title: Decreased head circumference in shunt-treated compared with healthy children.
abstract: OBJECTIVE
  In this study, the authors' goal was to compare head circumference in hydrocephalic children during the first 4 years of ventriculoperitoneal (VP) shunt treatment with data on healthy children and to investigate predictors of skull growth in children with a VP shunt.
  
  
  METHODS
  Children from western Sweden treated for hydrocephalus with an initial VP shunt insertion performed between 2001 and 2006 who were younger than 12 months of age at the time of surgery were included. Children with major brain malformations, craniofacial syndromes, large cysts, and tumors were excluded. Head circumference, weight, and height at 9 defined ages up to 4 years were obtained and compared with data from a reference population of 3650 healthy children using the standard deviation score (SDS). Predictors (length, weight, etiology of hydrocephalus, valve type, number of revisions, valve setting, number of adjustments, and time of first surgery) for head circumference SDS and changes in head circumference SDS from shunt insertion at 1 year to last measurement were analyzed using bivariate and multiple linear regression analysis.
  
  
  RESULTS
  Fifty children were included. The mean SDSs for head circumference in shunt-treated compared with healthy children were 1.95 ± 2.50 at shunt insertion (p < 0.001, n = 44), 0.38 ± 1.97 at 1 year (p = 0.27, n = 33), -0.96 ± 2.05 at 2 years (p = 0.046, n = 21), -1.39 ± 2.25 at 3 years (p = 0.026, n = 16), and 0.63 ± 3.34 at 4 years (p = 0.73, n = 4). Significant predictors for low head circumference SDS at 1 year of age were low weight (p = 0.002) and short height (p = 0.022) and at last measurement low weight (p < 0.0001), short height (p = 0.002), and 1-4 shunt revisions (p = 0.034). A significant predictor for change in head circumference SDS from shunt insertion to 1 year of age was the number of shunt valve revisions (p = 0.04) and at last measurement an etiology of intraventricular hemorrhage (p = 0.0058).
  
  
  CONCLUSIONS
  Shunt-treated children have smaller head circumferences at 2 and 3 years of age than healthy children. Low weight, short height, etiology of intraventricular hemorrhage, and frequent shunt valve revisions are predictors for decreased head circumference. Prospective, randomized studies comparing skull growth using fixed and adjustable pressure-regulated shunt valves and flow-regulated valves are needed.
authors.affiliation: Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg; and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nilsson
authors.forename: Johanna
authors.initials: J
authors.lastname: Svensson
authors.forename: Betül A
authors.initials: BA
authors.lastname: Korkmaz
authors.forename: Helena
authors.initials: H
authors.lastname: Nelvig
authors.forename: Magnus
authors.initials: M
authors.lastname: Tisell
mesh_terms: D016022:Case-Control Studies; D002508:Cephalometry; D002543:Cerebral Hemorrhage / Q000150:complications / Q000601:surgery; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D003398:Craniosynostoses / Q000209:etiology* / Q000601:surgery; D005260:Female; D006257:Head / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D012886:Skull / Q000473:pathology* / Q000601:surgery*; D013548:Sweden; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000295:instrumentation