Pediatric hydrocephalus outcomes: a review

Pediatric hydrocephalus (HC) is a surgical disease. If left untreated, most cases are lethal [1]. With present-day standard of care, most patients with HC will survive; however, death from hydrocephalus still exists [2,3], and the sequelae among long-term survivors are frequent and often severe [4]. Because of the multiplicity of causes of hydrocephalus, associated diseases, complications of treatment, and the inherent complexity of the patient population, reliable data on outcomes are difficult to obtain. The outcome of hydrocephalic patients has been the subject of many studies, some presenting conflicting results, and many focusing on a limited view of this vast field. Among the questions asked by legitimately anxious parents, and sometimes by the patient himself, are: what are the risks of complication of surgery? What are the risks that my child dies of this disease? What are the sequels that my child might suffer? We shall therefore categorize hydrocephalus outcomes under the following broad headings: surgical outcome (shunt half-life, rate of shunt malfunction, rate of infection, and the issue of shunt-independence) and complications of endoscopy; mortality (shunt-related as well as related to other causes); morbidity (cognition, motor system, vision, epilepsy, neuroendocrine problems and fertility, chronic headache); and functional social outcome (schooling, social integration, marital status). The present review aims to discuss these different facets of outcome in pediatric hydrocephalus, review the available literature on the topic and identify the gaps in our present knowledge. We will try to identify predictive factors for outcome and to define what are the medical needs for this population in the future, especially when they become adults, how to evaluate them, and which guidelines can be proposed for follow-up.Shunt failure can be aseptic (malfunction) or septic (shunt infection). Malfunction includes obstruction, overdrainage, underdrainage, and occul