Tiller C, Myhrvold S, Lundar T
Nevrokirurgisk avdeling Rikshospitalet, Oslo.
Tidsskr Nor Laegeforen. 2000 Apr 30;120(11):1298-302.
The aims of this study were to determine the ten-year outcome of hydrocephalic children, both in terms of academic results, social skills, physical functioning and surgical morbidity and mortality.
A cohort of 128 children shunted for hydrocephalus at the National Hospital in Oslo between 1985 and 1988 were retrospectively analysed by registering their medical records and in a questionnaire survey.
We found that 23 (18%) children died during the ten-year observation period. Six patients died from shunt system failure, ten died from their malignant tumour, six died of their complex cerebral malformations and one died of unknown cause. Of the 105 (82%) children still alive, 104 returned our questionnaire. 92 (88%) reported to be attending a normal school, while 77 (74%) are in the same grade as children of similar age. Of those children at same grade level, 39 (51%) needed extra tutoring, while 35 (45%) reported speech and writing difficulties. Among children not in their adequate grade level, 25 (93%) (p < 0.01) needed extra tutoring, and 23 (85%) (p < 0.01) reported speech and writing difficulties. 50 (48%) participate in physical exercise along with the other children, while 53 (51%) report having normal social relations with children of the same age. 34 (33%) has suffered from epileptogenic seizures, while 24 (23%) daily use prescribed antiepileptic drugs. During the ten-year follow-up period, 108 (84%) patients had a total of 342 shunt revisions. We found no correlation between high incidence of revisions and negative long-term outlook. 99 out of the 105 children alive are considered to be life-long dependent of their shunt system.
The vast majority of the children shunted for hydrocephalus that are still alive, have a good or satisfactory level of functioning ten years after their first shunt insertion. This view seems to be shared by the parents of these children, of whom 50 (48%) state that the development of their child has been "very good" compared to what they initially feared.
本研究的目的是确定脑积水患儿在学业成绩、社交技能、身体功能以及手术发病率和死亡率方面的十年预后情况。
对1985年至1988年期间在奥斯陆国家医院接受脑积水分流手术的128名儿童进行回顾性分析，通过查阅他们的病历并进行问卷调查。
我们发现，在十年观察期内有23名（18%）儿童死亡。6名患者死于分流系统故障，10名死于恶性肿瘤，6名死于复杂脑畸形，1名死因不明。在105名（82%）仍存活的儿童中，104名回复了我们的问卷。92名（88%）报告正在正常上学，而77名（74%）与同龄儿童处于同一年级。在同一年级的儿童中，39名（51%）需要额外辅导，而35名（45%）报告存在言语和书写困难。在未处于适当年级水平的儿童中，25名（93%）（p<0.01）需要额外辅导，23名（85%）（p<0.01）报告存在言语和书写困难。50名（48%）与其他儿童一起参加体育锻炼，而53名（51%）报告与同龄儿童有正常的社会关系。34名（33%）曾发生致痫性发作，24名（23%）每天使用处方抗癫痫药物。在十年随访期间，108名（84%）患者共进行了342次分流器修订。我们发现修订发生率高与长期预后不良之间没有相关性。105名存活儿童中有99名被认为终身依赖分流系统。
绝大多数仍存活的接受脑积水分流手术的儿童，在首次分流手术后十年功能水平良好或令人满意。这些儿童的父母似乎也认同这一观点，其中50名（48%）表示，与他们最初的担忧相比，孩子的发育“非常好”。
