Long-Term Complications of Hydrocephalus

Sgouros, Spyros; Malluci, Connor; Walsh, A. R.; Hockley, A. D.

doi:10.1159/000120949

Cited by 94 publications

(40 citation statements)

References 15 publications

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“…11,12,16,17 Data from the Norwegian background population show that 81% males and 77% females in their 40s are living with a partner. The poor partnering (relationship) rate of 35% in our cohort is lower than expected.…”

Section: Social Outcomementioning

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: Social Outcomementioning

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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“…Abdominal pseudocyst formation with signs of shunt malfunction and/or abdominal symptoms is very infrequent, but they are important complications. [2][3][4][5][6] In the literature, the incidence of the formation of CSF pseudocyst ranged between 2 and 5%. Rainov described an incidence of 4.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Although this is the preferential method, it is not free from complications. [1][2][3] Abdominal pseudocyst formation is an infrequent complication and is characterized with signs of shunt malfunction and/or abdominal symptoms.…”

Section: Introductionmentioning

confidence: 99%

Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experienceFNx01

Şanal

Laimer

Häussler

et al. 2007

J Indian Assoc Pediatr Surg

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“…There were 4 sudden deaths in the community suspected to have been due to shunt failure. Sgouros et al 75 reported the adulthood experiences of 70 patients followed from childhood for congenital hydrocephalus, including 23 with myelomeningocele. Thirty-three of 201 shunt revisions and 5 of 8 subtemporal decompressions were required after the age of 16 years.…”

Section: Hydrocephalusmentioning

confidence: 99%

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

Piatt¹

2010

PED

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Object Myelomeningocele is the most severe congenital malformation of the CNS that is compatible with survival. From the time of the development of practical treatment for hydrocephalus in the late 1950s, affected individuals began to survive into adulthood in substantial numbers. Data on the neurological status of these individuals are sparse, as are descriptions of their continuing requirements for neurosurgical care. Methods A review of the literature was undertaken using the PubMed database maintained by the National Library of Medicine. Formal grading of the quality of evidence was not attempted, but methodological issues affecting validity or generalizability were noted. Results Observations from 2 major longitudinal studies of cohorts of patients treated without selection using contemporary neurosurgical techniques have been published at intervals beginning in the mid-1970s. Numerous cross-sectional, institutional reviews have focused on neurosurgical issues in adulthood: hydrocephalus, Chiari malformation Type II and syringomyelia, and secondary spinal cord tethering. The organization of medical services for adults with myelomeningocele has received limited study. Conclusions Surviving adults with myelomeningocele achieve a wide range of neurological and functional outcomes, the most critical and adverse determinant of which is symptomatic CSF shunt failure. From a neurosurgical standpoint, adults with myelomeningocele remain clinically active indefinitely, and they deserve periodic neurosurgical surveillance.

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Long-Term Complications of Hydrocephalus

Cited by 94 publications

References 15 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

Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experienceFNx01

Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults

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