Surgical treatment of post-inflammatory hydrocephalus. Analysis of 101 cases

The aim of this paper was to evaluate the outcomes of surgical treatment for post-inflammatory hydrocephalus in pediatric patients. The patient's age, surgical technique and type of implants, revision rate (depending on the cause for revision and shunt type), and final outcome measured with Neurologic Outcome Scale for Infants and Children (NOSIC) scale were evaluated.

We performed a retrospective analysis of 101 patients with post-inflammatory hydrocephalus, treated in Polish Mother's Memorial Hospital Research Institute since 2005. Children with comorbidities (e.g., tumors or hemorrhages) were excluded from the study. The assessment included patient age, surgical technique (ventriculoperitoneal shunt (VPS) or neuroendoscopy) and type of implant, revision rate (considering its cause), and final outcome measured in Neurologic Outcome Scale for Infants and Children (NOSIC) scale.

VPS implantation was the most common surgical technique. It was performed in 66.33% (n = 67) of cases. Neuroendoscopic procedure was used in 33.66% of cases (n = 34). Revision rate of VPS was 52.23% (n = 35). Endoscopic third ventricle ventriculostomy (ETV) was efficient only in 5 cases (14.7%), whereas in 29 cases (85.3%), it was followed by VPS implantation. Revision rate in VPS implantation after ETV reached 55.17% (n = 16). In all age groups, VPS implantation was the most frequently used procedure. Revisions of the shunt systems occurred most frequently in the 1-3 (n = 21 41.18%) and < 1 (n = 12, 23.53%) age ranges. The type of valve that most often underwent dysfunction was flow-regulated type (n = 23, 62.16%). The type of valve that was the least frequently revised was differential pressure type (n = 11, 17.18%). In all age groups, mechanical dysfunction was the most frequent cause of shunt disability. Average NOSIC score ranged from 39 to 98 (average 80.58, standard deviation ± 13.34). NOSIC result relative to individual operational techniques was as follows: ETV + VPS-80.17 (n = 29, standard deviation ± 11.44), VPS-80.44 (n = 67, standard deviation ± 14.30), and ETV-80.80 (n = 5, standard deviation ± 11.62). There was no difference between the outcome of the NOSIC and the type of implanted valve or its dysfunction.

In our analysis, post-inflammatory hydrocephalus accounts for 11.7% of all hydrocephalus types. Of post-inflammatory hydrocephalus, multiloculated type accounts for 14.9%. The most common type of surgery in these patients is implantation of the ventriculoperitoneal system. The most frequent revisions of the VPS system occur in the group of the younger children (< 3). The most common type of a dysfunction shunt is the differential pressure valve, and the rarest type the flow-regulated type. In the case of mechanical dysfunction, occlusion of the intraventricular catheter is the most common reason. ETV does not affect the frequency of VPS revisions. The average NOSIC score in children treated with hydrocephalus is below normal, and the best results are observed in the youngest children.