Craniosynostosis is a developmental anomaly with premature closure of the cranial sutures causing an abnormally shaped skull in an infant. Recommended surgical treatment involves cranial vault reconstruction to open the closed suture, increase intracranial volume, and allow the brain to grow normally. Parents work with a multidisciplinary team during the evaluation process and face various preoperative and postoperative stressors. Critical care nurses can improve the care of the infants and their families by being knowledgeable about the anatomy, assessment, and surgical and nursing management of infants with this anomaly and its impact on the patients’ families. This article discusses the definitions, diagnosis, and treatment of craniosynostosis and support for parents of infants with this malformation.

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Unique features of this case include the presence of intermittent pain symptoms, which may be attributable to cyst filling and emptying. Hydrocephalus is an uncommon finding that may be secondary to aseptic meningitis from cyst rupture. Tethered cord is also an unusual entity that can accompany this diagnosis, warranting additional imaging work-up and monitoring.

Background: Cerebral spinal fluid eosinophilia (CSFe) is correlated with increased risk of cranial shunt malfunctions. Although antibiotics coated shunt catheters have significantly reduced the incidence of infections and associated shunt malfunction, on rare occasion they may contribute to a shunt allergy and become the source of subsequent malfunction.Objective: We present a very rare case of a patient with an arachnoid cyst treated with cysto-peritoneal shunt (CPS), complicated by rifampin allergy manifesting as sterile CSFe and subsequent shunt malfunction.Case Report: A 17-months-old-male with symptomatic arachnoid cyst underwent uneventful craniotomy for cyst fenestration and CPS placement. At 2-month follow up he was neurologically stable; however, he developed an expanding pseudomeningocele that was palpable at the site of the prior craniotomy. Although shunt and pseudomeningocele taps were both negative for infectious etiology, the CSF analysis was notable for isolated CSFe.Given the persistence of symptoms, and well as subsequent emergency room visits for abdominal swelling, lowgrade fevers, and intermittent presence of pseudomeningocele, patient was admitted for further workup. Radio-Allergosorbent testing (RAST) was performed and revealed newly diagnosed rifampin allergy. CPS was then removed and patient was treated with a course of steroids until resolution of CSFe, and underwent placemen of a new CPS with non-antibiotics coated catheter. One week after discharge, patient returned with Staphylococcus Aureus related shunt malfunction, for which the shunt was externalized. He underwent a course of antibiotics treatment and was subsequently trialed to be weaned off the CPS, in light of recent cyst fenestration. A

In caring for pediatric patients, a multifaceted approach in decision-making is utilized. The role of the medical team in complementary and alternative medicine is controversial. In cases of conventional treatment refusal by parents in pursuit of complementary and alternative medicine, there must be balanced decision-making, autonomy, and the best interest of the child. This report highlights two illustrative cases (ages 4, 17 years) of patients with brain tumor, whereby parents refused postoperative conventional therapy involving chemoradiotherapy, in pursuit of complementary and alternative medicine alone. Parental decision-making in complementary and alternative medicine, in lieu of medical recommendations, poses an ethical and legal dilemma that may impede care of the pediatric patient and compromise outcome of oncological care.