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Hydrocephalus in infancy and childhood. Our experience of CSF shunting
Insights
This study analyzed 346 children with nontumoral hydrocephalus who underwent shunting surgery. Long-term follow-up revealed that 60.7% of patients achieved excellent outcomes, with others showing residual deficits or severe handicaps.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Neurology
Background:
- Hydrocephalus is a complex neurological condition requiring surgical intervention.
- Shunt surgery has been a primary treatment for hydrocephalus in children.
- Long-term outcomes and complication rates of pediatric hydrocephalus surgery require ongoing evaluation.
Purpose of the Study:
- To analyze the long-term outcomes of shunted nontumoral hydrocephalus in children.
- To investigate etiological factors, surgical complications, and mortality in pediatric hydrocephalus.
- To assess the physical, neurological, and mental status of patients after shunt surgery.
Main Methods:
- Retrospective surgical series of 346 children with nontumoral hydrocephalus (1957-1973).
- Analysis of etiological factors, preoperative status, surgical procedures, and revision rates.
- Long-term clinical and instrumental review of physical, neurological, and mental status for surviving patients.
Main Results:
- 141 patients (40.7%) required 218 revision operations.
- Mortality was observed in 81 patients (23.4%) over the follow-up period.
- Of 224 patients reviewed, 136 (60.7%) were well/very well, 68 (30.3%) had regressive deficits, and 20 (8.9%) were severely handicapped.
Conclusions:
- Shunt surgery for pediatric nontumoral hydrocephalus can yield favorable long-term outcomes for a majority of patients.
- Revision rates and mortality remain significant considerations in hydrocephalus management.
- Comprehensive long-term follow-up is crucial for assessing the functional status and guiding further treatment in pediatric hydrocephalus.
Abstract:
A surgical series of 346 children with nontumoral hydrocephalus shunted in the period January 1957 to December 1973 is presented. The etiological factors, preoperative clinical and anatomical status of the patients, their surgical career, the reasons for revision operations and causes of death, are analyzed and discussed in relation to each of the four groups constituting the series: tetraventricular communicating hydrocephalus, triventricular hydrocephalus, obstructive hydrocephalus from ventriculocisternal block and postmeningocele or postmyelomeningocele hydrocephalus. 141 patients required 218 revision operations. 16 patients died after the first operation, 27 on revision and 38 sometime later. 41 patients were lost to follow-up. A recent clinical and instrumental review of the physical, neurological and mental status of the remaining 224 patients showed that 136 (60.7%) are well or very well, 68 (30.3%) have residual deficits likely to regress with treatment and 20 (8.9%) are severely handicapped. These long-term results and the surgical aspects of the problem are discussed in the light of the literature.