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Clinical significance of ventricular size in shunted-hydrocephalic children
H Sakamoto1, S Kitano, M Nishikawa
1Department of Pediatric Neurosurgery, Osaka City General Hospital, Japan.
Insights
Maintaining adequate lateral ventricle size is crucial for shunted hydrocephalic children. Keeping the Evans
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Cerebrospinal Fluid Dynamics
Background:
- Shunt obstruction is a common complication in hydrocephalus management, necessitating emergent revision.
- Intracranial buffering capacity is vital for maintaining neurological function in shunted hydrocephalic children.
- The optimal size of lateral ventricles to prevent shunt obstruction is not well-defined.
Purpose of the Study:
- To determine the most suitable lateral ventricular size for maintaining intracranial buffering capacity in hydrocephalic children.
- To identify factors associated with shunt obstruction in pediatric hydrocephalus.
Main Methods:
- Retrospective analysis of 37 shunted-hydrocephalic children requiring emergent shunt revision.
- Classification into 'Slit-like' (Evans' index ≤ 0.35) and 'Dilated' (Evans' index > 0.35) groups based on lateral ventricle size at obstruction.
- Comparison of patient demographics, clinical presentation, and CT findings between the two groups.
Main Results:
- The 'Slit-like' group (n=13) had significantly older patients (≥3 years) and showed more rapid deterioration into lethargy compared to the 'Dilated' group (n=24).
- CT scans in the 'Slit-like' group revealed a higher incidence of ambient cistern narrowing at the time of obstruction.
- In the 'Slit-like' group, the Evans' index was consistently ≤ 0.33 prior to shunt malfunction.
Conclusions:
- Small lateral ventricles (Evans' index ≤ 0.33) in shunted hydrocephalic children (≥3 years) suggest ventricular tautness and increased risk of obstruction.
- Maintaining lateral ventricular size above an Evans' index of 0.33 is recommended to preserve intracranial buffering capacity and prevent shunt obstruction.
- This finding aids in optimizing shunt management strategies for pediatric hydrocephalus.
Abstract:
For maintaining the intracranial buffering capacity against shunt obstruction, we tried to seek the most suitable size of the lateral ventricles in hydrocephalic children. Thirty-seven shunted-hydrocephalic children who required emergent revision of the shunt were analyzed. At the time of shunt obstruction, the lateral ventricle remained small (0.35 or less than 0.35 on the Evans' index) in 13 patients (Slit-like group), but it enlarged (more than 0.35 on the Evans' index) in 24 patients (Dilated group). The mean age in the Slit-like group was significantly older than in the Dilated group and there was no patient younger than 3 years in the Slit-like group. Compared with the Dilated group, the Slit-like group showed significantly rapid deterioration into lethargy after shunt obstruction. Also, at the time of obstruction CT scans showed a significantly higher rate of narrowing of the ambient cistern. While the shunt was working well before shunt obstruction, the Evans' index was less than 0.33 in all patients of the Slit-like group. In conclusion, because small ventricles after shunt strongly suggest the presence of ventricular tautness, the lateral ventricular size should be maintained at more than 0.33 on the Evans' index in shunted children at an age of 3 or more than 3 years.