Complications of surgical treatment of hydrocephalus
Authors:
D. Dúbravová 1; M. Fuňáková 1; E. Valachovičová 1; D. Šandorová 1; M. Kabát 1; V. Matejčík 2; J. Trnka 1; F. Horn 1
Authors‘ workplace:
Klinika detskej chirurgie LFUK a DFNsP, Bratislavaprednosta doc. MUDr. J. Trnka, CSc.
1; Neurochirurgická klinika LFUK a UNB, Bratislavaprednosta prof. MUDr. J. Šteňo, CSc.
2
Published in:
Čes-slov Pediat 2014; 69 (2): 95-105.
Category:
Original Papers
Overview
Background:
Clinical outcome of children with hydrocephalus is determined by primary brain pathology and, nevertheless, by strategy of surgical treatment and subsequent complications. The aim of this study was to define the postoperative complication´s rate and its possible predictive factors.
Methods:
We studied a population of 280 patients and 739 surgical procedures performed at the Department of paediatric surgery, Bratislava, in the years 2005–2012. We assessed the complication rate of external, internal drainage and neuroendoscopy.
Results:
We observed a lower complication rate in patients with ventricular reservoir when compared to external ventricular drain (EVD) (3.2% versus 35% revision rate (p<0.001) and 11% versus 10.6 % infection rate (p=0.818) for reservoir and EVD respectively). Conversion to shunt or further neuroendoscopic procedure was needed in 77.3% patients. The EVDs were in situ for a mean time of 21.89 days, and the duration of EVD placement did not significantly influenced the infection rate (p=0.994).
Overall shunt complication rate was 50.4% (33.8% shunt revisions and 9.6% infection rate). Factors associated with higher complication rate were aetiology of hydrocephalus (p= 0.027) and age of child at the surgery <1 year (p=0.004). Overall success rate of endoscopic interventions (n=69) was 66.7%. Ventriculostomy (ETV) success rate was 58.5%. The positive predictive factors of successful ETV were age <1 year (p=0.001) and hydrocephalus without associated intraventricular cyst (p=0.043).
Conclusion:
Neonatal ventricular reservoir due to its lower complication rate seems to be optimal for initial treatment of posthaemorrhagic hydrocephalus. The overall complication rate for endoscopic interventions was significantly lower compared to shunts (p=0.017).
Key words:
hydrocephalus, surgical treatment, external drainage, shunt, neuroendoscopy
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Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2014 Issue 2
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