Background and aims
Hydrocephalus, a common condition in the pediatric population due to its various etiologies, proves to be an issue in many cases, due to its various etiologies, thereby threatening the children's life-expectancy and neurodevelopmental outcome. This study primarily sought to evaluate the prognosis of children diagnosed with hydrocephalus before the age of five, in addition to the implications of determinants like etiology, type of treatment, complications, and associated neurological malformations and sequelae.
Materials and methods
The study was conducted at Saint-Luc University Hospital (Brussels). Inclusion criteria comprised a diagnosis of hydrocephalus before the age of five, regardless of etiology, and a birth date between 01/01/2000 and 12/31/2014. Children with external hydrocephalus and hydrocephalus ex vacuo were excluded from participation.
The study sample comprised 142 children divided into eleven etiological groups: post-intraventricular hemorrhage hydrocephalus of prematurity (16.2%), brain tumor (16.2%), myelomeningocele (14.8%), aqueductal stenosis (8.5%), post-meningitic (8.5%) and post-hemorrhagic hydrocephalus (7.75%), Dandy-Walker malformation (6.3%), unknown cause (5.6%), and arachnoid cysts (4.9%). The remaining etiologies were grouped as diverse obstructive (3.5%) and various causes (7.75%). The mortality rate reached 16.2%. Two children died due to a treatment complication of hydrocephalus; the other children died of the underlying cause, mainly tumors. Ventriculostomy was performed 42 times in 40 patients with a failure rate of 52.4% and 4.8% of infectious complications. The best success rate was observed in aqueductal stenosis (7/8), diverse obstructive causes (4/4), and Dandy-Walker malformation (1/1). A total of 226 internal shunts were inserted into 99 children. Infectious complications were estimated at 19.0%, and mechanical ones at 50.4%. Psychomotor development was evaluated based on neuropediatric follow-up and type of education. Average follow-up and type of education. Overall, 23.5% of the children showed a normal development, while 37.0% exhibited mild, 23.5% moderate, and 16.0% severe developmental delay. The children attended either ordinary education (42.9%) or special needs education (24.4%). Any education type was impossible for 6.7%, half of which suffered from post-meningitic hydrocephalus. Furthermore, 26.0% were of preschool age or following an unknown type of education. Primarily 60.5% evolved favourably. This involved mainly children with aqueductal stenosis, arachnoid cysts, hydrocephalus of unknown or diverse obstructive causes. A moderate or severe development delay was noticed for more than 60% of children with post-meningitic or post-hemorrhagic hydrocephalus, or myelomeningocele.
For cases with purely obstructive hydrocephalus and ventriculostomy, evolution was more likely to be favorable. Communicating hydrocephalus, shunt placement, and moreover, occurrence of complications, neurological malformations and sequelae (more common in communicating hydrocephalus), as well as microcephaly were more often associated with a poor outcome. Children carrying a shunt were at higher risk of complications. Such complications, however, were either not observed or remained limited for a considerable number of cases.
1 Université catholique de Louvain, Cliniques universitaires Saint-Luc, B-1200, Bruxelles, Belgique.