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The patterns of late deterioration in patients with transitional lipomyelomeningocele.

https://arctichealth.org/en/permalink/ahliterature195679
Source
Eur J Pediatr Surg. 2000 Dec;10 Suppl 1:13-7
Publication Type
Article
Date
Dec-2000
Author
D D Cochrane
C. Finley
J. Kestle
P. Steinbok
Author Affiliation
Division of Pediatric Neurosurgery, Children's and Women's Health Center of British Columbia, Vancouver, Canada. dcochrane@cw.bc.ca
Source
Eur J Pediatr Surg. 2000 Dec;10 Suppl 1:13-7
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
British Columbia - epidemiology
Child
Child, Preschool
Female
Humans
Infant
Lipoma - complications - surgery
Lumbosacral Region
Male
Meningomyelocele - complications - surgery
Musculoskeletal Diseases - epidemiology - etiology
Nervous System Diseases - epidemiology - etiology
Postoperative Complications - epidemiology
Retrospective Studies
Spina Bifida Occulta - complications
Spinal Cord Neoplasms - complications - surgery
Survival Analysis
Time Factors
Treatment Outcome
Urologic Diseases - epidemiology - etiology
Abstract
Tethering is assumed to be the primary cause of deterioration seen in children with transitional lipomyelomeningocele as they age. The inevitability of deterioration has led to recommendations for prophylactic interventions to stabilize or prevent further clinical deterioration.
Determine the frequency and patterns of functional deterioration observed after successful untethering in patients with transitional lipomyelomeningocele and compare functional outcomes with what is known regarding untreated patients.
Fifty patients having transitional LMMC, treated at a single institution and followed in a multidisciplinary clinic were retrospectively reviewed to determine their clinical status prior to untethering, and the time to development of new symptoms or signs following untethering.
82% of patients were diagnosed and 78% underwent untethering prior to one year of age. All patients had a cutaneous lumbosacral lipoma, 22 patients were considered normal at presentation and 28 showed abnormalities on clinical examination. Forty-nine patients were untethered successfully and all were available for follow-up ranging from 2 to 138 months (mean 39 months). Acute morbidity was limited to transient neurogenic bladder dysfunction and minor wound complications. Late clinical deterioration occurred in the majority of patients. Orthopedic and neurological deterioration occurred over the first 60 months following untethering and urological deterioration occurred thereafter.
Functional loss after untethering is common and the pattern of loss is likely a reflection of the ability to detect abnormalities in this infant population. Untethering does not usually result in permanent acute morbidity, and does not prevent longer-term functional deterioration. The ratio of asymptomatic to symptomatic patients at follow-up in this operative series is similar to age-matched historical series of untreated patients.
PubMed ID
11214824 View in PubMed
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Ventricular shunting for hydrocephalus in children: patients, procedures, surgeons and institutions in English Canada, 1989-2001.

https://arctichealth.org/en/permalink/ahliterature186944
Source
Eur J Pediatr Surg. 2002 Dec;12 Suppl 1:S6-11
Publication Type
Article
Date
Dec-2002
Author
D D Cochrane
J. Kestle
Author Affiliation
Department of Surgery, University of British Columbia and Children's and Women's Health Center of British Columbia, Vancouver BC, Canada. dcochrane@cw.bc.ca
Source
Eur J Pediatr Surg. 2002 Dec;12 Suppl 1:S6-11
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Canada - epidemiology
Cerebrospinal Fluid Shunts - statistics & numerical data
Child
Child, Preschool
Clinical Competence
Female
Humans
Hydrocephalus - etiology - surgery
Infant
Infant, Newborn
Male
Prosthesis-Related Infections - epidemiology
Quality of Health Care
Reoperation - statistics & numerical data
Retrospective Studies
Treatment Outcome
Abstract
Ventricular shunting remains the principle and most generally applicable method to treat hydrocephalus in children. This paper describes the demographics of this treatment in English Canada during the period of 1989 to March 2001.
Hospital discharge records were obtained for patients less than 18 years who had a shunt inserted or revised. A database was constructed relating patients and procedures to hospital discharges based on scrambled patient identifiers, year of birth, sex, postal code and diagnoses.
5,947 patients underwent ventricular shunting procedures for hydrocephalus in this period. 261 surgeons working in 73 institutions provided 12,106 interventions (Shunt insertions: ventriculoperitoneal--5009, ventriculoatrial--119, ventriculopleural--28. Revisions: 6,950). Infection was deemed to have occurred in 1,059 procedures. Over the study period, the median number of procedures performed per surgeon per year was 2, with 75 % of surgeons performing 5 or fewer procedures in children per year. Although many surgeons operated on children throughout the thirteen years of the study, many did not acquire substantive cumulative experience. Overall infection rate was 8.6 %. Surgeon infection rates were greater than or equal to 20 % during the first four years of practice and thereafter they fell to and remained in the 10 % range. The mean shunt survival at 12 months of individual surgeons varied between 50 - 60 %, regardless of the number of years of experience of the surgeon; however, performance variability as measured by the standard deviation of 12 month survival rates for all surgeons, adjusted for years of experience, ranged widely until the fifth year of practice. The average number of procedures per year for treating hospitals was 2 with 75 %, providing 12 or fewer services annually. Over the entire study, 50 % of institutions provided 10 or fewer procedures. The mean institutional infection rate was 11.4 % (SD 23, median--6.0).
Quality monitoring of infection rate and duration of shunt function remains critical as many surgeons and hospitals provide care to children with hydrocephalus infrequently. Variability in infection rates and shunt survival at 12 months are a function of surgeon experience, measured by years in practice. Variability in outcome decreases with increasing surgeon experience.
PubMed ID
12541207 View in PubMed
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