Study of Neurodevelopmental Outcome in Patients with Non-tumoral Hydrocephalus with Shunt Surgery Done in Infancy.
Study of Neurodevelopmental Outcome in Patients with Non-tumoral Hydrocephalus with Shunt Surgery Done in Infancy.
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DOI：
10.4103/jpn.jpn_37_20
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发表时间：
2021-01
影响因子：
0.5
通讯作者：
Biyani N
中科院分区：
文献类型：
--
作者：
Garg S;Kulkarni S;Deopujari CE;Biyani N
脑积水（HC）是一种常见的神经系统疾病，在婴儿期出现，有无数的病因需要早期神经外科干预。研究婴儿期行分流术的HC患者的神经发育结局。这是一项观察性回顾性队列研究，涉及50名儿童患者（2至16岁）。这些患者被诊断为HC，并在婴儿期（不包括脑肿瘤患者）进行脑室-腹膜分流术（VP分流术）插入手术，随后在神经内科门诊（OPD）进行手术。回顾临床记录和神经发育评估（智商/发育商、视力和听力评估）。只有50%的先天性HC患者在出生时被诊断出来，其中包括那些在产前被诊断出来的患者，与那些后来出现HC的患者相比，他们的并发症更少，智力结果更好（P = 0.12）。患者相关因素，如HC的病因、产前诊断和分流修复的要求与神经发育结局相关性较差。术后晚期并发症患者的神经发育预后明显较差（P≤0.001）。与其他原因的患者相比，脑膜炎后HC患者需要更多的分流修复术（P = 0.04）。较好的神经发育结果取决于早期诊断和早期转诊管理，而不是HC的原因。定期监测头围是早期发现的最可行和最敏感的筛查工具。准确的预测需要更大规模的研究。
Hydrocephalus (HC) is a common neurological disorder presenting in infancy, with a myriad of etiologies requiring early neurosurgical intervention. To study neurodevelopmental outcome in patients with HC with shunt surgery done in infancy. This was an observational retrospective cohort study of 50 pediatric patients (2 years to 16 years of age). These patients were diagnosed with HC and were operated on with ventriculo-peritoneal shunt (VP shunt) insertion in infancy (did not include patients with brain tumors) and then later following in the neurology outpatient department (OPD). Clinical records and neurodevelopmental assessment (intelligence quotient [IQ]/development quotient [DQ] and vision and hearing assessment) were reviewed. Only 50% of the patients with congenital HC were diagnosed at birth, which included patients who had been diagnosed antenatally and they had lesser complications and better intellectual outcome (P = 0.12), compared with those who presented later with HC. Patient-related factors such as etiology of HC, antenatal diagnosis, and requirement of shunt revisions had poor correlation with neurodevelopmental outcome. Patients with late postoperative complications had significantly poor neurodevelopmental outcome (P ≤ 0.001). Patients with post-meningitis HC required a significantly higher number of shunt revisions than patients with other causes (P = 0.04). Better neurodevelopmental outcome depends on early diagnosis and early referral for the management than the cause of HC. Regular head circumference monitoring is the most feasible and sensitive screening tool for early pickup. Larger studies are needed for accurate prognostication.