Pediatric Hydrocephalus Research Articles

Developing Predictive Models to Anticipate Shunt Complications in 33,248 Pediatric Patients with Shunted Hydrocephalus Utilizing Machine Learning

Introduction: Hydrocephalus is a common pediatric neurosurgical pathology, typically treated with a ventricular shunt, yet approximately 30% of patients experience shunt failure within the first year after surgery. As a result, the objective of the present study was to validate a predictive model of pediatric shunt complications with data retrieved from the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD). Methods: The HCUP NRD was queried from 2016 to 2017 for pediatric patients undergoing shunt placement using ICD-10 codes. Comorbidities present upon initial admission resulting in shunt placement, Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining criteria, and Major Diagnostic Category (MDC) at admission classifications were obtained. The database was divided into training (n = 19,948), validation (n = 6,650), and testing (n = 6,650) datasets. Multivariable analysis was performed to identify significant predictors of shunt complications which were used to develop logistic regression models. Post hoc receiver operating characteristic (ROC) curves were created. Results: A total of 33,248 pediatric patients aged 6.9 ± 5.7 years were included. Number of diagnoses during primary admission (OR: 1.05, 95% CI: 1.04–1.07) and initial neurological admission diagnoses (OR: 3.83, 95% CI: 3.33–4.42) positively correlated with shunt complications. Female sex (OR: 0.87, 95% CI: 0.76–0.99) and elective admissions (OR: 0.62, 95% CI: 0.53–0.72) negatively correlated with shunt complications. ROC curve for the regression model utilizing all significant predictors of readmission demonstrated area under the curve of 0.733, suggesting these factors are possible predictors of shunt complications in pediatric hydrocephalus. Conclusion: Efficacious and safe treatment of pediatric hydrocephalus is of paramount importance. Our machine learning algorithm delineated possible variables predictive of shunt complications with good predictive value.

Fully automated measurement of intracranial CSF and brain parenchyma volumes in pediatric hydrocephalus by segmentation of clinical MRI studies.

Brain parenchyma (BP) and intracranial cerebrospinal fluid (iCSF) volumes measured by fully automated segmentation of clinical brain MRI studies may be useful for the diagnosis and follow-up of pediatric hydrocephalus. However, previously published segmentation techniques either rely on dedicated sequences, not routinely used in clinical practice, or on spatial normalization, which has limited accuracy when severe brain distortions, such as in hydrocephalic patients, are present. We developed a fully automated method to measure BP and iCSF volumes from clinical brain MRI studies of pediatric hydrocephalus patients, exploiting the complementary information contained in T2- and T1-weighted images commonly used in clinical practice. The proposed procedure, following skull-stripping of the combined volumes, performed using a multiparametric method to obtain a reliable definition of the inner skull profile, maximizes the CSF-to-parenchyma contrast by dividing the T2w- by the T1w- volume after full-scale dynamic rescaling, thus allowing separation of iCSF and BP through a simple thresholding routine. Validation against manual tracing on 23 studies (four controls and 19 hydrocephalic patients) showed excellent concordance (ICC>0.98) and spatial overlap (Dice coefficients ranging from 77.2% for iCSF to 96.8% for intracranial volume). Accuracy was comparable to the intra-operator reproducibility of manual segmentation, as measured in 14 studies processed twice by the same experienced neuroradiologist. Results of the application of the algorithm to a dataset of 63 controls and 57 hydrocephalic patients (19 with parenchymal damage), measuring volumes' changes with normal development and in hydrocephalic patients, are also reported for demonstration purposes. The proposed approach allows fully automated segmentation of BP and iCSF in clinical studies, also in severely distorted brains, enabling to assess age- and disease-related changes in intracranial tissue volume with an accuracy comparable to expert manual segmentation.

A Selection of Surgical Interventions in Pediatric Hydrocephalus

Introduction: Hydrocephalus is a condition in which the flow of cerebrospinal fluid is disturbed due to an imbalance between production and reabsorption or because there are obstacles along its distribution channel. The most common surgical intervention and standard strategy for treating hydrocephalus in recent years has been the placement of a shunt, particularly a ventriculoperitoneal shunt (VP-Shunt). In addition to shunt placement, endoscopic third ventriculostomy (ETV) and choroid plexus coagulation (CPC) are currently being performed simultaneously, considering that the combination of the two procedures is sufficient to provide maximum results and can even reduce the risk of failure. Method: The method of literature review is used in this study.The method chosen is preferred reporting items for systematic reviews and meta-analyses (PRISMA), which involves selecting the characteristics of literature through electronic media with database searches through the PubMed and Google Scholar sites. Patients diagnosed with hydrocephalus, both communicative and noncommunicative, with an age of 18 years; surgical intervention with a Vp-shunt; EVT with or without CPC; and a 3-month follow-up were the inclusion criteria. Result: There were 1,251 samples included in the 10 articles in this study, 7 of these articles had samples with non-communicable hydrocephalus, with the most common etiologies being post-infection and hemorrhage. The selected interventions, both Vp-Shunt and ETV with or without CPC, have a high percentage of success rates, with an average age of intervention in this study of 6 months. Conclusion: The choice of intervention in cases of hydrocephalus should be based on patient characteristics. Installation of a shunt, ETV, or ETV/CPC may et he first choice based on the etiology of the hydrocephalus, the patient’s age, and a risk assessment that takes into account the complications that may arise from the selected procedure

Ventriculopleural shunt outcomes for pediatric hydrocephalus: a single-institution experience.

The aim of this study is to analyze rates of ventriculopleural (VPL) shunt failure and complications among patients with pediatric hydrocephalus, and to analyze which factors may predict early (< 1year) or late (> 1year) VPL shunt failure in this sample. A retrospective chart review was conducted of all consecutive VPL shunt placements from 2000 to 2019 at our institution. Data was collected on patient characteristics, shunt history, and shunt type. Primary endpoints include rates of VPL shunt survival and rates of symptomatic pleural effusion. The Kaplan-Meier method was used to calculate shunt survival, and Fisher's exact test and t-test were used to compare differences between categorical variables and means, respectively (p < 0.05). Thirty-one patients with pediatric hydrocephalus underwent VPL shunt placement (mean age 14.2years). Of the 27 patients with long-term follow-up (mean 46months), VPL shunt revision was required in 19, seven of which were due to pleural effusion. Overall shunt survival rates at 1, 3, 5, and 7years were 76%, 62%, 55%, and 46%, respectively. Mean duration of shunt survival was 26.74months. Overall pleural effusion rate was 26%. No patient-specific factors, including shunt valve type, were significantly associated with shunt survival, risk of early revision, or risk of pleural effusion. Our results are comparable to those reported in the literature and represent one of the largest case series on the topic. VPL shunts are a viable second-line option when ventriculoperitoneal (VP) shunt placement is not possible or desirable, though there are high rates of shunt revision and pleural effusion.

Initial Clinical Experience and Biomechanical Analysis of a Novel Gravity Unit-Assisted Valve (M.blue) in Pediatric Patients With Hydrocephalus: A Retrospective Study With Two Years of Follow-up.

Overdrainage is a widely reported complication representing common indication for shunt revision. Despite recent advances in valve design, repeated shunt revisions represent burden on healthcare systems. To investigate the efficiency of a novel gravity unit-assisted programmable valve "M.blue" in pediatric hydrocephalus using clinical and biomechanical analyses. Thisretrospective single-center study included pediatric patients who received M.blue valve between April 2019 and 2021. Several clinical and biomechanical parameters were documented including complications and revision rates. Flow rate, functional assessment in vertical and horizontal positions, and extent of depositions inside valve were analyzed in explanted valves. Thirty-seven M.blue valves in 34 pediatric patients with hydrocephalus (mean age 2.82 ± 3.91 years) were included. Twelve valves (32.4%) were explanted during a follow-up period of 27.3 ± 7.9 months. One-year survival rate of 89% and overall survival rate of 67.6% with a valve survival average of 23.8 ± 9.7 months were observed. Patients with explanted valves (n = 12) were significantly younger, with 0.91 ± 0.54 years of age in average ( P = .004), and showed significantly more adjustments difficulties ( P = .009 ). 58.3% of explanted valves showed deposits in more than 75% of the valve surface despite normal cerebrospinal fluid findings and were associated with dysfunctional flow rate in vertical, horizontal, or both positions. The novel M.blue valve with integrated gravity unit is efficient in pediatric hydrocephalus with comparable survival rate. Deposits inside valves could affect its flow rate in different body positions and might lead to dysfunction or difficulties in valve adjustments.

From fixed-pressure paediGAV to programmable proGAV/proSA serial valves for pediatric hydrocephalus within the 1st year of life: a technical single-center analysis.

Programmable valves have gained increasing popularity in the complex treatment of pediatric hydrocephalus. Over the last decade, adjustable serial valves have gradually replaced fixed-pressure valves in the authors' department. The present study investigates this development by analyzing shunt- and valve-related outcomes for this vulnerable population. A retrospective analysis of all shunting procedures between January 2009 and January 2021 in children younger than 1 year of age was performed at the authors' single-center institution. Postoperative complications and surgical revisions were set as outcome parameters. Shunt and valve survival rates were evaluated. Statistical analysis compared children who underwent implantation of the Miethke proGAV/proSA programmable serial valves with those who underwent implantation of the fixed-pressure Miethke paediGAV system. Eighty-five procedures were evaluated. The paediGAV system was implanted in 39 cases and the proGAV/proSA in 46 cases. The mean ± SD follow-up was 247.7 ± 140 weeks. In 2009 and 2010, paediGAV valves were used exclusively, but by 2019, the use of proGAV/proSA had evolved into the first-line therapy. The paediGAV system was significantly more often revised (p < 0.05). The main indication for revision was proximal occlusion, with or without impairment to the valve. The valve and shunt survival rates of proGAV/proSA were significantly prolonged (p < 0.05). The surgery-free valve survival of proGAV/proSA was 90% after 1 year and 63% after 6 years. There were no overdrainage-related revisions of proGAV/proSA valves. Favorable shunt and valve survival validates the increasing use of programmable proGAV/proSA serial valves in this delicate population. Potential benefits in postoperative treatment should be addressed in prospective multicenter studies.

Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Infantile Hydrocephalus: An Experience from Mali

Introduction: Pediatric hydrocephalus is a common disease in sub-Saharan Africa. In Mali, 350–400 new cases are diagnosed in our center yearly. With a total land mass of 1,241,000 km², patients in remote areas must travel up to 1,500 km to access neurosurgical care. Hence, treatment and follow-ups of “shunted” patients are difficult. In this context, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) provides an opportunity for an affordable and less constraining treatment for hydrocephalus children under 12 months of age. Methods: We performed a retrospective analysis of ETV/CPC performed on infants from July 2013 to January 2015. Patients were followed postoperatively on day 15, month 6, and month 12. Statistical analysis was conducted using Prism 9 GraphPad software. ETV successes were categorized according to the patient’s age into 3 groups: ≤3 months, 3–6 months, and 6–12 months. Statistical significance was defined at p < 0.05. Results: During the study period, 199 patients were included with 40% of patients aged between 0 and 6 months. The head circumference ranged from 35 cm to 79 cm. The etiology was congenital malformation in 55%. ETV/CPC was a success in 69% of 6- to 12-month-old patients, 54% in the 3- to 6-month-old patients, and 29% in ≤3-month-old patients. Overall, 94 (47%) patients were successfully treated without a shunt. The postoperative infection rate was 1% and mortality at 12 months was 8%. Conclusion: In a low-income environment such as Mali, ETV/CPC stands as a viable and alternative treatment option for pediatric hydrocephalus patients; our findings suggest that age is an important factor in predicting ETV success.

‘It is the child with the big head’ – Primary healthcare providers’ perceptions of paediatric hydrocephalus in Blantyre, Malawi: A qualitative study

ABSTRACT Children in Africa are disproportionately burdened by the neurosurgical condition hydrocephalus. In Blantyre, Malawi, paediatric hydrocephalus represents the majority of surgical procedures performed in the neurosurgical department at Queen Elizabeth Central Hospital. To reduce morbidity and mortality, timely detection followed by referral from surrounding primary health centres is crucial. Aiming to explore perceptions and identify enablers and barriers to detection and referral, we conducted a qualitative study among primary healthcare providers (n = 30) from ten health centres in Blantyre district. Using a semi-structured interview-guide, we audio-recorded and transcribed the interviews before conducting a thematic analysis. One main finding is that there is a potential to improve detection through head circumference measurements, which is the recommended way to detect hydrocephalus early, yet healthcare providers did not carry this out systematically. They described the health passport provided by the Malawian Ministry of Health as an important tool for clinical communication. However, head circumference growth charts are not included. To optimise outcomes for paediatric hydrocephalus we suggest including head circumference growth charts in the health passports. To meet the need for comprehensive management of paediatric hydrocephalus, we recommend more research from the continent, focusing on bridging the gap between primary care and neurosurgery.

Sociodemographic and clinical profile of patients with pediatric hydrocephalus who reside in Zanzibar: an exploratory study

Sociodemographic and clinical profile of patients with pediatric hydrocephalus who reside in Zanzibar: an exploratory study

Implementing evidence-based interventions for managing pediatric hydrocephalus: a systematic review protocol

Abstract Background Pediatric hydrocephalus (PH) accounts for one of the most frequent neurological conditions in children and with a high burden in developing countries. The plurality of its etiological mechanisms has led to several therapeutic modalities, including the endoscopic third ventriculostomy, which has shown significant benefits. This study aims to determine the availability of PH treatment modalities worldwide using an implementation science framework. Methods This systematic review will be conducted following AMSTAR guidelines and reported following PRISMA guidelines. A comprehensive search from database inception to the date the search is run will be conducted in Medline, Embase and Global Index Medicus. Conference abstracts, scoping, systematic reviews (SRs), book chapters and non-French/English publications will be excluded. After the screening process, data will be extracted, and its quality analyzed. Newcastle-Ottawa Scale and Cochrane risk of bias 2.00 tool will be employed to assess the risk of bias. Odds or risk ratios and mean differences with their 95% confidence interval will measure the effect. The I2 statistic will describe effect heterogeneity in meta-analysis data. No Ethic approval is required. Study Implications Evidence-based practice is a complex problem-solving approach derived from high-quality evidence. Their implementation models are well reported in neurosciences in resource-limited countries. This SR will use the Framework for Reach, Effectiveness, Adoption, Implementation and Maintenance to conceptualize the public health impact of PH treatment modalities. We will identify reasons for the low use of an evidence-based strategy to inform policy. Systematic Review Registration The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO CRD42022354804).

Ventriculoperitoneal shunt surgery in a Nigerian city

Introduction. Improvements in surgical techniques and advancements in antibiotic management have significantly reduced the complications associated with Ventriculoperitoneal Shunting which is still the most common procedure for the treatment of hydrocephalus. These complications are believed to be highest in Low and middle-income countries due to delayed presentation to care facilities. The authors report our experience of managing paediatric hydrocephalus in an institution with evolving Neurosurgical practice in North Central Nigeria. Material and methods. We retrospectively reviewed all cases of VP shunting from 2011 to 2018 taking into consideration the demographics, aetiologies of hydrocephalus, length of hospital stay, postoperative morbidity and mortality, and overall outcome. Complications sought included, Surgical Site infections, shunt exposure, obstruction or any other cause of shunt malfunction. The minimum follow-up period was 24 months Results. There were 27 VPS procedures done in 25 patients of whom 15 were males and 10 females (M:F ratio of 1.5:1). The age range was 8 days to 9 years with a median age of 5 months. Of the 25 cases, 24 (96%) were non-tumoral in origin comprising 17 congenital and 7 acquired hydrocephalus. At 2 years post shunt insertion, 21 (84%) of the 25 initial cases were still functional. The total complication rate was 28%, comprising Surgical Site infection, shunt exposure, shunt obstruction, seizure, and one death, There were 3 (12%) shunt failures from shunt obstruction (2) and shunt exposure (1). Conclusion With meticulous control of the surgical environment and improved experience in ventriculoperitoneal shunting, the complication rate can be significantly reduced. There is a need to increase the awareness of the population to the availability of care for seemingly hopeless conditions. The burden of the cost of care on individuals should be lightened through better health insurance coverage.

2144. Duration of perioperative antibiotic prophylaxis in ventriculoperitoneal shunt surgery in children

Abstract Background Placement of ventriculoperitoneal (VP) shunt is an important treatment for pediatric hydrocephalus. Although prolonged perioperative antibiotic prophylaxis has theoretically no benefit in reducing device-associated infections, duration of antibiotic prophylaxis for VP shunt placement in pediatrics is not well established. As a part of antimicrobial stewardship program (ASP), our ASP team recommended to stop perioperative antibiotic prophylaxis for sterile medical placement within 48 hours following surgery in April 2017. Our aim of this study was to evaluate rate of VP shunt-associated infections following shunt placement between children received &amp;lt; 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis. Methods Children aged 15 years old or younger who underwent VP shunt insertion between April 2014 and November 2021 were enrolled at Tokyo Metropolitan Children's Medical Center. Children with co-existing infection at time of surgery were excluded. Rates of VP shunt-associated infections following 1 month and 6 months of post-surgical periods were compared between children who received &amp;lt; 48 hours and ≧ 48 hours of perioperative antibiotic prophylaxis. Results A total of 110 children were identified. Among them, 11 cases with VP shunt-associated meningitis and 15 cases with other infections were excluded. Girl ratio was 44%. Median age was 4.5 months old (IQR 8-40). Numbers of children with cefazolin and vancomycin-contained regimen were 83 (98.8%) and 1 (1.2%), respectively. Numbers of children who received perioperative antibiotic prophylaxis for &amp;lt; 48 hours and ≧ 48 hours were 43 (51.2%) and 41 (48.8%), respectively. Incidence of VP shunt-associated infections for 1 month of post-surgical period in &amp;lt; 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 4.65% (2/43) and 12.2% (5/41), respectively. (P=0.211) Incidence of VP shunt-associated infections for 6 months of post-surgical period in &amp;lt; 48 hours and ≧ 48 hours antibiotic prophylaxis groups were 11.6% (5/43) and 12.2% (5/41), respectively. (P=0.936). Conclusion Shorter duration of &amp;lt; 48 hours of perioperative antibiotic prophylaxis did not increase rates of VP shunt-associated infections among children in short and long terms. Disclosures All Authors: No reported disclosures.

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

PurposeVentricular catheter implantation in pediatric hydrocephalus can become a highly challenging task due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the rate of successful catheter placements. This study aims to evaluate ShuntScope’s image qualities and related surgical outcomes in the pediatric population.MethodsA retrospective analysis of all pediatric patients undergoing ventricular catheter placement using the ShuntScope from 01/2012 to 01/2022 in the author’s department was performed. Demographic, clinical, and radiological data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into the categories of excellent, medium, and poor and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter occlusion.ResultsA total of 65 ShuntScope-assisted surgeries have been performed on 51 children. The mean age was 5.1 years. The most common underlying pathology was a tumor- or cyst-related hydrocephalus in 51%. Achieved image quality was excellent in 41.5%, medium in 43%, and poor in 15.5%. Ideal catheter placement was achieved in 77%. There were no intraoperative complications and no technique-related morbidity associated with the ShuntScope. The revision rate due to proximal occlusion was 4.61% during a mean follow-up period of 39.7 years. No statistical correlation between image grade and accuracy of catheter position was observed (p-value was 0.290).ConclusionThe ShuntScope can be considered a valuable addition to standard surgical tools in treating pediatric hydrocephalus. Even suboptimal visualization contributes to high rates of correct catheter placement and, thereby, to a favorable clinical outcome.

Aetiology and diagnostics of paediatric hydrocephalus across Africa: a systematic review and meta-analysis

We aimed to identify the aetiological distribution and the diagnostic methods for paediatric hydrocephalus across Africa, for which there is currently scarce evidence. In this systematic review and meta-analysis, we searched MEDLINE (Ovid), the Cochrane Database of Systematic Reviews (Wiley), Embase (Ovid), Global Health (Ovid), Maternity & Infant Care (Ovid), Scopus, African Index Medicus (Global Index Medicus, WHO) and Africa-Wide Information (EBSCO) from inception to Nov 29, 2021. We included studies from any African country reporting on the distribution of hydrocephalus aetiology in children aged 18 years and younger, with no language restrictions. Hydrocephalus was defined as radiological evidence of ventriculomegaly or associated clinical symptoms and signs of the disorder, or surgical treatment for hydrocephalus. Exclusion criteria were studies only reporting on one specific subgroup or one specific cause of hydrocephalus. We also excluded conference and meetings abstracts, grey literature, editorials, commentaries, historical reviews, systematic reviews, case reports and clinical guidelines, as well as studies on non-humans, fetuses, or post-mortem reports. The proportions of postinfectious hydrocephalus, non-postinfectious hydrocephalus, and hydrocephalus related to spinal dysraphism were calculated using a random-effects model. Additionally, we included a category for unclear cases. Diagnostic methods were described qualitatively. To assess methodological study quality, we applied critical appraisal checklists provided by the Joanna Briggs Institute. The study was registered in Prospero (CRD42020219038). Our search yielded 3783 results, of which 1880 (49·7%) were duplicates and were removed. The remaining 1903 abstracts were screened and 122 (6·4%) full articles were sought for retrieval; of these, we included 38 studies from 18 African countries that studied a total of 6565 children. The pooled proportion of postinfectious hydrocephalus was 28% (95% CI 22-36), non-postinfectious hydrocephalus was 21% (95% CI 13-30), and of spinal dysraphism was 16% (95% CI 12-20), with substantial heterogeneity. The pooled proportion of hydrocephalus of unclear aetiology was 20% (95% CI 13-28). Our findings suggest that postinfectious hydrocephalus is the single most common cause of paediatric hydrocephalus in Africa. For targeted investments to be optimal, there is a need for consensus regarding the aetiological classification of hydrocephalus and improved access to diagnostic services. Rikshospitalet, Oslo University Hospital, Oslo, Norway.

Original Ventriculoperitoneal Shunt for Pediatric Hydrocephalus

Although the use of newly developed procedures such as endoscopic third ventriculostomy or coagulation of the choroid plexus has gradually expanded, ventriculoperitoneal(VP)shunts are still not obsolete. They are the most commonly performed surgery for treating pediatric hydrocephalus. Young neurosurgeons may frequently encounter this CSF diversion procedure in clinical practice. However, the VP shunt remains a failure-prone procedure, as exemplified by obstruction, infection, mechanical shunt failure, over drainage, and distal catheter site-specific failures. Therefore, surgery requires exquisite techniques, especially in the pediatric population, to meet the needs of the child's growth. This article sheds light on the refined methodology for pediatric VP shunting with meticulous details of the surgical technique. Neurosurgeons must always remember that appropriate ICP control has a major impact on patient development and that a stably functioning VP shunt can deliver the full potential of children with hydrocephalus.

Neuroendoscopic Third Ventriculostomy

Endoscopy is essential in less invasive surgery and its use has widely expanded in almost all surgical specialties. This procedure has also been adopted for neurosurgery. It is now introduced in skull base surgery, expanded from endoscopic transsphenoidal surgery, to remove pituitary tumors, assisting tumor removal or removing a tumor only with the endoscope; spine surgery; and endoscopic third ventriculostomy(ETV). ETV is now accepted as a standard technique for treating noncommunicating hydrocephalus. Currently, 1067 neurosurgeons are certified by the Japan Society for Neuroendoscopy, and endoscopic surgery is recognized as a typical treatment option. This article describes the surgical procedure for ETV, a basic procedure for pediatric hydrocephalus. It is important to master intraventricular manipulation using the endoscope. Also, certain tips must be implemented before and after the endoscopic procedure to avoid complications. It is also necessary to emphasize the difference between adult cases, such as high risk of cerebrospinal fluid leakage in child cases. So that every single effort must be done to avoid this leak.

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers - A systematic review and meta-analysis.

Ventriculoperitoneal shunt (VPS) insertion and endoscopic third ventriculostomy (ETV) are common surgical procedures used to treat pediatric hydrocephalus. There have been numerous studies comparing ETV and VPS, but none from an African perspective. In this study, we sought to compare outcomes from African neurosurgical centers and review the associated complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on treatment successes and failures for ETV and VPS were pooled together and analyzed with a binary meta-analysis. A clinically successful outcome was defined as no significant event or complication occurring after surgery and during follow-up (e.g., infection, failure, CSF leak, malfunction, and mortality). Seven studies fully satisfied the eligibility criteria and were used in this review. There was no statistically significant difference between the outcomes of ETV and VPS (OR- 0.27; 95% CI -0.39-0.94, P = 0.42). After reviewing the rates of complications of ETV and VPS from the identified studies, four were recurrent. The infection rates of ETV versus VPS were 0.02% versus 0.1%. The mortality rates were 0.01% versus 0.05%. The reoperation rates were 0.05% versus 0.3%, while the rates of ETV failure and shunt malfunction were 0.2% versus 0.2%. This study concludes that there is no significant difference between the outcomes of ETV and VPS insertion.

Automatic determination of ventricular indices in hydrocephalic pediatric brain CT scan

ObjectiveHydrocephalus which is defined as excessive accumulation of cerebrospinal fluid in brain, is one of the most critical entities in pediatric neurosurgery; as it could result in severe developmental delay and neurologic deficits. Imaging evaluation of brain ventricular system is important for clinical decision-making in pediatric hydrocephalus. Manual measurement of linear ventricular indices is encumbered with human errors. Automatic measurement of these parameters would increase measurement reliability. The authors aimed to develop an accurate automatic algorithm for calculating pediatric, ventricular indices in brain computerized tomography)CT(scan slices. MethodsThe study cohort consisted of 30 brain CT scans of hydrocephalic children treated in Mofid Children hospital, Tehran, Iran. Various indices of ventricle were calculated automatically using GrabCut image segmentation algorithm for each patient and compared with manual assessment data which were measured by pediatric neurosurgeon. Data accuracy was assessed using Student’s t-test. Model application in asymmetrical ventricular anatomy and in patients with history of shunt insertion was assessed in the last step. ResultsThe proposed model was able to measure ventricular indices by accuracy of 94 to 97 %. It was also reliable in asymmetrical brain ventricles and presence of shunt hardware. Our results showed there were not any significant statistical differences between these patients and other patients (asymmetrical brain ventricles with p≥0.3190 and presence of shunt hardware with p≥0.1489). ConclusionThe authors present an automatic intelligence-based model for calculating different ventricular indices in pediatric hydrocephalus population with acceptable accuracy. This model could be adopted to the real-time clinical evaluation of hydrocephalus and improve clinician work flow in emergent neurosurgical situations or in developing countries, where brain CT scan is the most common brain imaging modality.

Neurosurgical shunt treatment of pediatric hydrocephalus: epidemiology and influencing factors on revision surgeries: a single-center retrospective analysis of 131 patients.

Paediatric hydrocephalus is a result of a dysfunction of cerebrospinal fluid circulation, and it has diverse pathogeneses. This study investigates the epidemiology of paediatric hydrocephalus, as well as the influences of primary aetiology 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 posthaemorrhagic. 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 (IQR25-75: 0.00-0.68) and was influenced by aetiology (p = 0.045) and valve type (p = 0.029). The highest rates were seen in patients with posthaemorrhagic 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 paediatric shunt patients. With the assessment of patients' risk profiles, physicians can classify paediatric 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.

Clinical and Radiological Outcome after Endoscopic Third Ventriculostomy with or without Choroid Plexus Cauterization in Management of Pediatric Hydrocephalus

Clinical and Radiological Outcome after Endoscopic Third Ventriculostomy with or without Choroid Plexus Cauterization in Management of Pediatric Hydrocephalus