OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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Purpose We evaluate a single-institution cohort of mothers contemporaneous with the Management of Myelomeningocele (MOMS) trial to determine the generalizability of MOMS results and compare shunt rates. Methods A retrospective chart review identified patients with myelomeningocele born between 2003 and 2009. We applied MOMS eligibility criteria, and compared sociodemographic variables between patients at our institution who would have been eligible or ineligible and MOMS participants. Finally, we applied the original MOMS primary outcome and the revised primary outcome to our cohort. Results Of the 78 patients, 55 (70.5%) were eligible for the MOMS trial. Mean maternal age, race, and marital status were different from both MOMS groups. Comparing our series to MOMS postnatal shows fewer female infants (44.9% vs. 63.8%, p=0.017) and more thoracic lesions (12.8% vs. 3.8%, p=0.038). Shunt rates in our cohort (84.6%) were higher than MOMS prenatal and similar to MOMS postnatal (44.0% and 83.7% respectively). Fewer children met the original primary outcome than the postnatal group (84.6% vs. 97.8%, p=0.002). There was no significant difference between our cohort and the prenatal group (84.6% vs. 72.5%, p=0.058). When applying the revised criteria, we find the opposite: a significant difference between local and MOMS prenatal (84.6% vs. 49.5%, p<0.001) but no difference between the local group and MOMS postnatal (84.6% vs. 87.0%, p=0.662). Conclusions Mothers in our cohort differ from mothers enrolled in MOMS via several sociodemographic factors. Baseline fetal characteristics show a significantly higher functional lesion level in between our cohort and MOMS. Treatment of hydrocephalus in our series tracks almost identically with original MOMS shunt criteria. Revision of the criteria led to greater concordance between meeting criteria and receiving a shunt in MOMS patients, but changes the results in our series.

OBJECTIVEPosthemorrhagic hydrocephalus of prematurity remains a significant problem in preterm infants. In the literature, there is a scarcity of data on the early disease process, when neurosurgeons are typically consulted for recommendations on treatment. Here, the authors sought to evaluate functional outcomes in premature infants at 2 years of age following treatment for posthemorrhagic hydrocephalus. Their goal was to determine the relationship between factors identifiable at the time of the initial neurosurgical consult and outcomes of patients when they are 2 years of age.METHODSThe authors performed a retrospective chart review of premature infants treated for intraventricular hemorrhage (IVH) of prematurity (grade III and IV) between 2003 and 2014. Information from three time points (birth, first neurosurgical consult, and 2 years of age) was collected on each patient. Logistic regression analysis was performed to determine the association between variables known at the time of the first neurosurgical consult and each of the outcome variables.RESULTSOne hundred thirty patients were selected for analysis. At 2 years of age, 16% of the patients had died, 88% had cerebral palsy/developmental delay (CP), 48% were nonverbal, 55% were nonambulatory, 33% had epilepsy, and 41% had visual impairment. In the logistic regression analysis, IVH grade was an independent predictor of CP (p = 0.004), which had an estimated probability of occurrence of 74% in grade III and 96% in grade IV. Sepsis at or before the time of consult was an independent predictor of visual impairment (p = 0.024), which had an estimated probability of 58%. IVH grade was an independent predictor of epilepsy (p = 0.026), which had an estimated probability of 18% in grade III and 43% in grade IV. The IVH grade was also an independent predictor of verbal function (p = 0.007), which had an estimated probability of 68% in grade III versus 41% in grade IV. A higher weeks gestational age (WGA) at birth was an independent predictor of the ability to ambulate (p = 0.0014), which had an estimated probability of 15% at 22 WGA and up to 98% at 36 WGA. The need for oscillating ventilation at consult was an independent predictor of death before 2 years of age (p = 0.001), which had an estimated probability of 42% in patients needing oscillating ventilation versus 13% in those who did not.CONCLUSIONSIVH grade was consistently an independent predictor of functional outcomes at 2 years. Gestational age at birth, sepsis, and the need for oscillating ventilation may also predict worse functional outcomes.

Due to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States and its anticipated ramifications, an emergency plan was deployed by the University of Alabama at Birmingham (UAB) Department of Neurosurgery on March 14, 2020. The design was centered on restructuring resident coverage, ambulatory encounters, continuing resident education, and implementation of transmission-mitigation strategies in accordance with the Centers for Disease Control and Prevention's (CDC's) guidelines for social distancing. 1

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over 2 million infections by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) have been reported and 166 256 people have died from corona virus disease 2019 (COVID-19). [1][2][3][4] As the surge continues, the management of neurosurgical patients infected with SARS-CoV-2 may become increasingly complex due to competing therapeutic goals. We describe the perioperative and neurocritical care management of the first reported patient with asymptomatic SARS-CoV-2 infection and aneurysmal subarachnoid hemorrhage (aSAH). CASE PRESENTATION Patient InformationA 56-yr-old, right-handed Caucasian female was transferred by an outside facility for definitive management of SAH (Hunt and Hess [HH] Grade II and World Federation of Neurological Surgeons [WFNS] Grade I). 5,6 The decision was made to test for SARS-CoV-2 given exposure to a concurrent outbreak of COVID-19 in the neuro-intensive care unit (neuro-ICU) at the time of admission.

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