Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy-how serious is it?

Area of Science:

• Pediatric Neurosurgery
• Craniofacial Development
• Neurology

Background:

• Positional plagiocephaly is a common condition in infants.
• Ventriculoperitoneal (VP) shunts are frequently used to treat hydrocephalus in children.
• The relationship between VP shunt placement and plagiocephaly requires further investigation.

Purpose of the Study:

• To test the hypothesis that ventriculoperitoneal (VP) shunt insertion increases contralateral positional plagiocephaly.
• To identify risk factors associated with VP shunt placement and positional plagiocephaly.

Main Methods:

• Retrospective review of 339 children undergoing VP shunt insertion.
• Assessment of positional plagiocephaly using the cranial vault asymmetry index.
• Multinomial logistic regression to analyze relationships between plagiocephaly, shunt position, gender, and age.

Main Results:

• Occipital VP shunts are significantly associated with an increased risk of contralateral positional plagiocephaly.
• This risk is particularly pronounced within the first 12 months of life.

Conclusions:

• Post-operative head positioning advice and careful follow-up are crucial for infants with VP shunts.
• Consideration of active monitoring, physiotherapy, and health visitor interventions may help prevent plagiocephaly.
• Alternative surgical approaches like endoscopic third ventriculostomy or anterior shunt placement may be beneficial in select cases.