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Outcome in shunted hydrocephalic children
Ina Heinsbergen1, Jan Rotteveel, Nel Roeleveld
1Department of Paediatric Neurology, University Hospital of Nijmegen, The Netherlands.
Insights
Key risk factors for poor outcomes in shunted hydrocephalus include post-hemorrhagic causes and delayed surgical intervention. Early treatment improves developmental outcomes for children with hydrocephalus.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Developmental Pediatrics
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
- Shunt surgery is a common treatment for hydrocephalus in children.
- Identifying risk factors for poor outcomes is crucial for improving patient care.
Purpose of the Study:
- To identify main risk factors for poor outcomes in children with shunted hydrocephalus.
- To investigate the impact of surgical timing on outcomes.
- To analyze the influence of hydrocephalus etiology and comorbidities.
Main Methods:
- Retrospective analysis of medical records of patients who underwent shunt surgery for hydrocephalus.
- Data collected included etiology, co-pathologies, timing of surgery, revisions, and outcome parameters.
- Outcome parameters included school type, seizures, and morbidity.
Main Results:
- Post-hemorrhagic hydrocephalus was associated with poor outcomes.
- Hydrocephalus due to spina bifida or congenital malformations had better outcomes.
- Delayed surgical intervention (over 1 month post-diagnosis) correlated with poorer mental and linguistic development.
- More than two shunt revisions increased the likelihood of seizures.
Conclusions:
- Peri- and postnatal hemorrhage are significant risk factors for poor outcomes in pediatric hydrocephalus.
- Delayed surgical treatment for hydrocephalus is a potential risk factor for adverse outcomes.
- Early surgical intervention is recommended to improve developmental trajectories in hydrocephalic children.
Abstract:
The purpose of the present study was to identify the main risk factors for poor outcome in children with shunted hydrocephalus, including the timing of the operation. The medical records of patients born between 1984 and 1992, who had undergone shunt operation for hydrocephalus before 1994, were analysed retrospectively. The following data were collected: aetiology of hydrocephalus, other pathology in addition to hydrocephalus, timing of drain implantation, number and indication of revisions and several outcome parameters such as school type, seizures and morbidity parameters. Children with a post-haemorrhagic hydrocephalus fared poorly. Children with hydrocephalus due to spina bifida or another congenital malformation had considerably better outcome scores. Pathology in addition to hydrocephalus negatively influenced the prognosis. Regarding the timing of drain implantation, we found a poorer mental and linguistic development in children operated more than 1 month after diagnosis. Patients with more than two revisions seem to have a higher chance of developing seizures. In conclusion, this study confirms earlier reports that peri- and postnatal haemorrhage is an important risk factor for poor outcome. More importantly, we found that delay in surgical treatment might also be a risk factor for poor outcome in hydrocephalic children.