Zhang Yi,Shen Chun,Xue Ping,et al.Effect of prenatal examination and surgical strategy for shunt outcome in neonatal hydrocephalus[J].Journal of Clinical Pediatric Surgery,,21():815-819.[doi:10.3760/cma.j.cn101785-202204092-004]
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Effect of prenatal examination and surgical strategy for shunt outcome in neonatal hydrocephalus

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第21卷 Number: 2022 09 Page: 815-819 Column: 专题·出生结构缺陷的早期干预 Date of publication: 2022-09-28
Author(s):
Zhang Yi1;  Shen Chun2;  Xue Ping1;  Zhao Rui1;  Shi Wei1;  Li Hao1
1. Department of Neurosurgery, Affiliated Children’s Hospital of Fudan University, Shanghai 201102, China;
2. Department of Neonatal Surgery, Affiliated Children’s Hospital of Fudan University, Shanghai 201102, China
Keywords:
Hydrocephalus/SU; Infant;  Newborn; Prenatal Diagnosis/MT; Cerebral Revascularization
DOI:
10.3760/cma.j.cn101785-202204092-004
Abstract:
Objective To explore the relationship of prenatal examinations, surgical strategies and the occurrences of shunt dysfunction in children with neonatal hydrocephalus undergoing ventriculoperitoneal shunt (VPS) and identify the related risk factors.Methods From January 2013 to August 2020, 53 children undergoing VPS due to neonatal hydrocephalus were recruited.They were divided into two groups according to the occurrence of shunt dysfunction.General profiles of pregnant women, complications during pregnancy, fetal complications, causes, imaging features and surgical approaches were compared between two groups.Through univariate, multivariate and survival curve analyses, the related influencing factors of therapeutic outcomes were summarized.Results During a mean follow-up of 54(27-112) months, 16 cases developed shunt dysfunction.Univariate analysis indicated that children with post-hemorrhagic/infected hydrocephalus (P=0.04) and those with a high level of cerebrospinal fluid protein had a higher incidence of shunt dysfunction (P=0.002).And children with frontal puncture (P=0.04) and strata shunt valve (P=0.02) had a lower incidence of shunt dysfunction.Congenital hydrocephalus was detected during prenatal examinations (6/8) and cesarean section predominated (6/8).For secondary hydrocephalus (after hemorrhage & infection), no fetal abnormality (35/37) was detected during prenatal examinations.However, there were many pregnancy complications and most of them had vaginal delivery (34/36).Multivariate analysis showed that preoperative protein level of cerebrospinal fluid (OR:2.198, 95%CI:1.015-4.758, P=0.04) and ventricular entry site (OR:3.600, 95%CI:1.257-7.088, P=0.03) were risk factors for the occurrence of shunt dysfunction.Conclusion In neonatal hydrocephalus, congenital hydrocephalus is more common in term delivery with a high prenatal diagnostic rate and a low incidence of shunt dysfunction.Secondary hydrocephalus is more likely to be premature, with more complications of prenatal pregnancy and a high incidence of shunt dysfunction.The use of frontal puncture can improve the success rate of ventriculoperitoneal shunt in neonatal hydrocephalus.

References:

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Memo

收稿日期:2022-04-29。
基金项目:国家自然科学基金（82101810）
通讯作者:李昊,E-mail:li_hao@fudan.edu.cn

Last Update: 1900-01-01