Long-term outcome after treatment of hydrocephalus in children.
OBJECTIVE
To provide long-term outcome data after treatment of hydrocephalus in children, and to identify risk factors for ventriculoperitoneal shunt (VPS) failure.


METHODS
Endoscopic third ventriculostomy (ETV) and VPS procedures in children between 2001 and 2005 were reviewed. Data collected prospectively included age at surgery, sex, aetiology of hydrocephalus, gestational age, emergency/planned surgery, duration of surgery, time of day, surgeon's experience and other concomitant surgery. The mean follow-up was 4.7 years (min. 2 years). The endpoint was a new surgery due to failure of treatment, and the time to failure was noted. Risk factors for VPS failure were analysed by univariate Cox proportional hazards regression.


RESULTS
Ninety-eight patients were included, 76 with a VPS, 22 with an ETV. Fifty-five percent of ETV and 58% of VPS failed. Significant risk factors (p < 0.05) for VPS failure were prematurity (HR: 2.05; 95% CI: 1.12-3.76), concomitant procedure (HR: 2.07; 95% CI: 1.04-4.12) and long duration of surgery (HR: 1.23; 95% CI: 1.06-1.44), while sex, surgeon's experience, shunt type, at what department the surgery was performed, whether the surgery was acute or elective, and time of day were not.


CONCLUSIONS
Treatment failure occurred in >50% of patients after ETV and VPS. Prematurity and concomitant surgery were major risk factors for VPS failure.
Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Tobias
T
Appelgren
Sofia
S
Zetterstrand
Jörgen
J
Elfversson
Daniel
D
Nilsson
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D020542:Third Ventricle / Q000601:surgery; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data*; D014696:Ventriculostomy / Q000706:statistics & numerical data*