Beschreibung
Purpose: Paediatric hydrocephalus is a result of cerebrospinal fluid circulatory dysfunction and has diverse pathogenesis. This study investigates the epidemiology of paediatric hydrocephalus and effects of aetiology and type of implants on complications to develop novel therapeutic approaches.
Methods: A retrospective analysis of 131 children < 18 years with hydrocephalus treated between 2013 and 2018 was conducted. Medical charts, operative reports, and clinical follow-up reports were reviewed. Statistical analysis was performed using t-test/ANOVA posthoc Bonferroni- test, Kruskal–Wallis test, and Mann–Whitney U test.
Results: The most common pathogenesis of hydrocephalus among our patients was meningomyelocele-associated (MMC) and post-haemorrhagic. The majority of patients received a programmable differential pressure valve (77.8%), or less often a fixed differential pressure valve with a gravitational unit (14.8%). 333 shunt-associated surgeries were performed. Thereby 220 were revision surgeries, 66% were performed because of mechanical shunt dysfunction (61%), infection (12%), or other reasons (27%). The median rate of revisions for each patient within 1 year was 0,38 ± 0,54 and was influenced by aetiology (p = 0.045) and the type of valve used (p = 0.029). The highest rates were seen in patients with post-haemorrhagic hydrocephalus and in those with fixed differential pressure valve with gravitational unit, whereas the lowest were observed in MMC-associated hydrocephalus and a programmable differential pressure valve. Mechanical dysfunction was associated with fixed differential pressure valve with gravitational unit (p = 0.014). The median time interval between initial shunt surgery and infections was shorter than that between initial shunt surgery and mechanical dysfunction (p = 0.033).
Conclusions: The present study identified several factors (age, etiology, type of implants) associated with the revision shunts in patients with paediatric hydrocephalus. By assessing the risk profiles of paediatric patients with hydrocephalus, unnecessary examinations or invasive procedures may be avoided and revisions surgeries may be prevented by using individual and specific shunt materials.
