Late outcome of the surgical treatment of hydrocephalus

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.

Repeated autologous umbilical cord blood infusions are feasible and had no acute safety issues in young babies with congenital hydrocephalus

“…A newer procedure called an endoscopic third ventriculostomy along with choroid plexus coagulation is now being performed in hopes of avoiding a shunt, although a shunt is still most common to manage severe hydrocephalus in the neonatal period. Survivors face the sequelae of both shunt complications and brain injury resulting from the prolonged hydrocephalic state in utero including motor deficits (50-60%), auditory and visual deficits (25-60%), seizures (20-50%), and impaired intelligence (50-70%) (6)(7)(8)(9)(10)(11)(12)(13). Additional comorbidities may be present if a genetic syndrome is diagnosed postnatally or if other anatomical abnormalities are present on imaging, such as agenesis of the corpus callosum, colpcephaly, holoprosencephaly, or Dandy Walker malformation.…”

Effects of Cranial Radiation on Structural and Functional Brain Development in Pediatric Brain Tumors

“…Side effects from hydrocephalus can be longstanding and include motor difficulties, visual/auditory difficulties, decreased intellectual functioning, special education, and behavior disorders (Hoppe-Hirsch et al 1998). The extent of hydrocephalus has been found to moderate the impact of radiation therapy on IQ as well as verbal and nonverbal abilities (Brookshire et al 1995;.…”

Hydrocephalus in Early Childhood

“…Hastaların yaklaşık %50'si ilk üç yıl içerisinde, %80'i yetişkin yaşa gelmeden kaybedilir 23 . Tedavi, tümöre bağlı olmayan hidrosefali olgularında sağ kalımı %89 -95 oranlarına çıkarmaktadır 28,31 .…”

“…Şant takılmış çocuklarda nöbet sıkça gelişebilmekte-dir [31][32][33] . Fransa'da ventriküloperitoneal şant ile tedavi edilen 802 çocuğu kapsayan bir çalışmada sekiz yıllık takip sonucunda %32 oranında epilepsi geliştiği rapor edilmiştir 33 .…”