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The arrest of treated hydrocephalus in children. A radionuclide study
Insights
In infants with hydrocephalus, radionuclide scans revealed that 3 of 24 patients regained normal cerebrospinal fluid (CSF) circulation, allowing shunt removal. This study highlights potential for shunt independence in pediatric hydrocephalus cases.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Imaging
Background:
- Non-neoplastic hydrocephalus is a common condition in neonates and infants requiring surgical intervention.
- Shunt placement is the standard treatment, but complications and the potential for shunt independence warrant investigation.
Observation:
- A prospective study followed 30 neonates and infants with treated non-neoplastic hydrocephalus over 5 years.
- Radionuclide assessment of cerebrospinal fluid (CSF) dynamics was performed independently of the shunt apparatus.
- Results were correlated with computerized tomography and clinical data.
Findings:
- Of 24 patients analyzed after 5 years, four demonstrated restored CSF circulation independent of their shunts.
- Three of these four patients had their shunts successfully clipped or removed without adverse effects.
- The cases included communicating hydrocephalus and probable aqueduct stenosis.
Implications:
- This study suggests that a subset of pediatric hydrocephalus patients may achieve shunt independence.
- Radionuclide assessment offers a valuable method for evaluating CSF dynamics and shunt function.
- Further research could refine criteria for identifying candidates for shunt weaning.
Abstract:
A prospective study was made of the incidence of arrest of treated non-neoplastic hydrocephalus in 30 neonates and infants over a 5-year period. Radionuclide assessment of shunt function and cerebrospinal fluid (CSF) dynamics was carried out at intervals over this period, using a method that allowed injection of the radionuclide into the ventricular system independent of the shunt apparatus. The radionuclide scanning results were correlated with computerized tomography and clinical findings. Of 24 patients still available for analysis at the end of 5 years, four patients showed restoration of CSF circulation independent of the shunt apparatus and, in three of these, the shunt has either been clipped or clipped and removed without any ill effects. Clinical details of these three patients are provided. Two initially had communicating hydrocephalus, and one had probable aqueduct stenosis.