Predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele.

OBJECT: Many patients with myelomeningocele (MMC) develop hydrocephalus, and most will undergo CSF diversion. The goal of this retrospective study was to determine whether there was a change in the shunt rate over the 7 consecutive years of the study. The authors will also identify the criteria used to determine the need for shunt placement. METHODS: During a 7-year period, 73 patients underwent MMC closure at Arkansas Children's Hospital. The shunt rate for each year was calculated. Clinical characteristics were evaluated, including apneic and bradycardic spells, CSF leak, level of the MMC, head circumference, and rate of head growth. In addition, radiological images were reviewed, and the frontooccipital horn ratio (FOHR), ventricular index (VI), and thalamooccipital distance (TOD) were calculated. Comparisons were made between those patients who underwent shunt placement and those who did not. RESULTS: One patient was excluded due to death in the perinatal period. Of the 72 remaining patients, 54 (75%) underwent placement of a ventriculoperitoneal shunt. This rate did not change significantly over time. Between the cohorts with and without a shunt there was no significant difference in age, sex, or race. There was no significant difference in apneic episodes or bradycardic episodes. There was a statistically significant difference in fontanelle characteristics, head circumference at birth, and rate of head growth. Patients who required CSF diversion had a mean head growth of 0.32 cm/day compared with those who did not receive a shunt (0.13 cm/day; p < 0.05). All radiological parameters were found to be statistically significant. CONCLUSIONS: In this study, several classic indicators of hydrocephalus in the neonate were not found to be significantly associated with the need for CSF diversion. Fontanelle characteristics, head circumference at birth, and head growth velocity were associated with the need for shunt placement. Imaging information including the VI, TOD, and FOHR are statistically significant measures to evaluate prior to placement of a ventriculoperitoneal shunt. The optimal patient with MMC for CSF diversion will have full to tense fontanelle, increasing head circumference of more than 3 mm/day, and radiological evidence of an elevated VI, TOD, and/or FOHR.

Spinal cord avulsion in the pediatric population: case study and review.

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare phenomenon, but with advances in imaging and improvements in magnetic resonance imaging more cases are being identified. Even more uncommon is the finding of spinal cord avulsion as a type of SCIWORA with only single case reports in the literature. We present the case reports of 2 patients both experiencing spinal cord avulsion as a type of SCIWORA, secondary to improper lap-belt restraint during a motor vehicle accident.

The current state of non-accidental head injury in Arkansas.

Child maltreatment syndrome (CMS) and non-accidental head injury (NAHI) are frequent causes of death and disability with national incidences reported as high as 24.6 per 100,000 children. At this time the true incidence of CMS is unknown in Arkansas. The purpose of this review is to illustrate the severity of non-accidental head injury and increase awareness in the state of Arkansas. This paper is the first in a planned series to determine the incidence, risk factors, presentation, best effective treatment strategies and outcomes of CMS and NAHI in Arkansas.

MIIG HV case analysis.

Total hip arthroplasty revision due to osteolysis is of considerable concern to the orthopedic surgeon because revisions make up 25% of all total hip arthroplasties today. These revision rates coupled with improvements in cup fixation highlight a common, yet challenging problem of osteolytic lesions in the presence of well-fixed acetabular components. Two case reports are presented of osteolytic lesions treated with debridement and a calcium sulfate graft without the removal of a well-fixed cup. At 3 years postoperatively, both cases show excellent results and no evidence of component compromise.