gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

5 years, 476 children, hydrocephalus and its treatment in the complete range

Meeting Abstract

Search Medline for

  • Elke Januschek - Sana Klinikum Offenbach GmbH, Offenbach, Deutschland
  • Nina Evertz - Asklepios Kinderkrankenhaus, Sankt Augustin, Deutschland
  • Andreas Röhrig - Asklepios Kinderkrankenhaus, Sankt Augustin, Deutschland
  • Sandra Kunze - Asklepios Kinderkrankenhaus, Sankt Augustin, Deutschland
  • Martina Messing-Jünger - Asklepios Kinderkrankenhaus, Sankt Augustin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 192

doi: 10.3205/17dgnc755, urn:nbn:de:0183-17dgnc7559

Published: June 9, 2017

© 2017 Januschek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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.