Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 706-713
DOI: 10.4103/ajns.AJNS_132_21
Original Article

Evaluation of pediatric hydrocephalus: Clinical, surgical, and outcome perspective in a tertiary center

Rahul Singh
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Ravi Prasad
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Ramit Singh
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Adarsh Trivedi
1   Department of Neurosurgery, Shri Shankracharya Institute of Medical Sciences, Bhilai, Madhya Pradesh, India
,
Kulwant Bhaikhel
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Anurag Sahu
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Context: Pediatric hydrocephalus (PH) results in significant clinical and psychosocial morbidity in pediatric population. Aims: The aims of the study are to evaluate clinical, surgical, and outcome perspective of PH patients of age <12 years. Settings and Design: This is a retrospective cohort study. Materials and Methods: This study includes 117 pediatric patients (age ≤12 years) of hydrocephalus due to various etiology admitted in our department between September 2018 and December 2020. Demographic profile, etiology, clinical presentation, management, complications and postoperative outcome characteristics were evaluated. Survival analysis was done with respect to etiology and age group. Statistical Analysis Used: P < 0.05 was considered statistically significant. Unpaired t-test and Chi-square test were used. Kaplan–Meier curve plotting and survival analysis were also done. Results: Male-to-female ratio was 1.3:1. Most frequent etiology of PH was postinfectious (35%). Posterior fossa pilocytic astrocytoma (34.2%) was the most common neoplastic etiology. Surgical procedure performed for PH was ventriculoperitoneal shunting (n = 103), Ommaya reservoir (n = 2) placement, and endoscopic third ventriculostomy (ETV) (n = 8). Mortality was significantly (P = 0.0139) more in patients of neoplastic etiology. Cognitive deficits and delayed developmental milestones were significantly (P < 0.05) more in congenital hydrocephalus etiology. There was a nonsignificant difference in survival between age groups (P = 0.1971). However, a significant survival difference was evident (P = 0.0098) for etiology. Conclusions: Disease-specific mortality is main cause of mortality in PH. Neoplastic etiology PH has poor survival when compared to others. Life-long routine controls are required to avoid future possible complications and enhance better rehabilitation of the child.

Key-words:

Congenital hydrocephalus - endoscopic third ventriculostomy - pediatric hydrocephalus - postinfectious hydrocephalus - survival - ventriculoperitoneal shunt

Financial support and sponsorship

Nil.




Publication History

Received: 26 March 2021

Accepted: 23 September 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Rekate HL. The definition and classification of hydrocephalus: A personal recommendation to stimulate debate. Cerebrospinal Fluid Res 2008;5:2.
  • 2 Abdullah J, Naing NN. Hydrocephalic children presenting to a Malaysian community-based university hospital over an 8-year period. Pediatr Neurosurg 2001;34:13-9.
  • 3 Al Salloum AA, El Mouzan MI, Al Omar AA, Al Herbish AS, Qurashi MM. The prevalence of neurological disorders in Saudi children: A community-based study. J Child Neurol 2011;26:21-4.
  • 4 Cavalcanti DP, Salomão MA. Incidence of congenital hydrocephalus and the role of the prenatal diagnosis. J Pediatr (Rio J) 2003;79:135-40.
  • 5 Harmat G, Jójárt G, Rubecz I. Coordinated ultrasound screening of infants: Hungary experience. Eur J Ultrasound 2001;12:209-19.
  • 6 Kahle KT, Kulkarni AV, Limbrick DD Jr., Warf BC. Hydrocephalus in children. Lancet 2016;387:788-99.
  • 7 Tully HM, Dobyns WB. Infantile hydrocephalus: A review of epidemiology, classification and causes. Eur J Med Genet 2014;57:359-68.
  • 8 Warf B, Ondoma S, Kulkarni A, Donnelly R, Ampeire M, Akona J, et al. Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda. J Neurosurg Pediatr 2009;4:564-70.
  • 9 Krishnan P, Raybaud C, Palasamudram S, Shroff M. Neuroimaging in pediatric hydrocephalus. Indian J Pediatr 2019;86:952-60.
  • 10 Raybaud C. MR assessment of pediatric hydrocephalus: A road map. Childs Nerv Syst 2016;32:19-41.
  • 11 Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: A review. Fluids Barriers CNS 2012;9:18.
  • 12 Kutscher A, Nestler U, Bernhard MK, Merkenschlager A, Thome U, Kiess W, et al. Adult long-term health-related quality of life of congenital hydrocephalus patients. J Neurosurg Pediatr 2015;16:621-5.
  • 13 Zahl SM, Wester K. Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: What is the gain? A nationwide survey. Pediatrics 2008;121:e416-20.
  • 14 Wiig US, Zahl SM, Egge A, Helseth E, Wester K. Epidemiology of benign external hydrocephalus in Norway – A population-based study. Pediatr Neurol 2017;73:36-41.
  • 15 Naddawi MN, Hameed NN, Rasheed AA. Demographic and clinical presentations of pediatric hydrocephalus in medical city. Iraqi Acad Sci J 2011;10:139-44.
  • 16 Warf BC, East African Neurosurgical Research Collaboration. Pediatric hydrocephalus in East Africa: Prevalence, causes, treatments, and strategies for the future. World Neurosurg 2010;73:296-300.
  • 17 Wright Z, Larrew TW, Eskandari R. Pediatric hydrocephalus: Current state of diagnosis and treatment. Pediatr Rev 2016;37:478-90.
  • 18 McAllister JP 2nd, Chovan P. Neonatal hydrocephalus. Mechanisms and consequences. Neurosurg Clin N Am 1998;9:73-93.
  • 19 Wong TT, Liang ML, Chen HH, Chang FC. Hydrocephalus with brain tumors in children. Childs Nerv Syst 2011;27:1723-34.
  • 20 Ferras M, McCauley N, Stead T, Ganti L, Desai B. Ventriculoperitoneal shunts in the emergency department: A review. Cureus 2020;12:e6857.
  • 21 Lotfinia I. A review in pediatric hydrocephalus: Physiology, classification, clinical presentation, imaging and treatment. JSM Pediatr Neurol 2017;1:1002.
  • 22 Riva-Cambrin J, Shannon CN, Holubkov R, Whitehead WE, Kulkarni AV, Drake J, et al. Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage. J Neurosurg Pediatr 2012;9:473-81.
  • 23 Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr 2013;11:15-9.
  • 24 Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg 2017;52:381-400.
  • 25 Dewan MC, Naftel RP. The global rise of endoscopic third ventriculostomy with choroid plexus cauterization in pediatric hydrocephalus. Pediatr Neurosurg 2017;52:401-8.
  • 26 Pan IW, Harris DA, Luerssen TG, Lam SK. Comparative effectiveness of surgical treatments for pediatric hydrocephalus. Neurosurgery 2018;83:480-7.
  • 27 Sridhar K, Karmarkar V. Peroral extrusion of ventriculoperitoneal shunt: Case report and review of literature. Neurol India 2009;57:334-6.
  • 28 Vuyyuru S, Ravuri SR, Tandra VR, Panigrahi MK. Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal. J Pediatr Neurosci 2009;4:124-6.
  • 29 Bhatnagar V, George J, Mitra DK, Upadhyaya P. Complications of cerebrospinal fluid shunts. Indian J Pediatr 1983;50:133-8.
  • 30 Kumar R, Singh V, Kumar MV. Shunt revision in hydrocephalus. Indian J Pediatr 2005;72:843-7.
  • 31 Kestle JR, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 2011;8:22-9.
  • 32 McGirt MJ, Leveque JC, Wellons JC 3rd, Villavicencio AT, Hopkins JS, Fuchs HE, et al. Cerebrospinal fluid shunt survival and etiology of failures: A seven-year institutional experience. Pediatr Neurosurg 2002;36:248-55.
  • 33 Jenkinson MD, Gamble C, Hartley JC, Hickey H, Hughes D, Blundell M, et al. The British antibiotic and silver-impregnated catheters for ventriculoperitoneal shunts multi-centre randomised controlled trial (the BASICS trial): Study protocol. Trials 2014;15:4.
  • 34 Thomas R, Lee S, Patole S, Rao S. Antibiotic-impregnated catheters for the prevention of CSF shunt infections: A systematic review and meta-analysis. Br J Neurosurg 2012;26:175-84.
  • 35 Kao CL, Yang TF, Wong TT, Cheng LY, Huang SY, Chen HS, et al. The outcome of shunted hydrocephalic children. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64:47-53.
  • 36 Heinsbergen I, Rotteveel J, Roeleveld N, Grotenhuis A. Outcome in shunted hydrocephalic children. Eur J Paediatr Neurol 2002;6:99-107.
  • 37 Tuli S, Tuli J, Drake J, Spears J. Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg 2004;100:442-6.
  • 38 Lumenta CB, Skotarczak U. Long-term follow-up in 233 patients with congenital hydrocephalus. Childs Nerv Syst 1995;11:173-5.
  • 39 Kokkonen J, Serlo W, Saukkonen AL, Juolasmaa A. Long-term prognosis for children with shunted hydrocephalus. Childs Nerv Syst 1994;10:384-7.
  • 40 Heinsbergen I, Rotteveel J, Roeleveld N, Grotenhuis A. Outcome in shunted hydrocephalic children. Eur J Paediatr Neurol 2002;6:99-107.