Study Analyzes the Efficacy of Ventriculopleural Shunt Placement in Children with Hydrocephalus

Newswise — Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. While it most commonly affects infants and older adults, it can occur in toddlers and older children. Hydrocephalus symptoms in toddlers/children include: abnormal enlargement of the head, headache, nausea, vomiting, fever, blurred or double vision, unstable balance, irritability, sleepiness, delayed progress in walking or talking, poor coordination, change in personality, inability to concentrate, loss of sensory motor functions, seizures, or poor appetite. Older children may experience difficulty in remaining awake or waking up. A large majority of children with myelomeningocele (a condition related to spina bifida) have associated hydrocephalus.

An estimated 2,000 cases of congenital hydrocephalus occur each year in the United States. Based on sample pediatric patient U.S. hospital data, an estimated 10,000 shunt procedures are performed annually. Direct treatment-related costs for patients of all ages with hydrocephalus exceed $1 billion annually in the United States.

Venticuloperitoneal shunts remain the standard of care for the treatment of hydrocephalus. However, for those older children who suffer from abdominal problems such as pseudocyst, adhesions, and/or peritonitis, ventriculopleural shunting is a viable alternative for the treatment of hydrocephalus.

Ventriculopleural shunting is not without risk of complications. Pleural effusions (excess fluid in the pleural cavity of the lungs), empyemas (areas of the lung filled with pus and fluid from infected tissue), and tension pneumothorax (life-threatening deterioration of a collapsed lung) can result from ventriculopleural shunting.

Researchers evaluated 105 children with ventriculopleural shunts placed at Children's Hospital Los Angeles over a 30-year period. The results of this study, Ventriculopleural Shunts in Children: A Single Institution's 30-Year Experience, will be presented by Parham Yashar, MD, 3:30 to 3:44 pm, Monday, May 4, 2009, during the 77th Annual Meeting of the American Association of Neurological Surgeons in San Diego. Co-authors are Cherisse Berry, MD, J. Gordon McComb, MD, and Gabriel Zada, MD.

"This study respresents the largest case series of ventriculopleural shunts in children age 8 and older with hydrocephalus and provides an invaluable efficacy assessment tool," stated Dr. Yashar.

"¢From 1977-2008, 105 children with hydrocephalus were treated with ventriculopleural shunts. "¢The mean age for ventriculopleural placement was 13.26 years +/- 5.17.

"¢Males treated: 61 percent; Females treated: 39 percent.

"¢The leading cause of hydrocephalus was myelomeningocele (37.14 percent).

"¢Patients with a history of abdominal infections (such as peritonitis or pseudocyst) represented the most common indication for placement of a ventriculopleural shunt.

Data was collected retrospectively from the patients' clinical records. The following results were noted:

"¢In 45.7 percent of the patients, there were no complications from placement of the ventriculopleural shunt. However, 12.4 percent of the patients developed a symptomatic pleural effusion.

"Given that nearly half of the patients in this series did not develop any complications from placement of ventriculopleural shunts, we believe that placement of these shunts for the treatment of hydrocephalus is a safe alternative to ventricuperitioneal and ventriculoatrial shunts in children age 8 and older," concluded Dr. Yashar.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,400 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.

The author reports no conflict of interest.

Media Representatives: If you would like to cover the meeting or interview a neurosurgeon " either on-site or via telephone " please contact the AANS Communications Department at (847) 378-0517 or call the Annual Meeting Press Room beginning Monday, May 4 at (619) 525-6252.