gms | German Medical Science

Objective: Hydrocephalus in childhood is a frequent condition known for long but still there are controversies referring to diagnostic procedures and treatment strategies. This study aimed to get an overview over concepts used worldwide.

Methods: We made an inquiry dealing with questions of hydrocephalus treatment in childhood taking into account several aspects of care in different countries and continents. Data were collected using a questionnaire distributed online.

Results: We evaluated 281 replies, mostly from countries of the European Union (23,3%), Japan, South Korea and China (20,4%), Latin America (15,8%) and North America and Canada (11,5%). CT, MRI and ultrasound (US) are commonly used. 53,8% always performed US, 36,5% CT and 28,5% MRI before 1st surgery. Primary treatment procedures include - in descending order - implantation of a reservoir, external ventricular drainage systems (EVD), vp-shunts, ventriculo-subgaleal shunts, ventriculostomy (ETV) and a repeated puncturing through the fontanel. 26% desired a body weight of the child of > 2500g for primary ventriculo-peritoneal shunt placement. 1,5% accept a weight of < 1000g. Frontal approach for ventricular catheter placement is preferred in 56,7%. Standard application of intraoperative guiding systems for catheter placement is not very common (US 8,3%, navigation 2,5%). Length of the peritoneal catheter varies from > 80cm (18,2%), 60-80cm (14,9%), 40-60cm (25,8%), 20-40cm (36,4%) to < 20cm (4,7%). Distal catheter revision for routine just due to the growth of the child is not favoured by a majority of the respondents.In all forms of hydrocephalus fixed differential pressure valves are used most frequently and adjustable antisiphon valves are used least. Asked about the use of perioperative antibiotics a single shot concept is used in 51,3% when shunt surgery is performed and 35,8% when an EVD is placed. 39,9% preferred antibiotic treatment for the whole time the EVD is in place. Clinical follow up is done every 6 months (32,4%), every 12 months (52,9%), every 24 months (4,7%) or only when the patient has complaints (10,1%). After shunting 54% perform radiologic examinations in regular intervals, 46% only when the child is symptomatic.

Conclusion: We found an impressive variety in treatment concepts used in various countries with different socio-economic background. Further investigation is needed to find out about feasable treatment solutions for children with hydrocephalus worldwide.