Infantile Hydrocephalus: Long-Term Results of Surgical Therapy

Amacher, A L; Wellington, J L

doi:10.1159/000120180

Cited by 60 publications

(43 citation statements)

References 14 publications

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“…Amacher and Wellington reported a 21% death rate over a 5-to 12-year follow-up study. 1 Our high mortality rate (39% in patients without tumors) must be considered in light of the era in which treatment was conducted, that is, before CT scans and without modern diagnostic tools. There was also at the time a lack of established routine controls for assessing persistent shunt function and recognizing shunt malfunctions.…”

Section: Discussion Mortalitymentioning

confidence: 99%

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Paulsen

Lundar

Lindegaard

2015

PED

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OBJECT Treatment for hydrocephalus has not advanced appreciably since the advent of CSF shunts more than 50 years ago. The outcome for pediatric patients with hydrocephalus has been the object for several studies; however, much uncertainty remains regarding the very long term outcome for these patients. Shunting became the standard treatment for hydrocephalus in Norway during the 1960s, and the first cohorts from this era have now reached middle age. Therefore, the objective of this study was to review surgical outcome, mortality, social outcome, and health-related quality of life in middle-aged patients treated for hydrocephalus during childhood. METHODS Data were collected in all patients, age 14 years or less, who required a CSF shunt during the years 1967–1970. Descriptive statistics were assessed regarding patient characteristics, surgical features, social functioning, and work participation. The time and cause of death, if applicable, were also determined. Kaplan-Meier survival estimates were used to determine the overall survival of patients. Information regarding self-perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and the Barthel Index score. RESULTS A total of 128 patients were included in the study, with no patient lost to follow-up. Of the 128 patients in the study, 61 (47.6%) patients died during the 42–45 years of observation. The patients who died belonged to the tumor group (22 patients) and the myelomeningocele group (13 patients). The mortality rate was lowered to 39% if the patients with tumors were excluded. The overall mortality rates at 1, 2, 10, 20, and 40 years from time of initial shunt insertion were 16%, 24%, 31%, 40%, and 48% respectively. The incidence of shunt-related mortality was 8%. The majority of children graduated from a normal school (67%) or from a school specializing in education for physically handicapped children (20%). Self-perceived health was significantly poorer in 6 out of 8 domains assessed by SF-36 as compared with the background population. Functional status among the survivors varied greatly during the follow-up period, but the majority of patients were self-dependent. A total of 56% of the patients were socially independent, and 42% of the patients were employed. CONCLUSIONS Approximately half of the patients are still alive. During the 42–45 year follow-up period, the mortality rate was 48%. Two deaths were due to acute shunt failure, and at least 8% of the deaths were shunt related (probable or late onset). The morbidity in middle-aged individuals treated for pediatric hydrocephalus is considerable. The late mortality rate was low, but not negligible. Twelve patients died during the last 2 decades, 1 of whom died because of acute shunt failure. Although the shunt revision rate was decreasing during the study period, many patients required shunt surgery during adulthood. Forty-one revisions in 21 patients were performed during the last decade. Thus, there is an obvious need for life-long follow-up in these patients.

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Section: Discussion Mortalitymentioning

confidence: 99%

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Paulsen

Lundar

Lindegaard

2015

PED

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“…1,2,9,10,12,15,17) The present study excluded patients whose age at the last assessment of clinical outcome was less than 1 year. The 10-year survival of surgically treated patients is more than 60%, half of whom live independently and have normal intelligence.…”

Section: Outcomementioning

confidence: 99%

“…However, not all studies have used the same definition of normal intelligence and the composition of the study populations has varied considerably. 1,17,19) Another good measure might be whether the child can attend a normal school or not, as integration into the normal school system was possible for 60% of the children but half of them were 1-2 years behind their age group or having difficulties. 10) The present study could not show better clinical outcome in the shunt group than in the non-shunt group, but suggested that early surgery is optimum for term infants and delay in surgical treatment increase the risk of poor outcome.…”

Section: Outcomementioning

confidence: 99%

“…1,7,9,11,15,27) Delay in surgical treatment might also be a risk factor for poor outcome in hydrocephalic children. 1) Delay in drain implantation until more than 1 month after diagnosis apparently increased the probability of impairment of mental development, such as speech and language, and possibly learning. 21) Mental and linguistic development was poorer in children who underwent surgery more than 1 month after diagnosis, suggesting that delay in surgical treatment might be a risk factor for poor outcome in hydrocephalic children.…”

Section: Outcomementioning

confidence: 99%

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Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

Moritake

Nagai

Miyazaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A nationwide questionnaire survey of congenital hydrocephalus in 2000 investigated the treatment and clinical outcomes for congenital hydrocephalus in Japan to evaluate the factors influencing clinical outcome. Surgical treatment was performed in 341 of 380 patients who survived the early neonatal period. Of 321 patients who had shunt operations, 295 (91.9%) underwent ventriculoperitoneal shunting and nine (2.8%) ventriculoatrial shunting. Programmable valves were used in 83 (33.6%) of the 247 patients at the first shunting and in 97 (39.3%) at the last shunting. The incidence of complications after the first shunting was 55.4% (46 of 83 patients) in the programmable and 61.6% (101 of 164) in the non-programmable valve groups. The types of shunt complication differed significantly between these groups (p º 0.001), as the incidence of shunt infection and malfunction was lower in the programmable valve group. Clinical outcome was generally better with later delivery stage during gestation (p º 0.02). The clinical outcome was statistically significantly better in term patients who underwent early shunt placement than in those who underwent late shunt placement (p º 0.05).

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“…VPS enfeksiyonlarının insidansının VP takılan olguların tümünde %6.5-23.5 oranında olduğu bildirilmektedir (3)(4)(5)(6)(7)(8)(9) . Enfeksiyon, VPS komplikasyonları arasında en çok korkulan ve şant yetmezliğine en çok neden olan komplikasyondur.…”

Section: Discussionunclassified

Çocuklarda Ventriküloperitoneal Şant Enfeksiyonları ve Tedavisi

Çağan¹,

Soysal²,

Şeker³

et al. 2015

Cukurova Medical Journal

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ÖZETAmaç: VPS cerrahisinin en önemli komplikasyonu cerrahi sonrası dönemde gelişen santral sinir sistemi enfeksiyonudur. VPS enfeksiyonlarının insidansının VPS takılan olguların tümünde %6.5-23.5 oranında olduğu bildirilmektedir. Bu çalışmanın amacı hidrosefalili çocuk hastalarda VPS ameliyatlarının enfeksiyon ilişkili komplikasyonlarını ve tedavilerini değerlendirmektir.

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Infantile Hydrocephalus: Long-Term Results of Surgical Therapy

Cited by 60 publications

References 14 publications

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Analysis of a Nationwide Survey on Treatment and Outcomes of Congenital Hydrocephalus in Japan

Çocuklarda Ventriküloperitoneal Şant Enfeksiyonları ve Tedavisi

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