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Late outcome of the surgical treatment of hydrocephalus
E Hoppe-Hirsch1, F Laroussinie, L Brunet
1Service de Neurochirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Shunt placement for hydrocephalus significantly reduces mortality but results in high long-term morbidity, impacting neurological function and psycho-intellectual development in children. Further research is needed to improve treatment outcomes and reduce complications.
Area of Science:
- Pediatric Neurosurgery
- Developmental Neurology
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
- Shunt placement is a common treatment for hydrocephalus, aiming to reduce intracranial pressure.
- Long-term outcomes, particularly psycho-intellectual development, require thorough investigation.
Purpose of the Study:
- To analyze the long-term outcomes of hydrocephalic children treated with shunt placement.
- To specifically evaluate the psycho-intellectual development of these children.
- To identify factors influencing outcomes and discuss potential improvements in care.
Main Methods:
- Study included 129 children with nontumorous hydrocephalus undergoing first shunt insertion before age 2 (1979-1982).
- Follow-up duration was at least 10 years.
- Evaluated neurological deficits, intelligence quotient (IQ), scholastic integration, and behavioral disorders.
Main Results:
- Postoperative mortality was near zero; 10-year mortality was <5%.
- High morbidity observed: 60% motor deficit, 25% visual/auditory deficits, 30% epilepsy.
- Psycho-intellectual outcomes varied: 32% IQ >90, 21% IQ <50. 60% achieved normal schooling, but many faced challenges. Severe behavioral disorders affected 30%.
Conclusions:
- While shunt placement is safe regarding mortality, significant long-term morbidity persists in hydrocephalic children.
- Etiology, initial ventricular size, epilepsy, and behavioral disorders are linked to poorer outcomes.
- Improving management strategies is crucial to enhance the quality of life and developmental trajectory for these children.
Abstract:
The purpose of this report is to analyze the long-term outcome in hydrocephalic children treated by shunt placement and in particular their psycho-intellectual development. In the case of shunt placement postoperative mortality is virtually nil, and the overall mortality rate after 10 years of follow-up has been reduced to less than 5%. Morbidity, in contrast, is far from satisfactory. This study was conducted in 129 consecutive children with nontumorous hydrocephalus who underwent a first shunt insertion before the age of 2 years between 1979 and 1982 and who were followed up for at least 10 years. The final neurological examination revealed a motor deficit in 60%, visual or auditory deficits in 25%, and epilepsy in 30%. The final IQs were above 90 in 32% of the children, between 70 and 90 in 28%, between 50 and 70 in 19%, and lower than 50 in 21%. Integration into the normal school system was possible for 60% of the children, but half of them were 1-2 years behind their age group or having difficulties; 31% were attending special classes or were in institutions; and 9% were considered ineducable. The presence of behavioral disorders was a determinant factor for scholastic and social integration. Such disorders were frequent, and were characterized as severe in 30%. A relationship between final outcome and etiology, initial ventricular size, and epilepsy was observed. These results are used as the basis of a discussion on how morbidity might be improved.