Adult long-term outcome of patients after congenital hydrocephalus shunt therapy
- 17 October 2014
- journal article
- Published by Springer Science and Business Media LLC in Child's Nervous System
- Vol. 31 (1), 49-56
- https://doi.org/10.1007/s00381-014-2571-8
Abstract
Even though shunt surgery has been an established and widely accepted treatment for congenital hydrocephalus for five decades, long-term follow-up and functional outcome data is rare. Sixty-nine patients were examined after congenital hydrocephalus had been treated between 1971 and 1987 at the Department of Pediatric Surgery (University of Leipzig) within the first 12 months of life. Median age of patients was 32 years (range 25–42 years). Patients agreed to undergo a contemporary hydrocephalus assessment. Seven patients (10.1 %) became shunt-independent before adulthood. By the age of 20, 82 % of the patients had needed at least one shunt revision, 100 % by the age of 30. 21.7 % of the primary valves (Spitz-Holter) remained intact without revision until today up to 35 years (mean functional intactness 23 years). Shunt infections occurred in 4.3 % of primary implantations. 48 % of the patients had a good functional outcome (mRS = 0–1). 40.9 % of the patients attended regular school. In summary, 75 % patients work on a daily basis. 44.6 % live an independent life, 35.4 % rely on parental supervision, and 20 % depend on professional care institutions. Compared to the pre-shunt era, surgery within the first year of life is advantageous regarding visual function, educational progress, and social results. The outcome achieved throughout childhood remains stable during adult life as long as catastrophic events of shunt malfunction can be prevented. Epilepsy, motor deficits, acute shunt dysfunction, and problems of social integration as well as aging parental caregivers seem to be prominent factors of morbidity in adulthood.Keywords
This publication has 12 references indexed in Scilit:
- Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA)Journal of Neurology, Neurosurgery & Psychiatry, 2013
- Adult outcome of pediatric hydrocephalusChild's Nervous System, 2012
- Ventriculoperitoneal Shunt Surgery Outcome in Adult Transition Patients With Pediatric-Onset HydrocephalusNeurosurgery, 2011
- Who Will Care for Me Next? Transitioning to Adulthood With HydrocephalusPediatrics, 2009
- The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliabilityDevelopmental Medicine and Child Neurology, 2006
- Development and reliability of a system to classify gross motor function in children with cerebral palsyDevelopmental Medicine and Child Neurology, 1997
- Consensus: long-term outcome in hydrocephalusChild's Nervous System, 1994
- Normal-pressure hydrocephalusJournal of Neurosurgery, 1974
- The Natural History of Hydrocephalus: Detailed Analysis of 182 Unoperated CasesArchives of Disease in Childhood, 1962
- Cerebral Vascular Accidents in Patients over the Age of 60: II. PrognosisScottish Medical Journal, 1957