Surgery without assistance in newborns and infants with hydrocephalus and neural tube defects

Standard neurosurgical procedures for hydrocephalus and open neural tube defects in newborns and infants under 6 months of age were performed by a single neurosurgeon on his own without the help of an assistant or scrub nurse. The objective of this study was to assess the outcome of these procedures in terms of operating time, the presence of bacterial infection, and wound healing. Between 2001 and 2004, a total of 126 procedures were performed on 82 patients under 6 months of age. We observed 1 bacterial and 2 fungal infections. Two infections had already been detected at the beginning of the surgical procedure in cerebrospinal fluid (CSF) specimens obtained from children with Candida ventriculitis. The other infection occurred after leakage of CSF from a myelomeningocele 10 days after initial surgery. Our study suggests that excellent results can be achieved in standard neurosurgical procedures without assistance even in high-risk newborns and infants if resource or other constraints require such an unconventional approach.