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Isosorbide in the management of infantile hydrocephalus
Insights
Isosorbide effectively managed hydrocephalus in infants, with many avoiding or delaying shunt surgery. This treatment showed few, reversible side effects, offering a safer alternative for pediatric hydrocephalus management.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Pharmacology
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) in the brain's ventricles.
- Shunt surgery is the traditional treatment but carries risks of complications.
- Developing non-surgical or delay strategies is crucial for managing infant hydrocephalus.
Purpose of the Study:
- To evaluate the efficacy and safety of isosorbide in treating hydrocephalus in infants.
- To determine if isosorbide can avoid or delay the need for shunt surgery.
- To assess the side effects associated with isosorbide treatment in this population.
Main Methods:
- Retrospective analysis of 101 hydrocephalic infants treated with isosorbide.
- Categorization of hydrocephalus severity (moderate vs. severe) and CSF characteristics.
- Monitoring of shunt surgery avoidance, delay, and complications.
Main Results:
- 31 of 43 infants with moderate hydrocephalus avoided shunt surgery.
- 5 of 48 infants with severe/abnormal CSF avoided shunts, and 30 achieved a delay.
- Toxic effects were infrequent, mild, and reversible.
- 63 infants ultimately required shunt insertion.
Conclusions:
- Isosorbide is a viable option for managing infant hydrocephalus, offering successful avoidance or delay of shunt surgery in a significant proportion of cases.
- The treatment is well-tolerated with minimal, reversible adverse effects.
- Isosorbide provides a valuable therapeutic window, potentially reducing shunt-related complications.
Abstract:
Experience with 101 hydrocephalic infants treated primarily with isosorbide is reported. For those with moderate hydrocephalus the aim was to avoid shunt surgery, and this was achieved in 31 of the 43 infants. In cases with severe hydrocephalus or when the cerebrospinal fluid was abnormal the aim was to delay shunt surgery until the optimum time, with a lower risk of complications. Five of 48 such infants avoided shunts and 30 achieved a worthwhile delay. Nine other children were treated with isosorbide following shunt complications. Toxic effects were infrequent, not severe, and reversible on stopping treatment or reducing dosage. 63 infants eventually had shunts inserted.