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Current prognosis in overt neonatal hydrocephalus

D C McCullough, L A Balzer-Martin

    Journal of Neurosurgery
    |September 1, 1982
    PubMed
    Summary

    Advances in prenatal diagnostics highlight the importance of congenital hydrocephalus prognosis. This study shows most infants with overt hydrocephalus benefit from cerebrospinal fluid shunts, with 86% survival and good intellectual outcomes.

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    Area of Science:

    • Neuroscience
    • Pediatric Neurosurgery
    • Developmental Biology

    Background:

    • Prenatal diagnostic ultrasonography has increased the relevance of prognostic data for congenital hydrocephalus.
    • Previous reports on hydrocephalus therapy reflect an evolutionary period with technical challenges and less favorable outcomes.
    • Neurosurgeons require updated prognostic information for gestational hydrocephalus cases.

    Purpose of the Study:

    • To update the prognostic picture for hydrocephalus that is overt at birth.
    • To review the outcomes of treated and untreated infants with congenital hydrocephalus.
    • To identify factors influencing prognosis in congenital hydrocephalus.

    Main Methods:

    • Evaluation of 37 children treated with cerebrospinal fluid shunts for overt hydrocephalus at birth, with an average 6-year follow-up.
    • Review of outcomes in 11 untreated infants with severe hydrocephalus.
    • Analysis of survival rates, intellectual capabilities (IQ), and correlation with specific malformations and pre-therapy brain metrics.

    Main Results:

    • 86% of treated patients survived 1 to 16 years, compared to 0% survival in untreated infants (average death at 2.5 months).
    • Approximately two-thirds of treated patients achieved normal or borderline intellectual capabilities (mean IQ 96).
    • Dandy-Walker malformation correlated with high mortality and low IQ; congenital aqueductal atresia with intellectual impairment; communicating hydrocephalus and myelomeningocele did not.

    Conclusions:

    • The majority of infants born with overt hydrocephalus have a good prognosis with appropriate cerebrospinal fluid shunt therapy.
    • Pre-therapy cortical mantle thickness and brain mass calculations can predict poor outcomes in survivors with low IQ.
    • Timely intervention with shunts significantly improves survival and cognitive outcomes in congenital hydrocephalus.

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