Quality of life in children with hydrocephalus treated with endoscopic third ventriculostomy

Abstract

OBJECTIVEThe objectives of this study were to determine the quality of life of a pediatric cohort with hydrocephalus treated by endoscopic third ventriculostomy (ETV), using the Hydrocephalus Outcome Questionnaire–Spanish version (HOQ-Sv), and study the clinical and radiological factors associated with a better or worse functional status.METHODSThis cross-sectional study was undertaken between September 2018 and December 2019. It comprised a series of 40 patients ranging from 5 to 18 years old with hydrocephalus treated by ETV. ETV was considered to be successful if there was no need for surgery for the treatment of hydrocephalus after a minimum follow-up of 6 months. The clinical variables included gender, age at hydrocephalus diagnosis, age at the time of ETV, age at completion of the questionnaire, etiology and type of hydrocephalus (communicating or not), prior shunt, repeat ETV, number of neurosurgical procedures, number of epileptic seizures, presenting signs, and follow-up duration until last office revision. The radiological variables were the Evans Index and the pre- and posttreatment frontooccipital horn ratio. An analysis was conducted of the association between all these variables and the various dimensions on the HOQ-Sv, completed by the parents of the patients via telephone or in the outpatient offices.RESULTSThe mean age of the children at ETV was 7 years (range 7–194 months), and on completing the questionnaire was 12 years (range 60–216 months). The mean HOQ scores were as follows: overall 0.82, physical domain 0.86, social-emotional (SE) domain 0.84, cognitive domain 0.75, and utility score 0.90. A history of epileptic crises was a predictive factor for a worse score overall and in the SE and cognitive domains. Factors related to a worse score in the physical domain were a previous shunt, the number of procedures, and the etiology and type of hydrocephalus. The mean follow-up duration from ETV to the last office visit was 5 years (64.5 months). No association was found between the degree of ventricular reduction and the quality of life.CONCLUSIONSThe factors related to a worse score in the different dimensions of the HOQ were a history of epileptic seizures, the number of procedures, communicating hydrocephalus, and having had a previous valve. No association was found between the reduction in ventricular size and the quality of life as measured on the HOQ-Sv.

Recognizing and managing hydrocephalus in children

“…Children with hydrocephalus often present with complaints consistent with increased intracranial pressure (ICP) 7. This presentation may differ based on age, cause, and comorbidities.…”

“…Other general findings of elevated ICP include profuse vomiting, changes in vision (diplopia or blurred vision), agitation, fatigue or lethargy, gait abnormalities, anorexia, seizures, weakness, strabismus (most often esotropia), and the setting sun sign, which is characterized by the downward gaze of pupils (Figure 2). 7-10…”

“…Elevated ICP generally is defined as pressure exceeding 20 mm Hg for 5 minutes or longer 25,26. Also track cerebral perfusion pressure (CPP), which can be calculated by subtracting ICP from mean arterial pressure 7. A low CPP (below 45 mm Hg) is suggestive of poor cerebral perfusion and a high risk for ischemic brain injury 27…”

“…Communicating processes develop in the setting of disproportionate absorption and production of CSF, without underlying ventricular obstruction. Congenital causes include primary aqueductal stenosis, Dandy-Walker malformation, spinal dysraphism (such as myelomeningocele or encephalocele), Chiari malformations, space-occupying lesions, and genetic disorders 7. Acquired causes include infection, intracranial hemorrhage, and benign and neoplastic lesions 7…”

“…(such as myelomeningocele or encephalocele), Chiari malformations, space-occupying lesions, and genetic disorders. 7 Acquired causes include infection, intracranial hemorrhage, and benign and neoplastic lesions. 7…”