The long-term outlook for hydrocephalus in childhood. A ten-year cohort study of 155 patients

• Published in: Pediatric neurosurgery Vol. 27; no. 2; p. 63
• Main Authors: Casey, A T, Kimmings, E J, Kleinlugtebeld, A D, Taylor, W A, Harkness, W F, Hayward, R D
• Format: Journal Article
• Language: English
• Published: Switzerland 01.08.1997
• Subjects: Cerebral Hemorrhage - etiology; Child; Cohort Studies; Education, Special; Female; Humans; Hydrocephalus - complications; Hydrocephalus - mortality; Hydrocephalus - rehabilitation; Hydrocephalus - surgery; Infant; Infant, Newborn; Male; Prognosis; Retrospective Studies; Treatment Outcome; Ventriculoperitoneal Shunt - adverse effects
• ISSN: 1016-2291
• DOI: 10.1159/000121229

Despite the fact that ventriculoperitoneal shunt insertion is the most commonly performed surgical operation in the pediatric neurosurgeon's repertoire, there is a surprising paucity of long-term outcome studies for these patients detailing either the complication rate over a predetermined time period or more importantly their intellectual outcome. The aims of this study, therefore, were to determine the 10-year outcome in a cohort of 155 children with shunted hydrocephalus, both in terms of the number and time sequence of shunt complications and also the long-term academic (schooling) outcome of these individuals. This was a cohort study of 155 hydrocephalic children who underwent first-time ventriculoperitoneal shunt insertion between the years 1978 and 1983, who were then followed up on an annual outpatient basis for a period of 10 years or until death. Their academic records and the surgical morbidity and mortality encountered over the 10-year study period were used as the main outcome measures. For those children surviving until schoolage, 59% were able to attend a normal school. The academic outlook for those children with hydrocephalus secondary to infection (postmeningitic) or intraventricular hemorrhage was less favorable with 52 and 60% requiring special schooling compared to those children with congenital hydrocephalus (29%; p = 0.036). 44% (68/155) of patients in this cohort did not require a shunt revision. The commonest reasons for shunt revision were blockage (49%) and infection (19%) which predominantly occurred within the first year of their original shunt procedure. Overall the infection rate was 12% (44/380 procedures). Furthermore an increased incidence of shunt infection was noted in those under 6 months old (p = 0.040). There was an 11 % mortality during the 10-year follow-up period for those with nontumor-related hydrocephalus.