title: The long-term outlook for hydrocephalus in childhood. A ten-year cohort study of 155 patients.
abstract: Despite the fact that ventriculoperitoneal shunt insertion is the most commonly performed surgical operation in the pediatric neurosurgeon's repertoire, there is a surprising paucity of long-term outcome studies for these patients detailing either the complication rate over a predetermined time period or more importantly their intellectual outcome. The aims of this study, therefore, were to determine the 10-year outcome in a cohort of 155 children with shunted hydrocephalus, both in terms of the number and time sequence of shunt complications and also the long-term academic (schooling) outcome of these individuals. This was a cohort study of 155 hydrocephalic children who underwent first-time ventriculoperitoneal shunt insertion between the years 1978 and 1983, who were then followed up on an annual outpatient basis for a period of 10 years or until death. Their academic records and the surgical morbidity and mortality encountered over the 10-year study period were used as the main outcome measures. For those children surviving until schoolage, 59% were able to attend a normal school. The academic outlook for those children with hydrocephalus secondary to infection (postmeningitic) or intraventricular hemorrhage was less favorable with 52 and 60% requiring special schooling compared to those children with congenital hydrocephalus (29%; p = 0.036). 44% (68/155) of patients in this cohort did not require a shunt revision. The commonest reasons for shunt revision were blockage (49%) and infection (19%) which predominantly occurred within the first year of their original shunt procedure. Overall the infection rate was 12% (44/380 procedures). Furthermore an increased incidence of shunt infection was noted in those under 6 months old (p = 0.040). There was an 11 % mortality during the 10-year follow-up period for those with nontumor-related hydrocephalus.
authors.affiliation: Department of Neurosurgery, Hospital for Sick Children, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Casey
authors.forename: E J
authors.initials: EJ
authors.lastname: Kimmings
authors.forename: A D
authors.initials: AD
authors.lastname: Kleinlugtebeld
authors.forename: W A
authors.initials: WA
authors.lastname: Taylor
authors.forename: W F
authors.initials: WF
authors.lastname: Harkness
authors.forename: R D
authors.initials: RD
authors.lastname: Hayward
mesh_terms: D002543:Cerebral Hemorrhage / Q000209:etiology; D002648:Child; D015331:Cohort Studies; D004519:Education, Special; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects