Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort

Rashid, Quratulain; Salat, Muhammad Sohail; Enam, Kishwar; Kazim, Syed Faraz; Godil, Saniya S.; Enam, Syed Ather; Iqbal, Saleem; Azam, Syed Iqbal

doi:10.1007/s00381-011-1527-5

Cited by 15 publications

(11 citation statements)

References 24 publications

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“…Other demographic factors like sex, age and co-morbid conditions did not influence the frequency of shunt failure in this study. A predominance of male patients (64.2%) was noted in our study and is in accordance with a previous report from our own hospital (38). This trend has also been noted in other studies from the developing world (12,24).…”

Section: █ Discussionsupporting

confidence: 93%

Ventriculoperitoneal (vp) shunt survival in patients developing hydrocephalus after cranial surgery

Khan

Rehman²,

Shamim³

et al. 2014

Turkish Neurosurgery

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ABSTRACThydrocephalus following cranial surgery is a well-recognized phenomenon (29) and results from a combination of collateral damage incurred during the surgical procedure (19) and the alterations occurring later in the CSF circulation, cerebral blood flow (CBF) auto-regulation and cerebral compliance (47).Complications resulting from VP shunts are notoriously common (7,9,13,24) and have been a subject of extensive research. (26, 27, 51) However, only a few studies have focused on VP shunt survival in patients who develop hydrocephalus as a consequence of cranial surgery itself. In this study, we report our experience of managing post-cranial surgery hydrocephalus in both pediatric and adult patients with particular emphasis on shunt complications and factors influencing shunt survival. █ INTRODUCTIONHydrocephalus results from abnormal production, flow or absorption of cerebrospinal fluid (CSF) causing an "active distension" of ventricles of the brain (40). Left untreated, this condition can lead to rapid deterioration and adverse long-term outcomes, both in pediatric (45) and adult (28) patients. Prompt CSF diversion with ventriculoperitoneal (VP) shunt insertion remains the most popular treatment for hydrocephalus (17).A number of classification schemes have been proposed to categorize hydrocephalus (3,22,32,33,37). However, no single scheme is comprehensive enough to encompass all aspects of this diverse entity (40). The development of AIM: Ventriculoperitoneal (VP) shunt insertion remains the most popular method for the treatment of hydrocephalus despite its associated complications. We assessed VP shunt survival in a group of patients who had developed hydrocephalus following cranial surgery. MATERIAL and METHODS:A retrospective charts review was done over a 10-year period at our institution. Kaplan-Meier survival curves and Log-Rank (Cox-Mantel) test were used to analyze various factors affecting VP shunt survival. RESULTS:Among the 67 cases included, a total of 28 (46.3%) patients had undergone cranial surgery for brain tumors. The overall rate of shunt failure was 14.9% at a mean follow-up of 16 months. Shunt failure in pediatric patients (20%) was slightly higher than that in adult patients (13.5%). The median time to first shunt failure was adversely influenced by a history of brain tumor (p = 0.019), prolonged antibiotic therapy (p = 0.018) and administration of steroids (p = 0.004).CONCLUSION: Shunt survival was worse in patients who developed hydrocephalus following cranial surgery performed for brain tumors and those who received either steroids or prolonged antibiotic therapy. Thus post-cranial surgery hydrocephalus represents a unique subset of hydrocephalus.

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Section: █ Discussionsupporting

confidence: 93%

Ventriculoperitoneal (vp) shunt survival in patients developing hydrocephalus after cranial surgery

Khan

Rehman²,

Shamim³

et al. 2014

Turkish Neurosurgery

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“…3,6,13,22 In addition to the overall effect in an unselected group of pediatric patients on whom we report, there was a significant improvement with respect to infection rates in the 0-6-month age group. This group of patients, particularly those with posthemorrhagic hydrocephalus, appear to be at greater risk of shunt-related morbidity and mortality, 19,27 and it is encouraging that in this study AIS tubing appears to be effective in improving outcomes in this group.…”

Section: Discussionmentioning

confidence: 67%

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

James¹,

Hartley

Morgan³

et al. 2014

PED

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Object Infection after both primary and revision shunt surgeries remains a major problem in pediatric neurosurgical practice. Antibiotic-impregnated shunt (AIS) tubing has been proposed to reduce infection rates. The authors report their experience with AIS catheters in their large pediatric neurosurgery department. Methods The authors conducted a retrospective case review of consecutive shunt operations performed before (1993–2003) and after (2005–2009) introduction of AIS tubing, with analysis of shunt infection rates and causative organisms identified. Results The historical control group consisted of 1592 consecutive shunt operations (657 primary insertions), and the AIS study group consisted of 500 consecutive shunt operations (184 primary insertions). Patients ranged in age from 0–17 years. In the historical group, 135 infections were identified (8.4%). In the AIS study group, 25 infections were identified (5%), representing a significant reduction (p < 0.005). The latency to diagnosis of infection was 23 days in the historical group and 139 days in the AIS study group. The infection rates in infants 0–6 months of age were 12.2% (historical group) and 6.7% (AIS group, p < 0.005), and in infants 7–12 months of age the rates were 7.9% (historical group) and 2.7% (AIS group, p < 0.005). In the historical control group, the frequency rank order of causative organisms was coagulase-negative staphylococcus (51.9%), Staphylococcus aureus (31.6%), streptococcus or enterococcus spp. (8.8%), gram-negative organisms (4.4%), and Propionibacterium acnes (2.2%). Organisms responsible for infections in AIS were S. aureus (40%), followed by streptococcus or enterococcus spp. (20%), P. acnes and coagulase-negative staphylococcus (both 16%), and gram-negative organisms (4%). No unusually antibiotic-resistant bacteria were identified in either group. The authors further subdivided the AIS group into those undergoing primary AIS insertion (Subgroup 1), those undergoing revision of non-AIS systems using AIS components (Subgroup 2), and those undergoing revision of AIS systems using AIS components (Subgroup 3). Infection rates were 1.6% in Subgroup 1, 2.5% in Subgroup 2, and 11.7% in Subgroup 3. Staphylococcus aureus was the most common organism identified in infections of the Subgroups 2 and 3. Conclusions Use of AIS tubing significantly improves shunt infection rates in both general pediatric and infant populations with no evidence of increased antibiotic resistance, which is in agreement with previous studies. However, the increased infection rate in revision surgery in children with AIS catheters in situ raises questions about their long-term application.

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“…We believe that this approach would help especially in resource-challenged health care systems and developing countries such as Pakistan, where CH is the most common neurologic congenital defect and also the most common reason for neurosurgical intervention in pediatric patients. 9,10 These children, after surgery and initial screening for possible complications, are critically exposed to economic and social handicaps due to a lack of awareness programs and good social rehabilitation centers, increasing the probability of suboptimal health outcomes and QOL.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 However, CH involves long-term follow-up and is associated with numerous possible complications. Rashid et al 10 reported a poor surgical outcome in children treated for pediatric hydrocephalus in Pakistan. Considering the prevalent poverty as well as the lack of well-developed social rehabilitation Key words -Congenital -Hydrocephalus -Hydrocephalus Outcome Questionnaire (HOQ) -Quality of life (QOL)…”

Section: Introductionmentioning

confidence: 99%

Quality of Life in Individuals Surgically Treated for Congenital Hydrocephalus During Infancy: A Single-Institution Experience

et al. 2017

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Time trends and age-related etiologies of pediatric hydrocephalus: results of a groupwise analysis in a clinical cohort

Abstract: Despite recent advancements, hydrocephalus is still associated with high rate of shunt failure and mortality. Factors associated with poor outcome include younger age group and etiology of hydrocephalus.

Cited by 15 publications

References 24 publications

Ventriculoperitoneal (vp) shunt survival in patients developing hydrocephalus after cranial surgery

Ventriculoperitoneal (vp) shunt survival in patients developing hydrocephalus after cranial surgery

Effect of introduction of antibiotic-impregnated shunt catheters on cerebrospinal fluid shunt infection in children: a large single-center retrospective study

Quality of Life in Individuals Surgically Treated for Congenital Hydrocephalus During Infancy: A Single-Institution Experience

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