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Prognosis regarding shunt revision and mortality among hydrocephalus patients below the age of 2 years and the association to patient-related risk factors

  • Original Article - Pediatric Neurosurgery
  • Published:
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Abstract

Background

Little is known about the prognosis regarding shunt revision and mortality among hydrocephalus patients below 2 years of age. The aims of this study were to investigate (1) the cumulative risks of shunt revision (SR) and mortality and (2) the potential associations between prematurity, low weight for gestational age (LWGA), underlying aetiology, sex, age of the child at shunt placement, and the risk of SR.

Method

This was a purely register-based cohort study including all shunted hydrocephalic infants in Denmark 1996–2015. The cumulative risks of SR and mortality were estimated using the Aalen-Johansen and Kaplan-Meier estimators, respectively. A multivariable Cox-regression model was used to estimate hazard ratios (HRs) for SR according to the listed patient-related risk factors.

Results

Among 374 shunted infantile hydrocephalus patients accounting for 1047 SRs, the 3-month and 1-year cumulative risks of SR were 36% and 50%, respectively. The overall 10-year cumulative mortality was 12%, and for non-tumour subgroups 7–16% (isolated hydrocephalus 7%). The 10-year cumulative mortality for children born with LWGA was 21%. Except for aetiology, we observed no strong overall associations between the investigated risk factors and the risk of SR but interaction analyses for aetiology showed that patients with Dandy-Walker malformation born with LWGA had a higher risk of SR compared to patients of similar aetiology with normal WGA (HR 2.47, 95% CI: 1.39–4.40).

Conclusions

We found very high cumulative risks of SR and mortality among this youngest group of hydrocephalus patients, disregarding aetiology, but none of them were strongly related to the investigated risk factors.

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Abbreviations

GA:

Gestational age

LWGA:

Low weight for gestational age

PIVH:

Perinatal intraventricular haemorrhage

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Acknowledgements

We thank for the continuous support from the research environment at Department of Epidemiology Research, Statens Serum Institut, Copenhagen. Equally, we thank for the continuous support and interest from the clinical neurosurgical environment at Department of Neurosurgery, Copenhagen University Hospital. The study was supported by grants from Dagmar Marshalls Foundation and The Aase and Einar Danielsen Foundation, both private philanthropic foundations.

Funding

The study was supported by grants from Dagmar Marshalls Foundation and The Aase and Einar Danielsen Foundation. The foundations had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark

    Tina Nørgaard Munch, Sanne Gørtz, Jan Wohlfahrt & Mads Melbye

  2. Department of Neurosurgery, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark

    Tina Nørgaard Munch & John Hauerberg

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Tina Nørgaard Munch & Mads Melbye

  4. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Mads Melbye

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  1. Tina Nørgaard Munch
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Correspondence to Tina Nørgaard Munch.

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The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required. All data in this study were handled in accordance with the Danish law of data protection, and purely register-based studies do not require ethical approval. The individual CPR numbers are encrypted as standard, and all analyses were performed and presented as aggregated data. In accordance with these requirements, all numbers below five individuals are presented as < 5 in both text and tables. Thus, no personally identifiable data was presented.

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Munch, T.N., Gørtz, S., Hauerberg, J. et al. Prognosis regarding shunt revision and mortality among hydrocephalus patients below the age of 2 years and the association to patient-related risk factors. Acta Neurochir 162, 2475–2485 (2020). https://doi.org/10.1007/s00701-020-04299-5

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  • DOI: https://doi.org/10.1007/s00701-020-04299-5

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