Shunt revision in hydrocephalus |
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Authors: | Raj Kumar Vinita Singh Marakani V K Kumar |
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Institution: | (1) Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 UP, India;(2) Department of Neuroanaesthesiology, King George’s Medical University, Lucknow, India |
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Abstract: | Objective : A retrospective analysis of 50 hydrocephalic children having a minimum follow-up of 6 months was carried out to see their
etiology, clinical features, complications, incidence of shunt revisions, outcome and the variation from their Western counterparts.Methods : Clinical features, image findings and treatment of all the cases were recorded from their discharge summaries. Record of
shunt revision complications and outcome was maintained by the principal author. The data of all the cases were analyzed.Results : The age of children varied from 1 month to 12 yr (mean 2.2 yr). The most common etiology of hydrocephalus was aqueductal
stenosis in 18 (36%) children. Post infective hydrocephalus, either of post-tubercular meningitis (TBM) or following bacterial
meningitis, remained the cause in 15 children (30%). Congenital TORCH infection was responsible for 3 cases of hydrocephalus
making infective etiology as the cause in 18 (36%) cases. Intra 4th ventricular neurocysticercus cyst caused blockade of CSF pathway in 2 children. 15 out of 50 children required shunt revision,
either due to infection (8,16%) or shunt obstruction (7, 14%). Multiple shunt revisions were required in 2 children only.
These revisions were required due to infection, obstruction or malfunction of the shunt.Conclusions : Infective etiology is responsible for hydrocephalus in significant number of children (36%). The possibility of TORCH infection,
as a cause of hydrocephalus should be considered even amongst the children of screened mothers during antenatal check-up.
Pure intra 4th ventricular neurocysticercus cysts (without intraparenchymal cyst), though rare, can manifest with outlet obstruction. Incidence
of shunt revision using Chhabra’s medium pressure shunt is very high in children at an average follow up of 1.6 yr. Post infective
hydrocephalus is a major cause of delayed milestones, contributing to mental retardation. |
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Keywords: | Hydrocephalus Etiology Complication Shunt revision |
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