Shunt independence in pediatric hydrocephalus

2019 ◽  
Vol 35 (11) ◽  
pp. 2035-2036
Author(s):  
Negin Naderian ◽  
Zohreh Habibi ◽  
Farideh Nejat
Keyword(s):  
Pediatric Hydrocephalus ◽  
Shunt Independence

Anxiety, depression, fatigue, and headache burden in the pediatric hydrocephalus population

2020 ◽  
Vol 26 (5) ◽  
pp. 483-489 ◽  
Author(s):  
Kathrin Zimmerman ◽  
Bobby May ◽  
Katherine Barnes ◽  
Anastasia Arynchyna ◽  
Elizabeth N. Alford ◽  
...  
Keyword(s):  
General Population ◽  
Emotional Health ◽  
Chronic Medical Condition ◽  
Measurement Information ◽  
Burden Of Headache ◽  
Pediatric Hydrocephalus ◽  
Patient Reported ◽  
The Mean ◽  
Moderate Range ◽  
Anxiety Depression

OBJECTIVEChildhood hydrocephalus is a common chronic medical condition. However, little is known about the burden of headache and psychological comorbidities in children living with hydrocephalus. The purpose of this study was to determine the prevalence and severity of these conditions among the pediatric hydrocephalus population.METHODSDuring routine neurosurgery clinic visits from July 2017 to February 2018, the authors administered four surveys to children ages 7 years and older: Pediatric Migraine Disability Assessment (PedMIDAS), Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, PROMIS Depression, and PROMIS Fatigue. The PedMIDAS is an assessment of headache disability in pediatric and adolescent patients. The PROMIS measures are pediatric self-reported instruments to assess social and emotional health. PROMIS measures utilize T-scores (mean 50, SD 10) to compare anxiety, depression, and fatigue in specific populations to those in the US general population. Clinical and demographic data were collected from the medical record (hydrocephalus etiology, shunt infection, race, etc.) and tested for associations with survey measure scores.RESULTSForty children completed the PedMIDAS. Ten percent of them were in the severe headache range, 5% were in the moderate range, and 5% were in the mild range. There was a statistically significant association between undergoing a cluster of shunt operations and headache burden (p = 0.003).Forty children completed all three PROMIS measures. The mean anxiety score was 45.8 (SD 11.7), and 2.5% of children scored in the severe anxiety range, 17.5% in the moderate range, and 20% in the mild range. The mean depression score was 42.7 (SD 10.0), with 2.5% of children scoring in the severe depression range, 5% in the moderate range, and 12.5% in the mild range. The mean fatigue score was 45.1 (SD 16.4), with 15% percent of children scoring in the severe fatigue range, 10% in the moderate range, and 7.5% in the mild range. There were no statistically significant associations between child anxiety, depression, or fatigue and clinical or demographic variables.CONCLUSIONSChildren with hydrocephalus have an average burden of headache, anxiety, depression, and fatigue as compared to the general population overall. Having a cluster of shunt operations correlates with a higher headache burden, but no clinical or demographic variable is associated with anxiety, depression, or fatigue.

Temporal trends in surgical procedures for pediatric hydrocephalus: an analysis of the Hydrocephalus Clinical Research Network Core Data Project

2020 ◽  
pp. 1-8
Author(s):  
Mandeep S. Tamber ◽  
John R. W. Kestle ◽  
Ron W. Reeder ◽  
Richard Holubkov ◽  
Jessica Alvey ◽  
...  
Keyword(s):  
Clinical Research ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Research Network ◽  
Third Ventriculostomy ◽  
Study Cohort ◽  
Core Data ◽  
Pediatric Hydrocephalus ◽  
Short Period ◽  
New Procedures

OBJECTIVEAnalysis of temporal trends in patient populations and procedure types may provide important information regarding the evolution of hydrocephalus treatment. The purpose of this study was to use the Hydrocephalus Clinical Research Network’s Core Data Project to identify meaningful trends in patient characteristics and the surgical management of pediatric hydrocephalus over a 9-year period.METHODSThe Core Data Project prospectively collected patient and procedural data on the study cohort from 9 centers between 2008 and 2016. Logistic and Poisson regression were used to test for significant temporal trends in patient characteristics and new and revision hydrocephalus procedures.RESULTSThe authors analyzed 10,149 procedures in 5541 patients. New procedures for hydrocephalus (shunt or endoscopic third ventriculostomy [ETV]) decreased by 1.5%/year (95% CI −3.1%, +0.1%). During the study period, new shunt insertions decreased by 6.5%/year (95% CI −8.3%, −4.6%), whereas new ETV procedures increased by 12.5%/year (95% CI 9.3%, 15.7%). Revision procedures for hydrocephalus (shunt or ETV) decreased by 4.2%/year (95% CI −5.2%, −3.1%), driven largely by a decrease of 5.7%/year in shunt revisions (95% CI −6.8%, −4.6%). Concomitant with the observed increase in new ETV procedures was an increase in ETV revisions (13.4%/year, 95% CI 9.6%, 17.2%). Because revisions decreased at a faster rate than new procedures, the Revision Quotient (ratio of revisions to new procedures) for the Network decreased significantly over the study period (p = 0.0363). No temporal change was observed in the age or etiology characteristics of the cohort, although the proportion of patients with one or more complex chronic conditions significantly increased over time (p = 0.0007).CONCLUSIONSOver a relatively short period, important changes in hydrocephalus care have been observed. A significant temporal decrease in revision procedures amid the backdrop of a more modest change in new procedures appears to be the most notable finding and may be indicative of an improvement in the quality of surgical care for pediatric hydrocephalus. Further studies will be directed at elucidation of the possible drivers of the observed trends.

THE SURGICAL MANAGEMENT OF PEDIATRIC HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_2) ◽  
pp. SHC633-SHC642 ◽  
Author(s):  
James M. Drake
Keyword(s):  
Surgical Management ◽  
Computer Models ◽  
Future Directions ◽  
Complex Disorders ◽  
Computed Tomographic ◽  
Pediatric Hydrocephalus ◽  
Past Generation ◽  
Current State ◽  
Technological Advances ◽  
Hydrocephalus Treatment

Abstract THE SURGICAL MANAGEMENT of hydrocephalus has undergone incredible changes over the past generation of neurosurgeons, including dramatic improvements in imaging, especially computed tomographic scanning and magnetic resonance imaging, and remarkably innovative advances in cerebrospinal fluid valve technology, complex computer models, and endoscopic equipment and techniques. In terms of overall patient outcomes, however, one could conclude that things are a little better, but “not much.” This frustrating yet fascinating dichotomy between technological advancements and clinical outcomes makes hydrocephalus, first described by the ancients, as one of the most understated and complex disorders that neurosurgeons treat. The challenge to the next generation of neurosurgeons is to solve this vexing problem through better understanding of the basic science, improved computer models, additional technological advances, and, most importantly, a broad-based, concerted multidisciplinary attack on this disorder. This review focuses on the evolution of surgery for hydrocephalus over the last 30 years, the current state of the art of hydrocephalus treatment, and what appear to be the most promising future directions.

scholarly journals P.028 Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

2017 ◽  
Vol 44 (S2) ◽  
pp. S20-S20
Author(s):  
S Wang ◽  
RT Muir ◽  
BC Warf
Keyword(s):  
Low Income ◽  
Developing World ◽  
Pediatric Neurosurgery ◽  
Cost Effective ◽  
Global Surgery ◽  
Low Income Countries ◽  
Global Burden ◽  
Pediatric Hydrocephalus ◽  
Cost Effective Treatment ◽  
Education Gaps

Background: Pediatric hydrocephalus is one of the most common neurosurgical conditions and is a major contributor to the global burden of surgically treatable diseases. Methods: The authors conducted a literature review around the topic of pediatric hydrocephalus in the context of global surgery, the unique challenges to creating access to care in low-income countries, and current international efforts to address the problem. Results: Developing countries face the greatest burden of pediatric hydrocephalus due to high birth rates and greater risk of neonatal infections. This burden is related to more general global health challenges, including malnutrition, infectious diseases, maternal and perinatal risk factors, and education gaps. Unique challenges pertaining to the treatment of hydrocephalus in the developing world include a preponderance of postinfectious hydrocephalus, limited resources, and restricted access to neurosurgical care. In the 21st century, several organizations have established programs that provide hydrocephalus treatment and neurosurgical training in Africa, Central and South America, Haiti, and Southeast Asia. These international efforts have employed various models to achieve the goals of providing safe, sustainable, and cost-effective treatment. Conclusions: Broader commitment from the pediatric neurosurgery community, increased funding, public education, surgeon training, and ongoing surgical innovation will be needed to meaningfully address the global burden of untreated hydrocephalus.

Pediatric Hydrocephalus in the Developing World

2018 ◽  
pp. 1-20
Author(s):  
Ryan T. Muir ◽  
Shelly Wang ◽  
Benjamin C. Warf
Keyword(s):  
Developing World ◽  
Pediatric Hydrocephalus

Cerebrospinal Fluid Biomarkers of Pediatric Hydrocephalus

2017 ◽  
Vol 52 (6) ◽  
pp. 426-435 ◽  
Author(s):  
David D. Limbrick Jr ◽  
Leandro Castaneyra-Ruiz ◽  
Roland H. Han ◽  
Daniel Berger ◽  
James P. McAllister ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pediatric Hydrocephalus ◽  
Cerebrospinal Fluid Biomarkers

scholarly journals Standard Treatment for Pediatric Hydrocephalus based on US Guidelines

2017 ◽  
Vol 26 (8) ◽  
pp. 564-573
Author(s):  
Masakazu Miyajima ◽  
Kazuaki Shimoji ◽  
Takaoki Kimura ◽  
Hajime Arai
Keyword(s):  
Standard Treatment ◽  
Pediatric Hydrocephalus

scholarly journals Endoscopic aqueductal stenting in the management of pediatric hydrocephalus

2020 ◽  
Vol 26 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Lelio Guida ◽  
Kevin Beccaria ◽  
Sandro Benichi ◽  
Anaïs Chivet ◽  
Timothée de Saint Denis ◽  
...  
Keyword(s):  
Stent Placement ◽  
Obstructive Hydrocephalus ◽  
Univariate Analysis ◽  
Aqueductal Stenosis ◽  
Neurological Deficits ◽  
Shunt Revision ◽  
Posthemorrhagic Hydrocephalus ◽  
Pediatric Hydrocephalus ◽  
Before And After ◽  
History Of

OBJECTIVEPediatric patients with long-term shunts may experience specific complications related to the segregation of the supra- and infratentorial spaces along with different pressure regimens, leading to either mesencephalic syndromes during shunt dysfunction or isolated fourth ventricle (IFV). An accepted treatment to reestablish normal CSF pathways and reequilibrate the transtentorial pressures is endoscopic aqueductal stenting (EAS) to avoid restenosis. In the present paper, the authors studied children treated with EAS during the last decade for both IFV and obstructive hydrocephalus, evaluated its impact on the course of the disease, and identified prognostic factors for EAS success.METHODSA noninterventional retrospective study of routinely acquired data was performed, including all hydrocephalic children undergoing EAS between 2011 and 2019 at Hôpital Necker, Paris, France. The following variables were analyzed: etiology of hydrocephalus; number of surgeries before and after stent placement; indication for EAS; type of stent connection (i.e., connected or not to a ventriculoperitoneal shunt); and the stent position. Stent failure was defined as the need to perform further shunt revision. Univariate and multivariate analyses were run to identify factors associated with stent failure.RESULTSSeventeen patients with a mean age at stent placement of 6 years (SD 6.5 years, range 1 month–18 years) and with a mean follow-up after EAS of 47.5 months (SD 33.7 months, range 5–120 months) were included in the analysis. The etiology of hydrocephalus was as follows: obstructive tumoral (41%), posthemorrhagic (35%), postinfectious (12%), and dysraphism related (12%). The indication for EAS was IFV (47%), rostral midbrain dysfunction syndrome (35%), prevention of secondary aqueductal stenosis after debulking surgery (12%), or primary aqueductal stenosis (6%). No transient or permanent neurological deficits related to the procedure were observed. After EAS, 10 patients did not require further surgeries (59%), and for the others the number of hydrocephalus-related surgeries significantly decreased after stenting. In univariate analysis posthemorrhagic etiology and prevention of aqueductal stenosis were identified as predictors of a good outcome, whereas in multivariate analysis posthemorrhagic hydrocephalus was found to predict a favorable outcome.CONCLUSIONSThe results confirm EAS as a first-line treatment for IFV and suggest its efficacy in changing the history of hydrocephalic patients who have undergone multiple operations and who experience rostral midbrain dysfunction syndrome, as well as efficacy in the prevention of aqueductal stenosis in selected cases of obstructive tumoral hydrocephalus.

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