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[Surgical treatment of hydrocephalus in children. II. Complications]
Insights
Surgical treatment for pediatric hydrocephalus involves various shunting procedures. Ventriculo-peritoneal shunting showed the highest complication rates, necessitating careful patient selection and monitoring.
Area of Science:
- Pediatric Neurosurgery
- Neurological Surgery
- Pediatric Neurology
Context:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
- Congenital malformations, meningitis, and tumors are common causes of pediatric hydrocephalus.
- Surgical intervention is often required to manage increased intracranial pressure.
Purpose:
- To analyze and compare the complication rates of different surgical treatments for pediatric hydrocephalus.
- To evaluate the efficacy and risks associated with various shunting procedures in children.
Summary:
- This study reviewed 57 children with hydrocephalus treated surgically between 1970 and 1980.
- Complications varied across procedures: ventriculostomy reservoir (0.47 revisions/patient), hypothalamic ventriculostomy (0.57 revisions/patient), ventriculoatrial shunting (0.57 revisions/patient), and ventriculo-peritoneal shunting (high rates of infection, malfunction, and leakage).
- Ventriculo-peritoneal shunting exhibited the most frequent complications, including infection (30.8%), valve malfunction (32.2%), and cerebrospinal fluid leakage (17.3%).
Impact:
- Findings highlight the significant risks associated with different hydrocephalus surgical techniques in children.
- Results inform clinical decision-making regarding the choice of shunting procedure based on potential complications.
- This historical data provides a baseline for evaluating newer hydrocephalus management strategies.
Abstract:
The authors analized the complications of fifty seven children with hydrocephalus due to congenital malformation (42.1%), meningitis (36.8%) and tumor (21.1%), that were submitted to surgical treatment for hydrocephalus, from 1970 to 1980. External ventricular drainage and insertion of ventriculostomy reservoir were used to control the expanding hydrocephalus in children with meningitis. Complications weren't observed in the first procedure. Cutaneous abscess, brain abscess, cerebrospinal fluid leakage, wound dehiscence, malposition of the reservoir and local tumor were observed in the use of the ventriculostomy reservoir and these complications caused a revision rate of 0.47 revisions per patient. Hypothalamic ventriculostomy with catheter showed complications (catheter obstruction and meningitis) that caused a revision rate of 0.57 revisions per patient. Ventriculoatrial shunting procedure showed several complications (malposition of the distal catheter, malfunction of the valvular system without obstruction and infection and thrombosis of the superior vena cava), that caused a revision rate of 0.57 revisions per patient. Ventriculo-peritoneal shunting procedure showed infections in 30.8%, malfunction of the valvular system in 32.2% cerebrospinal fluid leakage in 17.3%, malposition of catheter in 13.5%, catheter disconnection in 9.6%, transient abdominal distension in two cases and overdrainage phenomena, ascites and abdominal pseudocyst in one case.