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Follow-up of children with shunted hydrocephalus
A Colak1, A L Albright, I F Pollack
1Department of Neurosurgery, University of Pittsburgh and the Children's Hospital of Pittsburgh, PA 15213, USA.
Insights
Routine yearly evaluations for shunted hydrocephalus in children rarely detect shunt malfunction. Biennial follow-up may be more appropriate after one year of shunt function.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Device Monitoring
Background:
- Shunt malfunction is a significant complication in pediatric hydrocephalus management.
- Current follow-up protocols often involve annual clinical evaluations.
Purpose of the Study:
- To assess the diagnostic yield of routine yearly evaluations for shunt malfunction in children.
- To determine the optimal follow-up interval for shunted hydrocephalus in pediatric patients.
Main Methods:
- Retrospective review of medical records for 100 children with routine yearly evaluations.
- Retrospective review of medical records for 100 children undergoing shunt revisions.
- Analysis of clinical signs, symptoms, and imaging for shunt malfunction.
Main Results:
- Only 4 children in the routine evaluation group had potential symptoms, with no confirmed malfunctions.
- Two children in the shunt revision group were diagnosed during routine follow-up (2%).
- Only one child overall presented with signs/symptoms of malfunction after one year of shunt function.
Conclusions:
- Yearly evaluations are unlikely to detect shunt malfunction in children with hydrocephalus.
- Biennial follow-up evaluations may be sufficient for children over two years old with a functioning shunt for at least one year.
Abstract:
In order to determine if routine yearly evaluations of children with shunted hydrocephalus were likely to diagnose shunt malfunction, we reviewed the medical records of the last 100 children who had such routine evaluations. Only 4 children had symptoms that were potentially referable to malfunction; none were subsequently found to have malfunction and no child had signs of malfunction. We also reviewed the medical records of the last 100 children who had shunt revisions to determine if any of them were diagnosed during routine follow-up examinations. Four were: 2 with clinical signs of malfunction and 2 with evidence of malfunction on routine scans. Only 1 child in either group had signs or symptoms of malfunction if they had a functioning shunt in place for longer than 1 year. Although yearly follow-up visits are common practice, we conclude that such examinations are unlikely to detect shunt malfunction. Follow-up at intervals of 2 years is probably appropriate after 2 years of age if the child has had a functional shunt for 1 year and has had a scan that indicates a functioning shunt.