gms | German Medical Science

Objective: In Europe the prevalence of congenital and infantile hydrocephalus is 0.5 – 0.8 per 1000 births. After primary shunting further interventions become necessary during lifetime. Despite significant improvements failure rate can be up to 40% during the first year. The aim of this study was to analyse a typical pediatric hydrocephalus cohort regarding etiology, shunt types and revision rates and underlying causes.

Methods: We retrospectively analyzed all consecutive patients with congenital or infantile hydrocephalus operated between 1/2010 and 12/2014 in our institution. We also included children who were previously operated in another institution or inhouse before 2010 requiring a shunt revision. Hydrocephalus etiology, number and cause of revisions, shunt types/pressure levels and site of derivation were investigated.

Results: 476 children (283 males, 193 females) were included in to the analysis. Hydrocephalus etiology was posthemorrhagic in 162, dysraphic in 119, brain malformation and cystic in 79, tumor in 28, syndromal in 11, posttraumatic in 11, postinfectious in 11, pseudotumor cerebri in 8 and other causes in 33 cases. Drainage of hygroma became necessary in 14 patients. In 46% the primary shunt insertion was in another institution. In the primary inhouse group a nonadjustable valve with integrated gravitational unit was implanted in 78%. In 40 cases initially an antibiotic coated catheter were used. The preferred derivation was lumboperitoneal (84%). 50% of the patients did not require revisions in the follow up period (1/2010-12/2014), the other half had 2 to 5 revision surgeries. No mortality and no intraoperative complications occurred. In the high risk population with posthemorrhagic hydrocephalus 2 to 5 revisions became necessary in 43%.

Conclusion: Posthemorrhagic and dysraphism-associated hydrocephalus are the most common etiologies, both with higher revision rates. Shunt surgery in early childhood is a safe procedure. The high rate of patients primarily treated in another institution demonstrates a trend to refer complicated cases to a specialized pediatric neurosurgical center.