascal Lavergne, Serge Makarenko, Matthew E. Eagles, Huphy Ghayur, Ru Chen Guo, Alwalaa Althagafi, Jonathan Chainey, Charles J. Touchette, Cameron Elliott, Christian Iorio-Morin, Michael K. Tso, Ryan Greene, Laurence Bargone, and Sean D. Christie

OBJECTIVE

External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion.

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A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category.

RESULTS

错位的利率,ECI /脑室炎,ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782).

CONCLUSIONS

EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.

InJournal of Neurosurgery Volume 137: Issue 1 (Jul 2022)

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Intracranial invasive group A streptococcus: a neurosurgical emergency in children

Dana Hutton, Michelle Kameda-Smith, Fardad T. Afshari, Ahmed Elawadly, Florence Hogg, Samir Mehta, James Samarasekara, Kristian Aquilina, Noor ul Owase Jeelani, M. Zubair Tahir, Dominic Thompson, Martin M. Tisdall, Adikarige Haritha Dulanka Silva, James Hatcher, and Greg James

OBJECTIVE

Invasive group A streptococcus (iGAS) infections are associated with a high rate of morbidity and mortality. CNS involvement is rare, with iGAS accounting for only 0.2%–1% of all childhood bacterial meningitis. In 2022, a significant increase in scarlet fever and iGAS was reported globally with a displacement of serotype, causing a predominance of theemm1.0subtype. Here, the authors report on iGAS-related suppurative intracranial complications requiring neurosurgical intervention and prolonged antibiotic therapy.

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The authors performed a retrospective chart review of consecutive cases of confirmed GAS in pediatric neurosurgical patients.

RESULTS

Five children with a median age of 9 years were treated for intracranial complications of GAS infection over a 2-month period between November 2022 and December 2022. All patients had preceding illnesses, including chicken pox and upper respiratory tract infections. Infections included subdural empyema with associated encephalitis (n = 2), extradural empyema (n = 1), intracranial abscess (n = 1), and diffuse global meningoencephalitis (n = 1).Streptococcus pyogeneswas cultured from 4 children, and 2 were of theemm1.0subtype. Antimicrobial therapy in all patients included a third-generation cephalosporin but varied in adjunctive therapy, often including a toxin synthesis inhibitor antibiotic such as clindamycin. Neurological outcomes varied; 3 patients returned to near neurological baseline, 1 had significant residual neurological deficits, and 1 patient died.

CONCLUSIONS

Despite the worldwide increased incidence, intracranial complications remain rarely reported resulting in a lack of awareness of iGAS-related intracranial disease. Awareness of intracranial complications of iGAS and prompt referral to a pediatric neurology/neurosurgical center is crucial to optimize neurological outcomes.

In开云手机版app下载安装最新版神经外科杂志:儿科开云体育app官方网站下载入口Publish Before Print

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