Analysis of Clinical Presentation and Surgical Outcomes of Shunt Surgery of Congenital Hydrocephalus
Authors/Creators
- 1. Professor and Director, CN Center, Gauhati Medical College & Hospital
- 2. MCh Senior Resident, Department of Neurosurgery, CN Center, Gauhati Medical College & Hospital
Description
Background: Congenital hydrocephalus, characterized by the abnormal accumulation of cerebrospinal fluid within the brain, presents a significant challenge in pediatric neurosurgery. Early intervention and proper management are vital for improving the clinical outcomes in affected infants. This study aimed to analyze the clinical presentations and surgical outcomes of shunt surgery in congenital hydrocephalus patients. Methods: A meticulous two-year analysis was conducted at the Department of Neurosurgery at Gauhati Medical College and Hospital, involving 50 patients who underwent shunt surgery. The parameters analyzed encompassed demographic details, clinical presentations, etiologies, and surgical outcomes. Results: The majority of the patients were aged between 2-4 months (50%) and had a male predominance (60%). Clinical presentations were marked by increased head circumference (90%), developmental delays (70%), and motor deficits (50%). Aqueductal stenosis (26%) and meningomyelocele (24%) emerged as the primary etiological factors. Ventriculoperitoneal shunt was the preferred surgical intervention, utilized in 70% of cases, with an 80% success rate involving the standard technique. The post-operative period witnessed a 52% complication rate, predominantly characterized by shunt obstruction (14%) and infection (12%). Encouragingly, 70% of the patients did not require revision surgeries, indicating initial surgical success. Conclusion: The study highlights the critical need for early detection and intervention in congenital hydrocephalus, emphasizing the significance of monitoring head circumference as a potential early indicator. The findings underscore the necessity for continued advancements in surgical techniques and post-operative care to further enhance the successful outcomes.
Abstract (English)
Background: Congenital hydrocephalus, characterized by the abnormal accumulation of cerebrospinal fluid within the brain, presents a significant challenge in pediatric neurosurgery. Early intervention and proper management are vital for improving the clinical outcomes in affected infants. This study aimed to analyze the clinical presentations and surgical outcomes of shunt surgery in congenital hydrocephalus patients. Methods: A meticulous two-year analysis was conducted at the Department of Neurosurgery at Gauhati Medical College and Hospital, involving 50 patients who underwent shunt surgery. The parameters analyzed encompassed demographic details, clinical presentations, etiologies, and surgical outcomes. Results: The majority of the patients were aged between 2-4 months (50%) and had a male predominance (60%). Clinical presentations were marked by increased head circumference (90%), developmental delays (70%), and motor deficits (50%). Aqueductal stenosis (26%) and meningomyelocele (24%) emerged as the primary etiological factors. Ventriculoperitoneal shunt was the preferred surgical intervention, utilized in 70% of cases, with an 80% success rate involving the standard technique. The post-operative period witnessed a 52% complication rate, predominantly characterized by shunt obstruction (14%) and infection (12%). Encouragingly, 70% of the patients did not require revision surgeries, indicating initial surgical success. Conclusion: The study highlights the critical need for early detection and intervention in congenital hydrocephalus, emphasizing the significance of monitoring head circumference as a potential early indicator. The findings underscore the necessity for continued advancements in surgical techniques and post-operative care to further enhance the successful outcomes.
Files
IJPCR,Vol15,Issue12,Article143.pdf
Files
(4.0 MB)
| Name | Size | Download all |
|---|---|---|
|
md5:17e4185fc4cc5abdbd2cdbbc0e77a03b
|
4.0 MB | Preview Download |
Additional details
Dates
- Accepted
-
2023-11-30
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue12,Article143.pdf
- Development Status
- Active
References
- 1. Rekate HL. A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics. Child's Nervous System. 2011; 27(10):1535-1541. 2. McAllister JP 2nd. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012; 17(5):285-294. 3. Youmans JR, Winn HR. Ventriculoperitoneal shunt. In: Youmans JR, Winn HR, eds. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2022:1410- 1418. 4. Jernigan SC, Berry JG, Graham DA, Goumnerova L. The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants. Journal of Neurosurgery: Pediatrics. 2014; 13(3):295- 300. 5. Kulkarni AV, Riva-Cambrin J, Butler J, et al. Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls: clinical article. Journal of Neurosurgery: Pediatrics. 2013; 12(4):334- 338. 6. O'Halloran PJ, Kaliaperumal C, Caird J. A review of the management of shunt infection and ventriculitis. Br J Neurosurg. 2012; 26(4):578-585. 7. Stone SS, Warf BC. Combined endoscopic third ventriculostomy and choroid plexus cauterization as primary treatment for infant hydrocephalus: a prospective North American series. Journal of Neurosurgery: Pediatrics. 2014; 14(5):439-446. 8. Warf BC. Comparison of endoscopic third ventriculostomy alone and combined with choroid plexus cauterization in infants younger than 1 year of age: a prospective study in 550 African children. Journal of Neurosurgery. 2005;103(6 Suppl):475-481. 9. Piatt JH, Carlson CV. A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. PediatrNeurosurg. 1993; 19(5):233-241. 10. Kestle J, Drake J, Milner R, et al. Long-term follow-up data from the Shunt Design Trial. PediatrNeurosurg. 2000; 33(5):230-236. 11. Sciubba DM, Stuart RM, McGirt MJ, et al. Effect of antibiotic-impregnated shunt catheters in decreasing the incidence of shunt infection in the treatment of hydrocephalus. J NeurosurgPediatr. 2005; 103(2):131-136. 12. Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS. 2012; 9(1):18. 13. Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014; 81(2):404-410. 14. Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children. Lancet. 2016; 387(10020):788-799. 15. Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014; 57(8):359-368. 16. Simon TD, Riva-Cambrin J, Srivastava R, et al. Hospital care for children with hydrocephalus in the United States: utilization, charges, comorbidities, and deaths. J NeurosurgPediatr. 2008; 1(2):131-137. 17. Wellons JC 3rd, Holubkov R, Browd SR, et al. The assessment of bulging fontanel and splitting of sutures in premature infants: an interrater reliability study by the Hydrocephalus Clinical Research Network. J NeurosurgPediatr. 2013; 11(1):12-14. 18. Rekate HL. A contemporary definition and classification of hydrocephalus. Semin Pediatr Neurol. 2009; 16(1):9-15. 19. Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J NeurosurgPediatr. 2011; 7(2):143-14620. Lacy M, Pyykkonen BA, Hunter SJ, Do T, Oliveira M, Austria E, Mottlow L. Cognitive outcomes and familial factors in the prediction of anomalies in children with a history of congenital hydrocephalus. J Pediatr Psychol. 2008; 33(4):368-378. 21. 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. 22. Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS. 2012; 9(1):18. 23. Oi S, Di Rocco C. Proposal of "evolution theory in cerebrospinal fluid dynamics" and minor pathway hydrocephalus in developing immature brain. Childs Nerv Syst. 2006; 22(7):662-669. 24. McAllister JP 2nd. Pathophysiology of congenital and neonatal hydrocephalus. Semin Fetal Neonatal Med. 2012; 17(5):285-294. 25. Engel M, Carmeliet P, De Zegher F, Claes A, Mildner R, Heimann G, Bielen H. Fetal hydrocephalus and situs inversus in DNA ciliaopathy due to mutations in the OFD1 gene: a case report and review of literature. Clin Case Rep. 2018; 6(8):1481-1486. 26. Drake JM, Kestle JR, Milner R, et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998; 43(2):294-303; discussion 303-305. 27. Vinchon M, Rekate H, Kulkarni AV. Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS. 2012; 9(1):18. 28. Kulkarni AV, Riva-Cambrin J, Holubkov R, et al. Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J NeurosurgPediatr. 2016; 18(4):423-429. 29. Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014; 81(2):404-410. 30. Kestle JR, Riva-Cambrin J, Wellons JC 3rd, et al. A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J NeurosurgPediatr. 2011; 8(1):22-29. 31. Kulkarni AV, Shams I. Quality of life in children with hydrocephalus: results from the Hospital for Sick Children, Toronto. J NeurosurgPediatr. 2007; 107(5):358-364.