Editorial. The challenges of implementing evidence-based practices in pediatric neurosurgery

Abstract

D r. Kraemer and colleagues are to be congratulated for taking on the challenge of deciphering the shunt practice patterns of seasoned North American pediatric neurosurgeons. Shunt management for hydrocephalus in children remains a pressing clinical problem. Despite advances in shunt protocols and hardware, shunts to treat hydrocephalus remain troublesome devices, and patients continue to experience pain and morbidity. Families must deal with the stress of caring for children with chronic, potentially life-threatening illnesses. The diagnosis of hydrocephalus can carry lifechanging medical, surgical, and behavioral consequences. And families must often cope with significant financial burdens. Hospital admissions and surgeries for shunt malfunction and infection consume enormous health care resources each year. In the report of their survey-based study, entitled "Shunt-dependent hydrocephalus: management style among members of the American Society of Pediatric Neurosurgeons," the authors attempt to take an educated snapshot of practical clinical judgment based on the responses of experienced surgeons to commonly encountered clinical scenarios. 7 The authors' goal was to evaluate differences in the evaluation and management of shuntdependent hydrocephalus by using a targeted questionnaire. Overall, 130 senior pediatric neurosurgeons participated as members of the American Society of Pediatric Neurosurgeons, with a response rate of 64%. Multiplechoice questions were posed and free-text responses were solicited. The 4 main topics covered were the management of shunt malfunction, chronic shunt overdrainage, chronic headaches in shunt patients, and slit ventricle syndrome. The first topic focused on identifying the preferred shunt valve for most pediatric patients and the most common cause of shunt malfunction. Consistent with welldesigned shunt valve trials that have shown that no shunt valve performs better than another, 1 pediatric neurosur