Managing hydrocephalus in 54 infants under 3 months of age: A single center cohort study.

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
S R M Van Rijen, F Groenendaal, K S Han, M L Tataranno, P A Woerdeman
{"title":"Managing hydrocephalus in 54 infants under 3 months of age: A single center cohort study.","authors":"S R M Van Rijen, F Groenendaal, K S Han, M L Tataranno, P A Woerdeman","doi":"10.1007/s00381-025-06769-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Managing hydrocephalus in infants can be very challenging. The most used permanent hydrocephalus treatment in young patients is a ventriculoperitoneal shunt (VPS) placement. Obstructive hydrocephalus in selected young patients can be treated with endoscopic third ventriculostomy (ETV). However, in infants less than 6 months of age, the outcome of both procedures remains to be bothered with complications, revision surgeries and long-term shunt dependency. This retrospective study analyzes the management of hydrocephalus in 54 very young infants with different etiological causes.</p><p><strong>Methods: </strong>Data was collected retrospectively from a single center university hospital over a 5-year period (2018-2022). All patients under 3 months of age with progressive ventriculomegaly confirmed by cranial ultrasound (cUS), who required neurosurgical intervention, were eligible for this study. Hydrocephalus was treated with serial tapping from a ventricular access device (VAD), placement of ventriculoperitoneal shunts and/or performing a thulium laser-assisted ETV.</p><p><strong>Results: </strong>Twelve patients benefited sufficiently from a VAD to normalize ventricular volume lastingly. Forty-two patients required permanent treatment (28 underwent a VPS; 14 an ETV if there was obstructive hydrocephalus) at an average age of 2.5 months. The VPS failure rate was 32.1% and the ETV failure rate was 50%. Although not significantly different, patients with failed ETV tended to be younger than patients with successful ETV (p = 0.38). One week before permanent ETV treatment, relatively large ventricular volumes were measured in failed ETV patients, as compared to successful ETVs.</p><p><strong>Conclusions: </strong>Managing hydrocephalus in very young infants remains challenging regarding surgical strategy, reducing shunt dependency and decreasing current complication rates. In addition to a VPS, an ETV has shown to be a successful treatment option for hydrocephalus in well-selected very young infants. The opportunity to decrease ventricular volume with a VAD could have contributed to the success of an ETV in this young patient group.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"115"},"PeriodicalIF":1.3000,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836075/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child's Nervous System","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00381-025-06769-6","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: Managing hydrocephalus in infants can be very challenging. The most used permanent hydrocephalus treatment in young patients is a ventriculoperitoneal shunt (VPS) placement. Obstructive hydrocephalus in selected young patients can be treated with endoscopic third ventriculostomy (ETV). However, in infants less than 6 months of age, the outcome of both procedures remains to be bothered with complications, revision surgeries and long-term shunt dependency. This retrospective study analyzes the management of hydrocephalus in 54 very young infants with different etiological causes.

Methods: Data was collected retrospectively from a single center university hospital over a 5-year period (2018-2022). All patients under 3 months of age with progressive ventriculomegaly confirmed by cranial ultrasound (cUS), who required neurosurgical intervention, were eligible for this study. Hydrocephalus was treated with serial tapping from a ventricular access device (VAD), placement of ventriculoperitoneal shunts and/or performing a thulium laser-assisted ETV.

Results: Twelve patients benefited sufficiently from a VAD to normalize ventricular volume lastingly. Forty-two patients required permanent treatment (28 underwent a VPS; 14 an ETV if there was obstructive hydrocephalus) at an average age of 2.5 months. The VPS failure rate was 32.1% and the ETV failure rate was 50%. Although not significantly different, patients with failed ETV tended to be younger than patients with successful ETV (p = 0.38). One week before permanent ETV treatment, relatively large ventricular volumes were measured in failed ETV patients, as compared to successful ETVs.

Conclusions: Managing hydrocephalus in very young infants remains challenging regarding surgical strategy, reducing shunt dependency and decreasing current complication rates. In addition to a VPS, an ETV has shown to be a successful treatment option for hydrocephalus in well-selected very young infants. The opportunity to decrease ventricular volume with a VAD could have contributed to the success of an ETV in this young patient group.

54例3月龄以下婴儿脑积水的处理:一项单中心队列研究
目的:处理婴儿脑积水是非常具有挑战性的。年轻患者最常用的永久性脑积水治疗是脑室-腹膜分流术(VPS)放置。梗阻性脑积水患者可采用内镜下第三脑室造口术(ETV)治疗。然而,在6个月以下的婴儿中,这两种手术的结果仍然受到并发症、翻修手术和长期分流依赖的困扰。本文回顾性分析了54例不同病因的婴幼儿脑积水的处理方法。方法:回顾性收集某单中心大学医院5年(2018-2022年)的数据。所有年龄小于3个月且经颅超声(cUS)证实为进行性脑室肿大且需要神经外科干预的患者均符合本研究的条件。脑积水的治疗采用脑室通路装置(VAD)连续叩击、放置脑室-腹膜分流和/或进行铥激光辅助ETV。结果:12例患者从VAD中获得足够的益处,使心室容量持久正常化。42例患者需要永久性治疗(28例行VPS;14(如果有阻塞性脑积水),平均年龄为2.5个月。VPS失败率为32.1%,ETV失败率为50%。虽然没有显著差异,但ETV失败患者比ETV成功患者更年轻(p = 0.38)。在永久性ETV治疗前一周,与成功的ETV相比,失败的ETV患者的心室容积相对较大。结论:治疗非常年幼的婴儿脑积水在手术策略、减少分流依赖和降低当前并发症发生率方面仍然具有挑战性。除了VPS外,ETV已被证明是精心挑选的非常年幼的婴儿脑积水的成功治疗选择。在这个年轻的患者群体中,通过VAD减少心室容积的机会可能有助于ETV的成功。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Child's Nervous System
Child's Nervous System 医学-临床神经学
CiteScore
3.00
自引率
7.10%
发文量
322
审稿时长
3 months
期刊介绍: The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信