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Published on: October 14, 2022
Managing hydrocephalus in 54 infants under 3 months of age: A single center cohort study
S R M Van Rijen1, F Groenendaal2, K S Han1
1Division of Neuroscience, Department of Neurosurgery, University Medical Center Utrecht, and Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Insights
Managing hydrocephalus in infants is challenging. Ventriculoperitoneal shunts (VPS) and endoscopic third ventriculostomy (ETV) are options, but outcomes vary. Ventricular access device (VAD) use may improve ETV success in very young infants.
Area of Science:
- Pediatric Neurosurgery
- Infant Neurology
- Hydrocephalus Management
Background:
- Hydrocephalus in infants presents significant management challenges.
- Ventriculoperitoneal shunts (VPS) are common but associated with complications and long-term dependency.
- Endoscopic third ventriculostomy (ETV) is an alternative for obstructive hydrocephalus, yet outcomes in infants under six months are variable.
Purpose of the Study:
- To analyze the management strategies and outcomes of hydrocephalus in 54 very young infants (under three months).
- To evaluate the effectiveness of ventricular access device (VAD) tapping, VPS, and ETV in this cohort.
- To identify factors influencing treatment success and complications in infant hydrocephalus.
Main Methods:
- Retrospective study of 54 infants under three months with progressive ventriculomegaly requiring neurosurgical intervention.
- Treatments included serial ventricular access device (VAD) tapping, ventriculoperitoneal shunt (VPS) placement, and thulium laser-assisted endoscopic third ventriculostomy (ETV).
- Data collected over a five-year period (2018-2022) at a single university hospital.
Main Results:
- Twelve infants achieved lasting normalization of ventricular volume with VAD alone.
- Forty-two infants required permanent treatment: 28 received VPS (32.1% failure rate) and 14 received ETV (50% failure rate).
- Failed ETV cases tended to be in younger infants with larger ventricular volumes prior to treatment.
Conclusions:
- Managing hydrocephalus in very young infants remains complex, with ongoing challenges in surgical strategy, shunt dependency, and complication rates.
- ETV can be a successful treatment for selected very young infants with hydrocephalus, in addition to VPS.
- Pre-treatment reduction of ventricular volume using VAD may contribute to the success of ETV in this patient group.
Purpose:
Managing hydrocephalus in infants can be very challenging. The most used permanent hydrocephalus treatment in young patients is a ventriculoperitoneal shunt (VPS) placement. Obstructive hydrocephalus in selected young patients can be treated with endoscopic third ventriculostomy (ETV). However, in infants less than 6 months of age, the outcome of both procedures remains to be bothered with complications, revision surgeries and long-term shunt dependency. This retrospective study analyzes the management of hydrocephalus in 54 very young infants with different etiological causes.
Methods:
Data was collected retrospectively from a single center university hospital over a 5-year period (2018-2022). All patients under 3 months of age with progressive ventriculomegaly confirmed by cranial ultrasound (cUS), who required neurosurgical intervention, were eligible for this study. Hydrocephalus was treated with serial tapping from a ventricular access device (VAD), placement of ventriculoperitoneal shunts and/or performing a thulium laser-assisted ETV.
Results:
Twelve patients benefited sufficiently from a VAD to normalize ventricular volume lastingly. Forty-two patients required permanent treatment (28 underwent a VPS; 14 an ETV if there was obstructive hydrocephalus) at an average age of 2.5 months. The VPS failure rate was 32.1% and the ETV failure rate was 50%. Although not significantly different, patients with failed ETV tended to be younger than patients with successful ETV (p = 0.38). One week before permanent ETV treatment, relatively large ventricular volumes were measured in failed ETV patients, as compared to successful ETVs.
Conclusions:
Managing hydrocephalus in very young infants remains challenging regarding surgical strategy, reducing shunt dependency and decreasing current complication rates. In addition to a VPS, an ETV has shown to be a successful treatment option for hydrocephalus in well-selected very young infants. The opportunity to decrease ventricular volume with a VAD could have contributed to the success of an ETV in this young patient group.
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