Nagl Jasmin, Schwarm Frank P, Bender Michael, Gencer Aylin, Ehrhardt Harald, Hahn Andreas, Neubauer Bernd A, Kolodziej Malgorzata A
Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany.
Department of General Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany.
Minerva Pediatr (Torino). 2025 Feb;77(1):18-27. doi: 10.23736/S2724-5276.22.06816-1. Epub 2022 Oct 25.
Pediatric hydrocephalus is a result of a dysfunction of cerebrospinal fluid circulation, and it has diverse pathogeneses. This study investigates the epidemiology of pediatric hydrocephalus, as well as the influences of primary etiology and implant type on treatment complications and the development of new therapeutic approaches and strategies.
Between 2013 and 2018, a retrospective analysis of 131 children, who were suffering from hydrocephalus, was conducted. Medical charts, operative reports and clinical follow-up visits were reviewed. Statistical analysis was performed using t-test/ANOVA and Kruskal-Wallis Test/Mann-Whitney U Test.
The most common pathogeneses of hydrocephalus among our patients were meningomyelocele-associated and posthemorrhagic. The majority of patients received a programmable differential pressure valve (PPV, 77.8%) or a fixed differential pressure valve with a gravitational unit (FPgV, 14.8%). Among 333 shunt-associated surgeries, 66% of surgeries were revision surgeries and were performed because of mechanical shunt dysfunction (61%), infection (12%), or other reasons (27%). The median rate of revisions within one year for each patient was 0.15 (IQR: 0.00-0.68) and was influenced by etiology (P=0.045) and valve type (P=0.029). The highest rates were seen in patients with posthemorrhagic hydrocephalus and in those with FPgVs; the lowest rates were seen in patients with meningomyelocele-associated hydrocephalus and PPVs. The occurrence of mechanical dysfunctions was correlated with FPgV patients (P=0.014). Furthermore, the median time interval between initial shunt surgery and onset of infection was shorter than that between initial surgery and mechanical dysfunction (P=0.033).
Based on this research, we can state several factors that influence revision surgeries in pediatric shunt patients. With the assessment of patients' risk profiles, physicians can classify pediatric shunt patients and thus avoid unnecessary examinations or invasive procedures. Furthermore, medical providers can prevent revision surgeries if they choose shunt material in accordance with a patient's associated shunt complications.
小儿脑积水是脑脊液循环功能障碍的结果，其发病机制多种多样。本研究调查小儿脑积水的流行病学，以及原发性病因和植入物类型对治疗并发症的影响，以及新治疗方法和策略的发展。
2013年至2018年，对131例脑积水患儿进行回顾性分析。查阅病历、手术报告和临床随访记录。采用t检验/方差分析以及Kruskal-Wallis检验/Mann-Whitney U检验进行统计分析。
在我们的患者中，脑积水最常见的发病机制是与脊髓脊膜膨出相关的和出血后的。大多数患者接受了可编程压差阀（PPV，77.8%）或带重力装置的固定压差阀（FPgV，14.8%）。在333例与分流相关的手术中，66%的手术是翻修手术，进行翻修手术的原因是机械性分流功能障碍（61%）、感染（12%）或其他原因（27%）。每位患者一年内翻修的中位率为0.15（四分位间距：0.00 - 0.68），且受病因（P = 0.045）和瓣膜类型（P = 0.029）影响。出血后脑积水患者和使用FPgV的患者翻修率最高；脊髓脊膜膨出相关脑积水患者和使用PPV的患者翻修率最低。机械性功能障碍的发生与使用FPgV的患者相关（P = 0.014）。此外，初次分流手术至感染发作的中位时间间隔短于初次手术至机械性功能障碍的时间间隔（P = 0.033）。
基于本研究，我们可以指出影响小儿分流患者翻修手术的几个因素。通过评估患者的风险状况，医生可以对小儿分流患者进行分类，从而避免不必要的检查或侵入性操作。此外，如果医疗服务提供者根据患者相关的分流并发症选择分流材料，就可以预防翻修手术。
