Article
Paediatric hydrocephalus – pathogenesis, therapy and complications in 131 patients
Pädiatrischer Hydrozephalus – Ursachen, Therapie und Komplikationen bei 131 Patienten
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Authors
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Jasmin Nagl
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Frank Patrick Schwarm
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Katharina Graf
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Marco Stein
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Eberhard Uhl
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
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Malgorzata Kolodziej
- Universitätsklinikum Gießen, Klinik für Neurochirurgie, Gießen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: The pathogenesis of hydrocephalus in paediatric patients is diverse. Ventriculoperitoneal (VP) shunt is the most frequently utilized diversion procedure. This study investigated the epidemiology of paediatric hydrocephalus, the influence of primary diagnosis, and type of implants for incidence, and type of complications.
Methods: A retrospective analysis of children (mean age: 13±33.8 months) being operated between 2013–2018 in our neurosurgical department was conducted. All patients underwent therapy of hydrocephalus by VP shunting. Medical charts, operative reports and clinical follow-up evaluations were reviewed and analyzed. Significant differences were analyzed by chi-square- and t-test. P-values <0.05 were considered significant.
Results: A total of 131 patients with a median age of 35 days (IQR 25-75: 17-170 days) at the time of VP shunt surgery were included. Hydrocephalus was associated with prenatal meningomyelocele (MMC) in 35.1% and intraventricular hemorrhage in 24.4% of cases. Median time of first revision surgery was 1 month (IQR 25-75: 0-2 months) after initial surgery. Most common causes of revision surgery were technical dysfunctions (66.1%), and infections (12.7%).
The number of revisions was associated with the etiology of the hydrocephalus. The lowest rate of revisions was found in hydrocephalus associated with MMC. The highest rate was observed in posthemorrhagic hydrocephalus (p=0.020).
While shunt infections were not associated with etiology (p=0.941), an increased incidence of technical shunt dysfunction was found in posthemorrhagic hydrocephalus (48.1%) and a lower rate (11.9%) was observed in hydrocephalus associated with MMC (p<0.001).
The valves most often used for first shunt surgery were Codman Hakim® (CH) (72.6%) and Miethke paediGAV© (MpGAV) (15.2%). Technical dysfunctions for revision surgery were independent of the implanted type of valve (p=0.351). The infection rate was higher in CH valves (88.9%) compared to MpGAV valves (11.1%; p=0.026).
Conclusion: In our cohort hydrocephalus was mostly associated with prenatal MMC and intraventricular hemorrhage. Furthermore the revision rate was lower in MMC associated hydrocephalus. Most technical shunt dysfunctions were found in posthemorrhagic hydrocephalus and most infections were associated with CH valve. The type of shunt complication was associated with the pathogenesis of the hydrocephalus and the used valve.
