Antibiotic prophylaxis in ventricular shunt surgery. I. Reduction of operative infection rates with methicillin.

Administration of prophylactic antibiotics is not a proven or universal practice in cerebrospinal fluid (CSF) shunt surgery although case and operative infection rates in hydrocephalic patients average 20 and 8%, respectively. In sequential series from 1969 through 1978 the authors achieved a reduction in case infection rates from 10.9 to 8.9% and in operative infections from 8 to 2.6% with the use of short-term prophylactic methicillin. Comparison of these results to those of other reported series supports the case for short-term prophylactic antibiotics in shunt surgery. Further reduction in shunt sepsis may be possible with the appropriate selection of other semisynthetic penicillins which achieve higher levels in CSF.

Surgical embolization of cerebral arteriovenous malformations through internal carotid and vertebral arteries. Long-term results.

The authors describe the clinical results of surgical embolization in 55 patients with large cerebral arteriovenous malformations. Follow-up intervals ranged from 2 months to 14 years, averaging 4 1/2 years. The authors believe the procedure is safe in properly selected patients and is useful as a preliminary to direct surgical excision. It relieves associated headaches, and usually reverses or stabilizes a progressive neurological deficit. The potential for seizures probably is not altered. The incidence of hemorrhage following embolization is low for patients with no previous history of hemorrhage; however, the procedure does not reduce the likelihood of recurrence in patients with a prior history of hemorrhage.