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Zhou F, Yang Z, Tang Z, Zhang Y, Wang H, Sun G, Zhang R, Jiang Y, Zhou C, Hou X, Liu L. Outcomes and prognostic factors of infantile acquired hydrocephalus: a single-center experience. BMC Pediatr 2023; 23:260. [PMID: 37226122 DOI: 10.1186/s12887-023-04034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
AIM To assess the etiologies and adverse outcomes of infantile acquired hydrocephalus and predict prognosis. METHODS A total of 129 infants diagnosed with acquired hydrocephalus were recruited from 2008 to 2021. Adverse outcomes included death and significant neurodevelopmental impairment which was defined as Bayley Scales of Infant and Toddler Development III score < 70, cerebral palsy, visual or hearing impairment, and epilepsy. Chi-squared was used to evaluate the prognostic factors of adverse outcomes. A receiver operating characteristic curve was calculated to determine the cutoff value. RESULTS Of 113 patients with outcome data, 55 patients (48.7%) had adverse outcomes. Late surgical intervention time (13 days) and severe ventricular dilation were associated with adverse outcomes. The combination of surgical intervention time and cranial ultrasonography (cUS) indices was a better predictive marker compared with any of them (surgical intervention time, P = 0.05; cUS indices, P = 0.002). Post-hemorrhage (54/113, 48%), post-meningitis (28/113, 25%), and hydrocephalus arising from both hemorrhage and meningitis (17/113, 15%) accounted for a large proportion of the etiologies in our study. Hydrocephalus occurs secondary to post-hemorrhage and had a favorable outcome compared with other etiologies in both preterm and term groups. A significant difference in adverse outcomes between the inherited error of metabolism as a cause and other etiologies (P = 0.02). CONCLUSION Late surgical treatment times and severe ventricular dilation can predict adverse outcomes in infants with acquired hydrocephalus. It is crucial to identify the causes of acquired hydrocephalus to predict the adverse outcomes. Research into measures of improving adverse outcomes following infantile acquired hydrocephalus is urgently necessary.
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Affiliation(s)
- Faliang Zhou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Zhao Yang
- Office of Academic Research, Peking University First Hospital, Beijing, China
| | - Zezhong Tang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Yang Zhang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Hongmei Wang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Guoyu Sun
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Rui Zhang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Yi Jiang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Congle Zhou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Xinlin Hou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Lili Liu
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China.
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Caudron Y, Beccaria K, Bourgeois M, Benichi S, Guida L, James S, Paternoster G, Blauwblomme T. Infantile hydrocephalus: a retrospective cohort of 467 patients from a single center. Neurochirurgie 2022; 68:373-378. [DOI: 10.1016/j.neuchi.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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Long-term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients. Childs Nerv Syst 2022; 38:1885-1894. [PMID: 35790573 PMCID: PMC9522746 DOI: 10.1007/s00381-022-05590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting are well-established treatments of obstructive hydrocephalus (HCP) in adult and pediatric patients. However, there is a lack of data with regard to the quality of life (QoL) of these patients during long-term follow-up METHODS: Inclusion criteria were pediatric patients with endoscopic treatment of hydrocephalus at the University Medicine Greifswald between 1993 and 2016. Patients older than 14 years at present were assessed with the Short Form-12 (SF-12) questionnaire. Patients younger than 14 years of age were assessed with the KINDL-R questionnaire that was completed by their parents. Patients' values were compared with the scores of a corresponding age-matched group of the healthy population and with patients who received later shunt treatment. Information about comorbidities, current symptoms, and educational level were gained by an additional part. Comparative analysis between patients with ETV success and failure (defined as shunt implantation after ETV) was performed. RESULTS A total of 107 patients (53 m, 54f) were included. Fifty-seven/107 patients (53.3%) were considered as ETV success. Mean age at ETV was 6.9 ± 5.9 years. Fifty-four statements of 89 patients that are still alive were gained (response rate 63%). Of these, 49 questionnaires were complete and evaluable (23 m, 26f; mean age 19.8 ± 10.0 years with an average follow-up period of 13.7 ± 7.2 years). Twenty-six/49 patients (53.1%) are considered ETV success. No statistically significant differences could be obtained between patients with ETV success and ETV failure. Patients older 14 years show QoL within normal range, patients younger than 14 years show significantly lower result regarding their environment of peers and social contacts. Patients younger than 6 months at the time of ETV and patients with posthemorrhagic HCP show significantly lower physical QoL. Gait disturbance, fatigue, and seizures are associated with a lower QoL, and educational level is lower than in the normal population. CONCLUSIONS Patients who underwent ETV in childhood do not have a lower health-related QoL in general. Subsequent insertions of ventriculoperitoneal (vp) shunts do not lower QoL. Certain subgroups of the patients show lower results compared to the healthy population.
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TULLY HANNAHM, DOHERTY DAN, WAINWRIGHT MARK. Mortality in pediatric hydrocephalus. Dev Med Child Neurol 2022; 64:112-117. [PMID: 34268734 PMCID: PMC8671148 DOI: 10.1111/dmcn.14975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
AIM To clarify the extent to which medical comorbidities and goals-of-care decisions influence death among individuals with childhood-onset hydrocephalus. METHOD This was a retrospective cohort study of 1705 individuals (759 males, 946 females, mean age 11y 5mo, SD 6y 6mo, range 0-37y 7mo at last follow-up) with childhood-onset hydrocephalus, of whom 88 (5.2%) were deceased. Existing medical records, death records, and publicly available internet sources were analyzed. We estimated hazard ratios for putative risk factors through Cox regression based upon 10 529 person-years of data and quantitatively and qualitatively analyzed the circumstances surrounding each death. RESULTS Mortality did not differ statistically by demographic factors, although higher proportions of non-White and Hispanic individuals were deceased. Most deaths were related to medical comorbidities rather than hydrocephalus itself. Of the 14 deaths directly related to hydrocephalus, seven were caused by shunt complications and four occurred after decisions to forgo treatment, apparently in response to poor outcomes predicted by the medical team. Half the deaths were preceded by shifts to comfort-based care; however, these decisions appeared to substantially change the patient's clinical trajectory only half the time. INTERPRETATION Children are more likely to die with, rather than from, hydrocephalus. Our results emphasize the complexities of medical decision-making and the influence of clinicians in guiding these choices.
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Affiliation(s)
- HANNAH M TULLY
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA,Department of Neurology, University of Washington, Seattle, WA,Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, WA
| | - DAN DOHERTY
- Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, WA,Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA, USA
| | - MARK WAINWRIGHT
- Division of Pediatric Neurology, Seattle Children’s Hospital, Seattle, WA,Department of Neurology, University of Washington, Seattle, WA,Center for Integrated Brain Research, Seattle Children’s Research Institute, Seattle, WA
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Abstract
BACKGROUND Despite advances in hydrocephalus shunt technology and improvement in hydrocephalus management, many patients have chronic disability and require multiple surgeries throughout their lifetime. There is limited data from patients' perspective regarding the impact of shunt devices on quality-of-life. METHODS A cross-sectional survey was developed to evaluate the impact of shunt devices on patient quality-of-life. The survey was distributed via social media platforms of the Hydrocephalus Association, and patients self-selected to anonymously complete the online questionnaire. A literature review was performed to contextualize the findings from the survey. RESULTS A total of 562 survey responses were obtained from a network encompassing 35,000 members. The mean age was 30 years old (0.5-87), and 65% identified as female. Eighty one percent underwent at least 1 shunt revision surgery, with a reported average of 10 shunt revision surgeries per patient (1-200 surgeries). Occlusion, shunt migration and infection were the leading causes for revision at 60%, 47%, and 35%, respectively. In addition, 72% of patients reported pain and discomfort from the device, and 68% expressed avoidance of certain activities due to "fear of bumping shunt." Despite numerous articles discussing shunt technology, a review of the literature indicated a paucity of studies specifically evaluating the burden of shunt devices from a patient/caregiver perspective. CONCLUSIONS The findings from this study suggest long-term physical and psychosocial burden associated with shunt devices. Importantly, this study highlights the need for concerted efforts to develop validated tools to study patient reported outcomes as it relates to neurocranial implanted devices.
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Gmeiner M, Wagner H, Schlögl C, van Ouwerkerk WJ, Senker W, Sardi G, Rauch P, Holl K, Gruber A. Adult Outcome in Shunted Pediatric Hydrocephalus: Long-Term Functional, Social, and Neurocognitive Results. World Neurosurg 2019; 132:e314-e323. [DOI: 10.1016/j.wneu.2019.08.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
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Krishnan SR, Ray TR, Ayer AB, Ma Y, Gutruf P, Lee K, Lee JY, Wei C, Feng X, Ng B, Abecassis ZA, Murthy N, Stankiewicz I, Freudman J, Stillman J, Kim N, Young G, Goudeseune C, Ciraldo J, Tate M, Huang Y, Potts M, Rogers JA. Epidermal electronics for noninvasive, wireless, quantitative assessment of ventricular shunt function in patients with hydrocephalus. Sci Transl Med 2019; 10:10/465/eaat8437. [PMID: 30381410 DOI: 10.1126/scitranslmed.aat8437] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/11/2018] [Indexed: 12/30/2022]
Abstract
Hydrocephalus is a common and costly neurological condition caused by the overproduction and/or impaired resorption of cerebrospinal fluid (CSF). The current standard of care, ventricular catheters (shunts), is prone to failure, which can result in nonspecific symptoms such as headaches, dizziness, and nausea. Current diagnostic tools for shunt failure such as computed tomography (CT), magnetic resonance imaging (MRI), radionuclide shunt patency studies (RSPSs), and ice pack-mediated thermodilution have disadvantages including high cost, poor accuracy, inconvenience, and safety concerns. Here, we developed and tested a noninvasive, skin-mounted, wearable measurement platform that incorporates arrays of thermal sensors and actuators for precise, continuous, or intermittent measurements of flow through subdermal shunts, without the drawbacks of other methods. Systematic theoretical and experimental benchtop studies demonstrate high performance across a range of practical operating conditions. Advanced electronics designs serve as the basis of a wireless embodiment for continuous monitoring based on rechargeable batteries and data transmission using Bluetooth protocols. Clinical studies involving five patients validate the sensor's ability to detect the presence of CSF flow (P = 0.012) and further distinguish between baseline flow, diminished flow, and distal shunt failure. Last, we demonstrate processing algorithms to translate measured data into quantitative flow rate. The sensor designs, fabrication schemes, wireless architectures, and patient trials reported here represent an advance in hydrocephalus diagnostics with ability to visualize flow in a simple, user-friendly mode, accessible to the physician and patient alike.
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Affiliation(s)
- Siddharth R Krishnan
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Tyler R Ray
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Amit B Ayer
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yinji Ma
- AML, Department of Engineering Mechanics, Interdisciplinary Research Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Philipp Gutruf
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - KunHyuck Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Chen Wei
- Departments of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xue Feng
- AML, Department of Engineering Mechanics, Interdisciplinary Research Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Barry Ng
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Zachary A Abecassis
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Nikhil Murthy
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Izabela Stankiewicz
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Juliet Freudman
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Julia Stillman
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Natalie Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Grace Young
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Camille Goudeseune
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - John Ciraldo
- Northwestern University Micro/Nano Fabrication Facility (NUFAB), Northwestern University, Evanston, IL 60208, USA
| | - Matthew Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Departments of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Matthew Potts
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. .,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John A Rogers
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA. .,Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
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Eloqayli H, Alyousef A. Infantile Hydrocephalus: Health-Related Quality of Life Outcome following Ventriculoperitoneal Shunt. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims:
To investigate the impact of Ventriculo-Peritoneal Shunt (VPS) on the Health-Related Quality of Life (HRQOL) of children with the infantile hydrocephalus who underwent their first shunt insertion in the first year of life. To compare the outcome of health domains according to sex, follow-up period, etiology and shunt valve type (fixed versus programmable pressure).
Methods:
102 children ≤1 years old at the time of new-onset hydrocephalus and shunt insertion. Age-appropriate PedsQL 4.0 versions were completed by the parents or caregivers with the assistance of single neurosurgery resident. Patients were divided into subgroups according to etiology; neural tube defect associated hydrocephalus (NTD-H), intra-ventricular hemorrhage associated with infantile hydrocephalus (IVH-H) and according to the shunt valve type; fixed versus programmable. Statistical analyses were performed using SPSS, IBM version 20. PedsQL 4.0 was presented using mean and standard deviations.
Results:
A decreasing social domain score at 1-3 years follow up (n=61) compared to 1 year follow up (n=41) was observed. The two groups did not differ significantly in sex distribution. The mean cognitive score was significantly lower in patients with IVH-H of prematurity compared to NTD-H. Better physical and cognitive domains in programmable shunts were compared to fixed pressure type.
Conclusion:
IVH-H associated with worse cognitive function possibly due to associated brain damage was reported. With long-term follow-up, social function decline probably due to the patients’ awareness of their disability was observed. Programmable shunt valve is recommended over fixed type due to the improvement in physical and cognitive functions. Sex of the patients did not affect the outcome.
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Gigi M, Roth J, Eshel R, Constantini S, Bassan H. Health-related quality of life after post-haemorrhagic hydrocephalus in children born preterm. Dev Med Child Neurol 2019; 61:343-349. [PMID: 30187913 DOI: 10.1111/dmcn.14012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine the health-related quality of life (HRQoL) of children born preterm (gestational age <32wks) after post-haemorrhagic hydrocephalus requiring shunt (PHH-S), and to examine the impact of perinatal and neurological morbidity on their QoL. METHOD Forty infants (18 females, 22 males; aged 2y 2mo-8y 4.5mo) born preterm with PHH-S were matched for gestational age, birthweight, and sex with infants born preterm with normal cranial ultrasonography. Pediatric QoL Inventory parent-proxy report was administered at a mean age of 5 years 8 months. RESULTS Children with PHH-S exhibited significantly lower mean HRQoL compared with controls in motor (36 [SD 34.9] vs 96.2 [SD 6.6]), emotional (59.8 [SD 26.7] vs 80.6 [SD 18.8]), social (55.6 [SD 29.7] vs 89.6 [SD 16.6]), and school (40.5 [SD 22.9] vs 89.7 [SD 15.2]) domains (p<0.001). Multivariate regression incorporating neonatal risk factors revealed an independent effect of parenchymal brain involvement (β=-0.6, p<0.01) and neonatal seizures (β=-0.2, p<0.02) on total HRQoL. Low HRQoL of children with PHH-S was associated with neurodevelopmental morbidities: cerebral palsy (CP), epilepsy, vision and feeding problems, low cognitive, personal-social, and adaptive scores (p<0.05). Multivariate analysis indicated an independent contribution from severe CP (β=-0.4, p<0.001) and low personal-social score (β=0.5, p<0.001). INTERPRETATION Children born preterm after PHH-S exhibit significantly lower HRQoL scores compared with preterm born peers. HRQoL is associated with neonatal cerebral complications and neurodevelopmental morbidities. WHAT THIS PAPER ADDS Children born preterm, after post-haemorrhagic hydrocephalus requiring shunt, have low health-related quality of life (HRQoL). A low HRQoL is associated with parenchymal brain involvement and with neurological morbidity. Severe cerebral palsy and low personal-social developmental scores have independent contributions to HRQoL.
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Affiliation(s)
- Moran Gigi
- Pediatric Neurology and Development Center, Assaf Harofe - Shamir Medical Center, Zerifin, Israel
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rina Eshel
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Haim Bassan
- Pediatric Neurology and Development Center, Assaf Harofe - Shamir Medical Center, Zerifin, Israel
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Prakash P, Dhandapani M, Ghai S, Singh NV, Dhandapani S. Quality of Life Among Children Who Had Undergone Ventriculoperitoneal Shunt Surgery. J Pediatr Neurosci 2018; 13:189-194. [PMID: 30090133 PMCID: PMC6057189 DOI: 10.4103/jpn.jpn_118_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunting is the most common neurosurgical treatment for hydrocephalus. In spite of significant developments in the technology and design of shunt systems, shunt surgery is still associated with morbidity. AIM To identify the problems faced by children on VP shunt and assess their quality of life (QOL). SETTING AND DESIGN A cross-sectional exploratory study. MATERIALS AND METHODS A total of 31 children on VP shunt were selected through consecutive sampling technique, and hydrocephalus outcome questionnaire was used to collect the data, with the converted metric score ranging from 0 to 1. Hydrocephalus due to stroke, hemorrhage, and malignant tumors was excluded. RESULTS The mean age of patients was 11.51 ± 4.26 years. Headache and generalized pain were the common problems experienced (42%). The mean score of QOL was 0.67 ± 0.21. Among the three domains, cognitive domain was the most affected. Among the clinicoradiological factors, multiple surgeries (P = 0.02) had the most significant impact on QOL. CONCLUSION Children who underwent VP shunt face various health-related problems in different domains and low QOL. Although cognitive domain was the most affected, multiple surgeries had the most significant impact on QOL. Appropriately focused interventions and holistic management are essential to improve the QOL of children undergoing VP shunt.
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Affiliation(s)
- Priyanka Prakash
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Manju Dhandapani
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Neena V. Singh
- National Institute of Nursing Education (NINE), Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bock HC, Kanzler M, Thomale UW, Ludwig HC. Implementing a digital real-time Hydrocephalus and Shunt Registry to evaluate contemporary pattern of care and surgical outcome in pediatric hydrocephalus. Childs Nerv Syst 2018; 34:457-464. [PMID: 29124391 DOI: 10.1007/s00381-017-3654-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/01/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Treatment monitoring and outcome evaluation in pediatric hydrocephalus require gapless documentation regarding surgical and clinical follow-up data beginning from day 1 of treatment in order to apply high quality of care. Endoscopic procedures, shunt insertion and revision surgeries, and individual modifications of valve hardware or pressure settings during follow-up as well as established outcome measurements are highly relevant for complete illustration of the patient's hydrocephalus histories. A digital tool to capture, organize, and analyze comprehensive treatment-related data was estimated long overdue, consequentially developed, and implemented in daily pediatric neurosurgical routine. METHODS We established a self-contained, network-capable database application to supply and back up clinical information of complete surgical treatment history with implant status and follow up for all institutional pediatric hydrocephalus patients from 1995 to date. The application content has been prospectively complemented since 2012 during daily pediatric neurosurgical routine. Beside surgical data, neurological outcome and quality of life assessment were integrated according to validated scales to be recordable 2, 3, and 5 years after initial surgical intervention for prospective administration. The application is in continuous and problem-free use since implementation offering homogeneous and structured real-time information of surgical and corresponding neurological hydrocephalus-related data. By using an automatized data extraction tool, an exemplary surgical outcome evaluation reviewing institutional ventriculo-peritoneal shunt (VPS) treatment in infants over a period of more than 20 years was performed. To validate applicability, the Registry was successfully implemented in an external institution under identical conditions continuously serving for the same purpose until today. RESULTS Upon completion of the developing process, the application was successfully implemented into routine clinical workflow of our institution. In total, 579 pediatric hydrocephalus patients entered into the Registry with collectively 1874 corresponding hydrocephalus-related surgeries (9% neuro-endoscopic procedures, 18% temporary CSF-diversions, 73% shunt surgeries) so far. For exemplary surgical outcome analysis, the total volume of complex data sets could easily be reduced stepwise in regard to requested inclusion criteria. The selection process generated conclusive data of 256 institutional pediatric VPS patients providing a median follow-up of 8.5 years. Surgical outcome was evaluated in regard to hydrocephalus etiology, applied valve design, valve augmentation, cause of initial malfunction, time to initial shunt revision, and number of total revisions. CONCLUSION The pediatric hydrocephalus registry application delivers easy access to contemporary and up-to-date clinical information during daily clinical routine and proves comprehensive value for various scientific purposes. Institutional hydrocephalus etiologies, treatment modalities, and surgical outcome could be reviewed for a selected pediatric patient collective during an interval of more than 20 years and confirmed initial shunt treatment within the first year of age, communicating hydrocephalus and a history of prematurity as significant variables for unfavorable shunt survival and long-term revision rate. At our institution, the Registry emerged to an essential and sustainable tool to capture, organize, and analyze patterns of care in pediatric hydrocephalus patients of all etiologies and treatment modalities. Because of its adaptable and reliable predicate, a prospective multi-center utilization is currently in preparation.
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Affiliation(s)
- Hans Christoph Bock
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. .,Abteilung Neurochirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. .,Pediatric Neurosurgery, Charité University Medical Center Berlin, Augustenburger Platz 1, 13533, Berlin, Germany.
| | - Maximilian Kanzler
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité University Medical Center Berlin, Augustenburger Platz 1, 13533, Berlin, Germany
| | - Hans Christoph Ludwig
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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12
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Iglesias S, Ros B, Martín Á, Carrasco A, Rius F, Arráez MÁ. Functional outcome in pediatric hydrocephalus: results of applying the Spanish version of the Hydrocephalus Outcome Questionnaire. J Neurosurg Pediatr 2018; 21:224-235. [PMID: 29303455 DOI: 10.3171/2017.8.peds16700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aims of the study were to assess whether the Spanish version of the Hydrocephalus Outcome Questionnaire (HOQ) could be useful for the evaluation and comparison of outcomes in the patients in the authors' region with those in patients in other institutions and to analyze predictors of functional outcome in patients with a shunt. METHODS The authors performed this cross-sectional study between March 2015 and April 2016. All the parents of a pediatric patient with hydrocephalus who attended the Hospital Regional Universitario de Málaga neurosurgery outpatient clinic were invited to enroll in the study and complete the HOQ-Spanish version. Age at diagnosis and at the time of the study, clinical data, shunt complications, and socioeconomic factors were also recorded. A descriptive analysis was performed, and independent variables related to the HOQ scores were studied. RESULTS A total of 132 patients participated in the study (100% participation rate). The mean ages were 16.74 months (range 0-142 months) at diagnosis and 10.45 years (range 5-16 years) at the time of the study. The mean overall HOQ score was 0.68 (on a scale from 0 [worse] to 1.0 [best]). Factors related to a worse quality of life were seizures, motor or visual impairment, shunt infection, need for shunt revision, need for more than 2 shunt revisions (range 0-8 revisions), symptomatic overdrainage, and older age at the time of the study. CONCLUSIONS The HOQ-Spanish version is useful in the authors' region; the dimension scores found in this study were comparable to those previously reported by referral centers. Future goals should be to prevent shunt complications, routinely get children to reach functional status, and refer patients for adjuvant therapy promptly.
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Affiliation(s)
- Sara Iglesias
- 1Neurosurgery Department, Hospital Regional Universitario de Málaga; and
| | - Bienvenido Ros
- 1Neurosurgery Department, Hospital Regional Universitario de Málaga; and
| | - Álvaro Martín
- 1Neurosurgery Department, Hospital Regional Universitario de Málaga; and
| | - Antonio Carrasco
- 1Neurosurgery Department, Hospital Regional Universitario de Málaga; and
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Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
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Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ. Rate and Risk Factors for Shunt Revision in Pediatric Patients with Hydrocephalus—A Population-Based Study. World Neurosurg 2017; 101:615-622. [DOI: 10.1016/j.wneu.2017.02.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
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Khan SA, Khan MF, Bakhshi SK, Irfan O, Khan HAR, Abbas A, Awan S, Bari ME. Quality of Life in Individuals Surgically Treated for Congenital Hydrocephalus During Infancy: A Single-Institution Experience. World Neurosurg 2017; 101:247-253. [PMID: 28179172 DOI: 10.1016/j.wneu.2017.01.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 01/22/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country. METHODS This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at <1 year old and underwent surgery for primary CH. The Hydrocephalus Outcome Questionnaire was used to assess outcomes with respect to QOL. RESULTS Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age <6 months at the time of first surgery was a poor predictor of overall health on the Hydrocephalus Outcome Questionnaire (P = 0.039). CONCLUSIONS In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH.
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Affiliation(s)
- Saad Akhtar Khan
- Department of Neurosurgery, Memon Medical Institute Hospital, Karachi, Pakistan; Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Faheem Khan
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Omar Irfan
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Asad Abbas
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ehsan Bari
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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