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[Neurosurgical shunt treatment of children with hydrocephalus]
C Tiller1, S Myhrvold, T Lundar
1Nevrokirurgisk avdeling Rikshospitalet, Oslo.
Insights
This study followed 128 children with hydrocephalus for ten years. Most survivors achieved good academic and social outcomes, despite needing lifelong shunt dependence.
Area of Science:
- Pediatric Neurosurgery
- Developmental Pediatrics
- Clinical Outcomes Research
Context:
- Hydrocephalus affects children, requiring surgical intervention with shunt systems.
- Long-term outcomes for pediatric hydrocephalus patients are crucial for understanding disease impact.
Purpose:
- To evaluate the ten-year academic, social, and physical functioning outcomes in children treated for hydrocephalus.
- To assess surgical morbidity and mortality rates in this cohort over a decade.
Summary:
- A retrospective analysis of 128 children shunted for hydrocephalus revealed a 10-year mortality rate of 18%. Among survivors, 88% attended normal schools, and 74% were age-appropriately graded.
- Significant tutoring needs and speech/writing difficulties were noted, particularly in lower-graded children. Epilepsy affected 33%, with 23% on antiepileptic drugs.
- Over 342 shunt revisions occurred in 84% of patients, but revision rates did not correlate with poorer outcomes. Lifelong shunt dependence was observed in 99% of survivors.
Impact:
- Provides critical long-term data on the functional status of pediatric hydrocephalus patients.
- Informs clinical practice regarding expectations and support for children with hydrocephalus and their families.
- Highlights the need for continued monitoring and management of shunt systems and associated comorbidities.
Background:
The aims of this study were to determine the ten-year outcome of hydrocephalic children, both in terms of academic results, social skills, physical functioning and surgical morbidity and mortality.
Material And Methods:
A cohort of 128 children shunted for hydrocephalus at the National Hospital in Oslo between 1985 and 1988 were retrospectively analysed by registering their medical records and in a questionnaire survey.
Results:
We found that 23 (18%) children died during the ten-year observation period. Six patients died from shunt system failure, ten died from their malignant tumour, six died of their complex cerebral malformations and one died of unknown cause. Of the 105 (82%) children still alive, 104 returned our questionnaire. 92 (88%) reported to be attending a normal school, while 77 (74%) are in the same grade as children of similar age. Of those children at same grade level, 39 (51%) needed extra tutoring, while 35 (45%) reported speech and writing difficulties. Among children not in their adequate grade level, 25 (93%) (p < 0.01) needed extra tutoring, and 23 (85%) (p < 0.01) reported speech and writing difficulties. 50 (48%) participate in physical exercise along with the other children, while 53 (51%) report having normal social relations with children of the same age. 34 (33%) has suffered from epileptogenic seizures, while 24 (23%) daily use prescribed antiepileptic drugs. During the ten-year follow-up period, 108 (84%) patients had a total of 342 shunt revisions. We found no correlation between high incidence of revisions and negative long-term outlook. 99 out of the 105 children alive are considered to be life-long dependent of their shunt system.
Interpretation:
The vast majority of the children shunted for hydrocephalus that are still alive, have a good or satisfactory level of functioning ten years after their first shunt insertion. This view seems to be shared by the parents of these children, of whom 50 (48%) state that the development of their child has been "very good" compared to what they initially feared.