Surgical Treatment for Pediatric Hydrocephalus: a Report of 163 Clinical Cases in a Single Center

Surgical Treatment for Pediatric Hydrocephalus: a Report of 163 Clinical Cases in a Single Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Surgical Treatment for Pediatric Hydrocephalus: a Report of 163 Clinical Cases in a Single Center Lin Yan, Chengyue Zhang, Shikuan Ding, Quan Cheng, Jian He, Zhiping Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1401292/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives: Surgical treatment is the preferred treatment for pediatric hydrocephalus. The analysis of the outcome of pediatric hydrocephalus surgery and its complications is limited by the lack of available data. Our goal was to better understand the effectiveness of surgery and to explore better surgical treatment methods and management of complications. Methods: 163 patients with pediatric hydrocephalus were included. A retrospective chart review was performed on all patients. Data collected included surgical techniques, number of surgical treatments, complications, and basic demographics. Results: There were 163 patients in this group including 103 males and 60 females. Among the patients, 106 (106/163, 65.0%) patients received ventricular peritoneal shunt (VP), 7 (7/163, 4.3%) patients received ventricle-right atrium shunt (VA) and 50 (50/163, 30.7%) patients received endoscopic third ventriculostomy (ETV). Among the patients who received VP, 74 (74/163, 45.4%) patients were cured and 32 (32/163, 19.6%) patients underwent surgery again. Among the patients who received VA, 38 (38/163, 23.3%) patients were cured and 12 (12/163, 7.4%) patients underwent surgery again. Among the patients who received ETV, 3 (3/163, 1.8%) patients were cured and 4 (4/163, 2.5%) patients underwent surgery again. The most common complication is shunt-related peritonitis or abdominal abscess, abdominal end obstruction (17/163，10.4%). Conclusion: A single surgery can cure most patients, and sometimes more than one surgery is required. For pediatric hydrocephalus, ETV is more efficient and has fewer surgical complications. However, the management of unrelieved symptoms and related complications after ETV surgery and bypass surgery should still be taken seriously. Hydrocephalus Pediatric hydrocephalus Surgical treatment Complication Outcome Figures Figure 1 Introduction Hydrocephalus refers to the state of excessive accumulation of cerebrospinal fluid in the cerebral ventricle system and/or subarachnoid space caused by excessive secretion of cerebrospinal fluid blocked circulation or impaired absorption caused for various reasons [ 27 ]. It is often accompanied by ventricular enlargement, a corresponding decrease in brain parenchymal, and increased intracranial pressure [ 9 ]. The incidence rate of hydrocephalus in the population is unclear, while the prevalence rate is 1.0%-1.5% [ 5 , 21 , 25 ]. Hydrocephalus is mostly sporadic without gender differences, and infants (congenital hydrocephalus mostly) and seniors over 60 (idiopathic normal pressure hydrocephalus mostly) are shown as two prone age groups [ 26 , 28 ]. In newborns, children, and adolescents, pediatric hydrocephalus is the most prevalent surgically correctable neurological problem[ 23 ]. Hydrocephalus affects one out of every 500 children, according to some estimates. Genetic causes like X-linked aqueductal stenosis, congenital causes like myelomeningocoele and Chiari malformation, and acquired causes like intraventricular hemorrhage, trauma, malignancies, and infection all contribute to this syndrome [ 8 ]. The symptoms vary with the age of onset of the child and mainly include irritability, developmental delay, headache and vomiting, drowsiness, epilepsy, etc. Surgical treatment is the preferred treatment for hydrocephalus. In recent years, the progress in the surgical treatment of hydrocephalus has mainly manifested in the application of anti-gravity and programmable shunt valves and EVP performance [ 2 , 4 ]. However, the incidence of complications and failure rate of hydrocephalus is still as high as 40% 1–2 years after the operation, while the failure rate is even up to 98% in the last 10 years [ 32 ]. This study explores the clinical characteristics of patients with pediatric hydrocephalus, surgical methods, and the management of postoperative complications to strengthen the understanding of clinicians about the surgical treatment of hydrocephalus and discuss the choice of surgical treatment methods for hydrocephalus and the management of postoperative complications. Methods General data A total of 163 patients with pediatric hydrocephalus received surgical treatment in the department of neurosurgery, Xiangya Hospital, Central South University between January 1, 2016, and December 30, 2019, were included. The patients all met the Evan’s Index (The distance between the anterior horn of the bilateral lateral ventricle/the length of the intracranial cavity in the same plane < 0.3) [ 18 ], with corresponding symptoms of hydrocephalus and intracranial hypertension being used as the primary reference index for judging hydrocephalus (patients with intracranial tumors complicated by hydrocephalus were not included in the study). All patients received head CT or MRI imaging before surgery, and some of them received lumbar puncture surgery, with clear indications for surgery. Surgical procedures All cases were diagnosed by CT or MRI before surgery and received lumbar puncture to consummate preoperative assessment whether accompanied by hydrocephalus or intracranial hypertension symptoms or not, and lumbar puncture was performed to consummate preoperative assessment. According to different imaging manifestations, lumbar puncture pressure, we determined the causes of hydrocephalus and adopted different ways of operation. Ward 36 of the neurosurgery department in our hospital mainly assumed VP, ETV, and VA as operation methods. For shunt surgery, the operating room set-up, patient positioning, skin preparation, disinfection, and draping are all critical to good results and prognosis. As for the active room set-up, Maurice Choux formulated the "shunt principle" as early as 1992 (especially for infant patients) [ 3 ]. For VP, we take a crucial incision in the dura and connect it to a small incision in the peritoneum by the shunt system. For VA, we just replace the dural incision with an incision over the internal jugular vein and its branches. For EVT, we make the triple ventricular floor fully accessible to the basal cistern. Preoperative MRI cerebrospinal fluid flow imaging will be added to patients in our department to observe whether the base of the third ventricle is bulging downward or sagging and whether the flow of cerebrospinal fluid in the mesencephalic aqueduct is unobstructed to aid in differentiation [ 29 ]. For patients with typical symptoms of normal pressure hydrocephalus, our department performs a preoperative cerebrospinal fluid tap test to assess the prognosis of the patient, whose specific operation is to administer a single dose of 40-60ml of cerebrospinal fluid at a single time and observe the improvement of the patient's symptoms 24–48 hours after the fluid release [ 33 ]. According to the Japanese Neurosurgical Association's guidelines for the management of idiopathic normal pressure hydrocephalus (NPH) [ 16 ] and the American Idiopathic NPH Study Group's guidelines [ 20 ], the positive predictive value of the fluid release test is 73%-100%. The classification of hydrocephalus is a guide to the choice of surgical approach. Statistical analysis In this study, we analyzed the clinical data of pediatric hydrocephalus patients admitted to the pediatric Neurosurgery Department of Xiangya Hospital between January 1, 2016, and December 31, 2019. Statistical analysis included surgical techniques, number of surgical treatments, complications, and basic demographics. SPSS software was used for the statistical analysis of the research data. Enumeration data were described by the number of cases (percentage). Results Patients Data were collected from 163 patients who underwent surgical treatment between January 1, 2016, and December 31, 2019. Of these 163 patients, 103 cases (63.2%) were male while 60 cases (36.8%) were female. The youngest patient was 0 years old and the oldest was 18 years old, and the average age of the patients was 5.8 ± 1.1 years. (Table 1) Among the 163 patients, 48 cases underwent more than one surgical procedure given the surgical outcome. A total of 211 surgeries were conducted. Surgical treatment of hydrocephalus 106 patients received VP at the first operation, among which 17 cases were readmitted due to shunt-related peritonitis or abdominal abscess, abdominal end obstruction (caused by ascites, abdominal infection, etc.), 16 of which received left lateral VP after the removal of abdominal end extraction, including 3 cases whose postoperative symptoms were still not relieved changing to have left lateral VP with prognosis good after follow-up, and 1 case that did not have shunt surgery after the removal of the whole shunt device with prognosis good after follow-up; 6 cases were readmitted due to shunt-related cerebrospinal fluid infection or meningitis, all of which underwent brain outdoor drainage after shunt tube removal, 4 of them with ventricular empyema were subjected to endoscopic ventricular irrigation, ETV and choroid plexus burning, 3 of which had a good prognosis, 1 of which died due to severe intracranial infection, and 2 of 6 cases did not undergo related surgery with a good prognosis after follow-up; 5 cases immediately underwent re-operative adjustment because of primary misplacement of the catheter during operation with prognosis good after follow-up; 4 patients were readmitted due to ventricular end obstruction of shunt, 2 of which underwent re-operative adjustment due to ventricular end prolapse with prognosis favorable after follow-up, and the other 2 cases received reoperation to replace the shunt to due to ventricular end obstruction and longtime of shunt placement with prognosis good after follow-up; the remaining 74 cases relieved relative symptoms and had a good prognosis after VP at the first operation, and did not undergo surgery again. There were 7 cases received VA at the first operation; 2 of them were readmitted and changed to have left lateral VP because of right atrial end obstruction; 1 of them underwent re-operative adjustment immediately due to postoperative review of atrial end overlong, with prognosis good after follow-up; 1 case with ventricular empyema received endoscopic ventricular irrigation, ETV and choroid plexus burning, and had left lateral VP, with prognosis favorable after follow-up; the remaining three patients relieved related symptoms and had a good prognosis after VA at the first operation, and did not have surgery again. 50 patients received ETV at the first operation, 12 of them were readmitted on account of unrelieved symptoms, among which 8 cases received VP for the second operation with a favorable prognosis after follow-up. 3 patients received VA due to cerebrospinal fluid infection with prognosis good after follow-up, 1 case with ventricular empyema underwent endoscopic irrigation and choroid plexus burning, and no shunt operation was performed, with related symptoms relieved and good prognosis after discharge; the remaining 38 patients had reduced associated symptoms and a favorable prognosis after ETV and did not have surgery again. The surgical treatments performed on 163 patients are shown. Here is a case of hydrocephalus, treatment, and follow-up. (Table 2) (Fig. 1 ) Surgical complications Complications were present in the series, including intraoperative complications, infection, and postoperative complications. Detailed complications are shown. (Table 3) Discussion The burden of pediatric hydrocephalus is significant: hydrocephalus can affect development as well as the overall quality of life. Hydrocephalus affects a disproportionate number of children who are admitted to hospitals [ 17 ]. There are effective surgical treatments that can protect and improve quality of life; nevertheless, these do not come without risks and failures. The need for advancements in surgical interventions is generally recognized. It is recognized that, while hydrocephalus problems appear simple, they are highly complex [ 8 ]. Nonetheless, there is agreement that current management may result in frequent complications, low shunt survival rates, and poor patient quality of life, resulting in disappointing outcomes [ 31 ]. At present, we prefer shunt surgery as the first choice of surgical treatment in these patients. Given a choice between VA and VP, the authors still prefer VP. The reason was that VP (69.8%) had a much higher healing rate than VA (14.3%), even though the rate of surgery-associated complications was slightly higher in VP (25.6%) than in VA (12.9%), and the potential complications of VA are more serious [ 11 ], especially in those who are elderly and have multiple underlying diseases, heart-associated difficulties tend to be more dangerous. However, if the patient has contraindications to VP (such as ascites, cholecystitis), VA is undoubtedly an appropriate choice. In addition, patients who received both VP and VA had a higher percentage of patients who underwent more than one surgical treatment (18/38, 37.5%), and all of them healed, suggesting a shift to studies on the use of VP in combination with VA. In the past 10 years, our experience with ETV has accumulated, and the procedure is currently considered safe and easy [ 10 , 19 ]. In our observation, ETV showed the highest healing rate (76%) and the lowest rate of surgery-associated complications (9.1%) among the three surgical treatments we mainly used. The effectiveness and reliability of ETV suggest that we should make ETV a focus of future studies. Meanwhile, the combination of VP (VA) (11/50, 22%) after ineffective ETV treatment had a significant effect on patient healing, with all patients who had received ETV and VP (VA) sequentially healed. However, there is perhaps a greater risk of treatment with ETV after ineffective treatment with VP(VA) first, and the only death among 163 patients occurred in this case. For obstructive hydrocephalus, the efficiency of ETV is high, even up to 95% [ 15 ]. Nevertheless, even in obstructive hydrocephalus, successful ETV does not mean a cure. There are a great many reports of occlusion of the stoma [ 7 , 15 ], and some of these patients suddenly deteriorated [ 1 ]. But ETV is not recommended for idiopathic NPH without considering its subtypes (e.g. InfinOH [ 12 ]). Clinicians should be careful not to settle for partial remission of symptoms after ETV and forgo treatment that might further improve symptoms. The complications of surgery and their corresponding management are the issues we pay the most attention to. The most common complication is shunt-related peritonitis or abdominal abscess, abdominal end obstruction (17/163, 10.4%), followed by shunt-related cerebrospinal fluid infection or meningitis (6/163, 3.7%). We have summarized the common surgical complications and their corresponding management as follows (Table 4) . Intraoperative complications, which only refer to the incorrect placement of the primary catheter during the operation, mainly occur at the ventricular end of the shunt [ 30 ]. The authors concluded that CT and abdominal X-ray films should be reviewed promptly after shunt surgery. When the catheter is poorly positioned, the catheter position should be adjusted as early as possible while the patient is generally well. Infections associated with shunts can be divided into three categories: shunt colony formation, shunt-associated cerebrospinal fluid infection or meningitis, and shunt-associated peritonitis or abdominal abscess. The appearance of colonies around the shunt comes from the following: 1. Direct contact between the skin and the shunt before or during shunting; 2. During the process, skin flora was inserted from the wound site [ 6 ], the skin protective film can prevent the former. At the same time, the latter can be avoided by increasing the speed of surgery, using some surgical techniques to reduce tissue damage, and applying the "principle of nonmaleficence" [ 24 ] (e.g. try to wait for the shunt to be used before opening the package). In general, as soon as a shunt colony forms, cerebrospinal fluid infection is bound to occur sooner or later [ 22 ], so once there is sufficient reason to suspect shunt colony formation in our department, even if there is no cerebrospinal fluid infection, meningitis, or general infection symptoms, we will remove the shunt promptly and then observe the prognosis of the patient to decide whether to perform shunt surgery again. For hunt-related cerebrospinal fluid infection or meningitis, if this occurs, our treatment is to remove the shunt promptly, drain the ventricle ipsilaterally or contralaterally, and swiftly perform a bacteriological examination of the cerebrospinal fluid and the tip of the shunt. Once the bacterial infection is identified, systemic and intrathecal antibiotics should be promptly applied according to the drug sensitivity. Postoperative complications mainly include inadequate shunt, excessive shunt, and shunt dysfunction. In such cases, we can clarify the specific cause by imaging and palpating the shunt function and then replacing the part of the shunt device according to the situation. In recent years, our department has been using programmable shunt valves. For patients with inadequate shunt and excessive shunt, we can adjust the pressure of the shunt valve first, and if the patient's symptoms still do not improve, it is necessary to look for other causes of shunt dysfunction carefully. We can clarify their classification by preoperative CT, MRI, cerebrospinal fluid flow imaging, and cerebrospinal fluid tap tests for patients with hydrocephalus. For obstructive hydrocephalus, ETV is more efficient, safe, and easy [ 14 ]. However, ETV is not recommended for patients with NPH if they do not take their specific subtype (e.g., InfinOH) into consideration. The NPH occurs mainly in people aged 65 years or older, and its primary clinical features are ventricular enlargement (Evan's index ≥ 0.3) and Hakim's triad (walking instability, dementia, and urinary incontinence). Such patients can choose a lumbar puncture fluid release experiment for preoperative evaluation. Their surgical treatment is VP, and the shunting of cerebrospinal fluid is safe and effective, and about 75% of patients can be effective for a long time [ 13 ]. The best treatment outcome is achieved when the shunt is performed early in the disease [ 18 ]. In addition, we should not blindly insist on a single surgical method of bypass or fistula for different patients but should consider the best surgical option after the failure of the preferred surgery. Early detection, timely surgical intervention, standardized surgical operation, and regular follow-up of discharged patients should be conducted to treat unrelieved symptoms and related complications after ETV and shunt surgery. Limitation The evaluation of our given patient series may be less representative due to the relatively small group size due to a lack of cases for a brief period even in a large volume pediatric neurosurgery facility unit. Furthermore, due to the variability of the treated pediatric hydrocephalus and the small number of each histological entity, major inferences concerning long-term prognosis and survival cannot be drawn. Conclusion A single surgery can cure most patients, and in a few cases more than one surgery is required. For pediatric hydrocephalus, ETV is more efficient and has fewer surgical complications. However, the management of unrelieved symptoms and related complications after ETV surgery and bypass surgery should still be taken seriously. Abbreviations VP = ventricular peritoneal shunt; ETV= endoscopic third ventriculostomy; VA= ventricle-right atrium shunt; NPH= normal pressure hydrocephalus Declarations Acknowledgment I would like to express my gratitude to all those who helped us during the writing of this manuscript and thanks to all the peer reviewers for their opinions and suggestions. Funding This work was supported by National Natural Science Foundation of China (No. 82171347), the Scientific Research Project of Hunan Provincial Health Commission of China (No. 202204040024), and the Students Innovations in Central South University of China (No. S2021105330599, No. 2021105330046, No. XCX2021035). Ethics approval The research project was reviewed and approved by No. 20200312 of the Ethic Committee of the Xiangya Hospital of Central South University and was conducted from January 2016 to December 2019. Consent to participate All participants provided written informed consent. Conflicts of interest/Competing interests The authors declare no conflict of interest. Consent for publish All authors have read and approved the content and agree to submit this manuscript for publication consideration to your journal. Authors' contributions LY collected the related paper. YCW, CYZ, SKD, QC, JH, ZPZ, and JPL drafted and revised the manuscript. YCW and GLX participated in the design of the article and helped to draft and revise the manuscript. All authors read and approved the final manuscript. References Bouras, T. and S. Sgouros. (2012) Complications of endoscopic third ventriculostomy: a systematic review. Acta Neurochir Suppl 113:149-53. https://doi.org/10.1007/978-3-7091-0923-6_30 Capion, T., et al. (2020) Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey. Acta Neurochir (Wien) 162:1363-1370. https://doi.org/10.1007/s00701-020-04317-6 Choux, M., J. Camboulives, and F. Rigaut. (1992) [Prevention of infections in ventriculoperitoneal shunts in children]. Ann Fr Anesth Reanim 11:699-704. https://doi.org/10.1016/s0750-7658(05)80793-2 Chung, D.Y., et al. (2017) Management of External Ventricular Drains After Subarachnoid Hemorrhage: A Multi-Institutional Survey. Neurocrit Care 26:356-361. https://doi.org/10.1007/s12028-016-0352-9 Connolly, E.S., Jr., et al. (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43:1711-37. https://doi.org/10.1161/STR.0b013e3182587839 Craven, C.L., et al. (2019) Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery : A Technical Note. J Korean Neurosurg Soc 62:123-129. https://doi.org/10.3340/jkns.2017.0282 Fabbro, S., et al. (2020) Late-onset occlusion of the Monro foramina after endoscopic third ventriculostomy in adults: Case discussion and review of the literature. Surg Neurol Int 11:326. https://doi.org/10.25259/SNI_519_2020 Flannery, A.M. and L. Mitchell. (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. Journal of Neurosurgery: Pediatrics 14:3-7. Hao, X. and D. Wei. (2019) The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Medicine (Baltimore) 98:e15970. https://doi.org/10.1097/MD.0000000000015970 Hellwig, D., et al. (2005) Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev 28:1-34; discussion 35-8. https://doi.org/10.1007/s10143-004-0365-2 Hung, A.L., et al. (2017) Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 157:1-6. https://doi.org/10.1016/j.clineuro.2017.03.014 Kehler, U. and B. Eckert. (2008) INFINOH–Infratentorieller intrazisternaler obstruktiver Hydrocephalus. Ein „neuer “Subtyp des kommunizierenden Hydrocephalus. Aktuelle Neurologie 35:P723. Larsson, A., et al. (1991) Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 84:475-82. https://doi.org/10.1111/j.1600-0404.1991.tb04998.x Lodha, K.G., et al. (2020) Endoscopic Third Ventriculostomy for Hydrocephalus in Infants: A Single-center Experience. Asian J Neurosurg 15:302-305. https://doi.org/10.4103/ajns.AJNS_17_20 Lu, L., et al. (2019) Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: Meta-Analysis of Randomized Controlled Trials. World Neurosurg 129:334-340. https://doi.org/10.1016/j.wneu.2019.04.255 Mori, E., et al. (2012) Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo) 52:775-809. https://doi.org/10.2176/nmc.52.775 Murphy, M., et al. (1998) Consensus development methods, and their use in clinical guideline development. Health Technology Assessment (Winchester, England) 2:i-88. Nakajima, M., et al. (2021) Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo) 61:63-97. https://doi.org/10.2176/nmc.st.2020-0292 Pande, A., et al. (2021) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. Neurosurg Rev 44:1227-1241. https://doi.org/10.1007/s10143-020-01320-4 Relkin, N., et al. (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57:S4-16; discussion ii-v. https://doi.org/10.1227/01.neu.0000168185.29659.c5 Sarfo, F.S., et al. (2020) Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study. J Neurol Sci 418:117158. https://doi.org/10.1016/j.jns.2020.117158 Tamber, M.S., et al. (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection. J Neurosurg Pediatr 14 Suppl 1:60-71. https://doi.org/10.3171/2014.7.PEDS14328 Tan, C., et al. (2021) The Pathogenesis Based on the Glymphatic System, Diagnosis, and Treatment of Idiopathic Normal Pressure Hydrocephalus. Clin Interv Aging 16:139-153. https://doi.org/10.2147/cia.S290709 Taylor, R.M. (2013) Ethical principles and concepts in medicine. Handb Clin Neurol 118:1-9. https://doi.org/10.1016/B978-0-444-53501-6.00001-9 Vinas Rios, J.M., et al. (2018) Predictors of hydrocephalus as a complication of non-traumatic subarachnoid hemorrhage: a retrospective observational cohort study in 107 patients. Patient Saf Surg 12:13. https://doi.org/10.1186/s13037-018-0160-6 Virta, J.J., et al. (2020) One-Year Outcome After Aneurysmal Subarachnoid Hemorrhage in Elderly Patients. World Neurosurg 143:e334-e343. https://doi.org/10.1016/j.wneu.2020.07.127 Wan, S., et al. (2021) Cerebrospinal Fluid from Aneurysmal Subarachnoid Hemorrhage Patients Leads to Hydrocephalus in Nude Mice. Neurocrit Care 34:423-431. https://doi.org/10.1007/s12028-020-01031-0 Wan, Y., et al. (2020) Effects of aging on hydrocephalus after intraventricular hemorrhage. Fluids Barriers CNS 17:8. https://doi.org/10.1186/s12987-020-0169-y Wang, C., et al. (2021) Novel therapeutics for hydrocephalus: Insights from animal models. CNS Neuroscience & Therapeutics 27:1012-1022. Wang, Y.-C., et al. (2021) Hydrocephalus after aneurysmal subarachnoid hemorrhage: epidemiology, pathogenesis, diagnosis, and management. Williams, M.A., et al. (2007) Priorities for hydrocephalus research: report from a National Institutes of Health–sponsored workshop. Journal of Neurosurgery: Pediatrics 107:345-357. Yengo-Kahn, A.M., et al. (2021) Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr :1-9. https://doi.org/10.3171/2020.11.Peds20806 Zhan, C., et al. (2020) Decreased MiR-30a promotes TGF-β1-mediated arachnoid fibrosis in post-hemorrhagic hydrocephalus. Transl Neurosci 11:60-74. https://doi.org/10.1515/tnsci-2020-0010 tables Tables 1 to 4 xlsx are available in the Supplemental Files section. Supplementary Files Table1.Demographicson163patientswith.xlsx Table2Surgicaltreatmentforpatients.xlsx Table3Surgeryassociatedcomplications.xlsx Table4Managementofcomplications.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1401292","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":89150368,"identity":"76927bdd-e78a-44ef-8483-8d0ac3440aae","order_by":0,"name":"Lin Yan","email":"","orcid":"","institution":"The Hospital of Hunan University of Chinese Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Yan","suffix":""},{"id":89150369,"identity":"99bef020-846f-468d-a03a-05cb3f53e15f","order_by":1,"name":"Chengyue Zhang","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chengyue","middleName":"","lastName":"Zhang","suffix":""},{"id":89150370,"identity":"4f6ad08d-0f40-4aef-94a4-4302631dd02b","order_by":2,"name":"Shikuan Ding","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shikuan","middleName":"","lastName":"Ding","suffix":""},{"id":89150371,"identity":"a78c77e0-0cb3-41fd-97ed-17b83518e702","order_by":3,"name":"Quan Cheng","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Quan","middleName":"","lastName":"Cheng","suffix":""},{"id":89150372,"identity":"9acdd553-babb-4cce-92e1-711c403924ae","order_by":4,"name":"Jian He","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"He","suffix":""},{"id":89150373,"identity":"52406ed6-4f52-4fcd-8bcd-11a5511cf674","order_by":5,"name":"Zhiping Zhang","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhiping","middleName":"","lastName":"Zhang","suffix":""},{"id":89150374,"identity":"6b8e9453-0c3e-41d0-a6f1-e117ca656212","order_by":6,"name":"Jingping Liu","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingping","middleName":"","lastName":"Liu","suffix":""},{"id":89150375,"identity":"722c7681-3470-444f-8307-4013cba80933","order_by":7,"name":"Yuchang Wang","email":"","orcid":"","institution":"Xiangya Hospital, Central South University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yuchang","middleName":"","lastName":"Wang","suffix":""},{"id":89150376,"identity":"5c6d845e-be33-4c01-85c9-9ee978ae21e1","order_by":8,"name":"Gelei Xiao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYDACZjBpwcDG3gBmMTYQqUWCgY3nALFaGKBaGCQSiNRicJz54cMvFRJyfJKPH3/mYbCR3XCA+dkDfFokm9mMjWXOSBizSaeZSfMwpBlvOMBmboBPCz8zg5m0ZJtEYpt0DhszD8PhxA0HeNgk8GlhY2b/Ji35T6K+TfIMM9Bh/wlr4WfmMZP82CCRwCbBwwB02AHCWiSbeYqNGY5JGLbxpJlJzjFINp55mM0MrxaD88c3PvxRYyMv33748Yc3FXayfcebn+HVAgJAX8NNYIBFLn7A+IMIRaNgFIyCUTCCAQDx9jwWBuiDsQAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-9234-0595","institution":"Xiangya Hospital Central South University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Gelei","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2022-02-27 15:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1401292/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1401292/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":19095293,"identity":"6616572d-0a28-4217-ac7d-d34fcaf4c2a0","added_by":"auto","created_at":"2022-03-10 19:58:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":299912,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe condition, treatment, and follow-up of a case with complex hydrocephalus\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eCase of a patient aged 4 years and 8 months was found to have intracranial Dandy-Walker deformity 50 days ago due to walking instability for 1 month, and cyst resection was performed.\u0026nbsp;After repeated high fever, waist puncture and related examination were performed. Intracranial infection was considered. \"vancomycin\" + \"meropenem\" was used to fight infection.\u0026nbsp;The patient came to our hospital 10 days ago for treatment because of the swelling of the incision and the aggravation of headache. CT examination showed the aggravation of intracranial hydrocephalus.\u0026nbsp;Third ventriculostomy and external ventriculostomy were performed, followed by bilateral choroid plexus burning and external ventriculostomy.\u0026nbsp;One year after surgery, the child attended school normally, had normal intelligence, and the wound healed well.\u0026nbsp;(N, O and P)\u003c/p\u003e\u003cp\u003eMRI examination before surgery in other hospital. (A, B, C and D)\u0026nbsp;\u003c/p\u003e\u003cp\u003eMRI examination in our hospital after surgery in other hospitals. (E, F and G)\u0026nbsp;\u003c/p\u003e\u003cp\u003eAfter the first operation in our hospital. (H, I, J and K)\u0026nbsp;\u003c/p\u003e\u003cp\u003eHalf a year later, MRI reexamination showed that the supratentorial ventricle system was normal and there was no posterior fossa effusion. (L and M)\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/d4a6956e0dae50dad2b02480.jpg"},{"id":20893601,"identity":"db589a70-4c87-4bec-a6ed-c55fa7bd3470","added_by":"auto","created_at":"2022-04-28 19:35:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":480306,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/d143ab97-654d-4419-842d-56ffbc53ca79.pdf"},{"id":19095721,"identity":"662905e4-bbaa-4962-ab3a-a23aef9f1aa4","added_by":"auto","created_at":"2022-03-10 20:01:57","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":10361,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.Demographicson163patientswith.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/330bb555b44752f990e60a59.xlsx"},{"id":19095296,"identity":"eae4b035-6a2c-440b-b9a9-b54d0c7c24b2","added_by":"auto","created_at":"2022-03-10 19:58:57","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":11304,"visible":true,"origin":"","legend":"","description":"","filename":"Table2Surgicaltreatmentforpatients.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/d6839d5557df3668b837d7f7.xlsx"},{"id":19095295,"identity":"016277b3-1381-4a18-a647-66b4ab759d4e","added_by":"auto","created_at":"2022-03-10 19:58:57","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":11356,"visible":true,"origin":"","legend":"","description":"","filename":"Table3Surgeryassociatedcomplications.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/364e1810249d2b3f1ac3e501.xlsx"},{"id":19095722,"identity":"21dceeb4-746f-4324-b852-fc6b68fb929c","added_by":"auto","created_at":"2022-03-10 20:01:57","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":10956,"visible":true,"origin":"","legend":"","description":"","filename":"Table4Managementofcomplications.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-1401292/v1/0e11c75c9764ef5641a4d4d0.xlsx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eSurgical Treatment for Pediatric Hydrocephalus: a Report of 163 Clinical Cases in a Single Center\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHydrocephalus refers to the state of excessive accumulation of cerebrospinal fluid in the cerebral ventricle system and/or subarachnoid space caused by excessive secretion of cerebrospinal fluid blocked circulation or impaired absorption caused for various reasons [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It is often accompanied by ventricular enlargement, a corresponding decrease in brain parenchymal, and increased intracranial pressure [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The incidence rate of hydrocephalus in the population is unclear, while the prevalence rate is 1.0%-1.5% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Hydrocephalus is mostly sporadic without gender differences, and infants (congenital hydrocephalus mostly) and seniors over 60 (idiopathic normal pressure hydrocephalus mostly) are shown as two prone age groups [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In newborns, children, and adolescents, pediatric hydrocephalus is the most prevalent surgically correctable neurological problem[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Hydrocephalus affects one out of every 500 children, according to some estimates. Genetic causes like X-linked aqueductal stenosis, congenital causes like myelomeningocoele and Chiari malformation, and acquired causes like intraventricular hemorrhage, trauma, malignancies, and infection all contribute to this syndrome [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The symptoms vary with the age of onset of the child and mainly include irritability, developmental delay, headache and vomiting, drowsiness, epilepsy, etc. Surgical treatment is the preferred treatment for hydrocephalus.\u003c/p\u003e \u003cp\u003eIn recent years, the progress in the surgical treatment of hydrocephalus has mainly manifested in the application of anti-gravity and programmable shunt valves and EVP performance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, the incidence of complications and failure rate of hydrocephalus is still as high as 40% 1\u0026ndash;2 years after the operation, while the failure rate is even up to 98% in the last 10 years [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This study explores the clinical characteristics of patients with pediatric hydrocephalus, surgical methods, and the management of postoperative complications to strengthen the understanding of clinicians about the surgical treatment of hydrocephalus and discuss the choice of surgical treatment methods for hydrocephalus and the management of postoperative complications.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eGeneral data\u003c/h2\u003e \u003cp\u003eA total of 163 patients with pediatric hydrocephalus received surgical treatment in the department of neurosurgery, Xiangya Hospital, Central South University between January 1, 2016, and December 30, 2019, were included. The patients all met the Evan\u0026rsquo;s Index (The distance between the anterior horn of the bilateral lateral ventricle/the length of the intracranial cavity in the same plane\u0026thinsp;\u0026lt;\u0026thinsp;0.3) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with corresponding symptoms of hydrocephalus and intracranial hypertension being used as the primary reference index for judging hydrocephalus (patients with intracranial tumors complicated by hydrocephalus were not included in the study). All patients received head CT or MRI imaging before surgery, and some of them received lumbar puncture surgery, with clear indications for surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurgical procedures\u003c/h2\u003e \u003cp\u003eAll cases were diagnosed by CT or MRI before surgery and received lumbar puncture to consummate preoperative assessment whether accompanied by hydrocephalus or intracranial hypertension symptoms or not, and lumbar puncture was performed to consummate preoperative assessment. According to different imaging manifestations, lumbar puncture pressure, we determined the causes of hydrocephalus and adopted different ways of operation. Ward 36 of the neurosurgery department in our hospital mainly assumed VP, ETV, and VA as operation methods.\u003c/p\u003e \u003cp\u003eFor shunt surgery, the operating room set-up, patient positioning, skin preparation, disinfection, and draping are all critical to good results and prognosis. As for the active room set-up, Maurice Choux formulated the \"shunt principle\" as early as 1992 (especially for infant patients) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For VP, we take a crucial incision in the dura and connect it to a small incision in the peritoneum by the shunt system. For VA, we just replace the dural incision with an incision over the internal jugular vein and its branches. For EVT, we make the triple ventricular floor fully accessible to the basal cistern.\u003c/p\u003e \u003cp\u003ePreoperative MRI cerebrospinal fluid flow imaging will be added to patients in our department to observe whether the base of the third ventricle is bulging downward or sagging and whether the flow of cerebrospinal fluid in the mesencephalic aqueduct is unobstructed to aid in differentiation [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. For patients with typical symptoms of normal pressure hydrocephalus, our department performs a preoperative cerebrospinal fluid tap test to assess the prognosis of the patient, whose specific operation is to administer a single dose of 40-60ml of cerebrospinal fluid at a single time and observe the improvement of the patient's symptoms 24\u0026ndash;48 hours after the fluid release [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. According to the Japanese Neurosurgical Association's guidelines for the management of idiopathic normal pressure hydrocephalus (NPH) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and the American Idiopathic NPH Study Group's guidelines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], the positive predictive value of the fluid release test is 73%-100%. The classification of hydrocephalus is a guide to the choice of surgical approach.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn this study, we analyzed the clinical data of pediatric hydrocephalus patients admitted to the pediatric Neurosurgery Department of Xiangya Hospital between January 1, 2016, and December 31, 2019. Statistical analysis included surgical techniques, number of surgical treatments, complications, and basic demographics. SPSS software was used for the statistical analysis of the research data. Enumeration data were described by the number of cases (percentage).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003ePatients\u003c/h2\u003e\n \u003cp\u003eData were collected from 163 patients who underwent surgical treatment between January 1, 2016, and December 31, 2019.\u003c/p\u003e\n \u003cp\u003eOf these 163 patients, 103 cases (63.2%) were male while 60 cases (36.8%) were female. The youngest patient was 0 years old and the oldest was 18 years old, and the average age of the patients was 5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 years. (Table 1) Among the 163 patients, 48 cases underwent more than one surgical procedure given the surgical outcome. A total of 211 surgeries were conducted.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eSurgical treatment of hydrocephalus\u003c/h2\u003e\n \u003cp\u003e106 patients received VP at the first operation, among which 17 cases were readmitted due to shunt-related peritonitis or abdominal abscess, abdominal end obstruction (caused by ascites, abdominal infection, etc.), 16 of which received left lateral VP after the removal of abdominal end extraction, including 3 cases whose postoperative symptoms were still not relieved changing to have left lateral VP with prognosis good after follow-up, and 1 case that did not have shunt surgery after the removal of the whole shunt device with prognosis good after follow-up; 6 cases were readmitted due to shunt-related cerebrospinal fluid infection or meningitis, all of which underwent brain outdoor drainage after shunt tube removal, 4 of them with ventricular empyema were subjected to endoscopic ventricular irrigation, ETV and choroid plexus burning, 3 of which had a good prognosis, 1 of which died due to severe intracranial infection, and 2 of 6 cases did not undergo related surgery with a good prognosis after follow-up; 5 cases immediately underwent re-operative adjustment because of primary misplacement of the catheter during operation with prognosis good after follow-up; 4 patients were readmitted due to ventricular end obstruction of shunt, 2 of which underwent re-operative adjustment due to ventricular end prolapse with prognosis favorable after follow-up, and the other 2 cases received reoperation to replace the shunt to due to ventricular end obstruction and longtime of shunt placement with prognosis good after follow-up; the remaining 74 cases relieved relative symptoms and had a good prognosis after VP at the first operation, and did not undergo surgery again.\u003c/p\u003e\n \u003cp\u003eThere were 7 cases received VA at the first operation; 2 of them were readmitted and changed to have left lateral VP because of right atrial end obstruction; 1 of them underwent re-operative adjustment immediately due to postoperative review of atrial end overlong, with prognosis good after follow-up; 1 case with ventricular empyema received endoscopic ventricular irrigation, ETV and choroid plexus burning, and had left lateral VP, with prognosis favorable after follow-up; the remaining three patients relieved related symptoms and had a good prognosis after VA at the first operation, and did not have surgery again.\u003c/p\u003e\n \u003cp\u003e50 patients received ETV at the first operation, 12 of them were readmitted on account of unrelieved symptoms, among which 8 cases received VP for the second operation with a favorable prognosis after follow-up. 3 patients received VA due to cerebrospinal fluid infection with prognosis good after follow-up, 1 case with ventricular empyema underwent endoscopic irrigation and choroid plexus burning, and no shunt operation was performed, with related symptoms relieved and good prognosis after discharge; the remaining 38 patients had reduced associated symptoms and a favorable prognosis after ETV and did not have surgery again. The surgical treatments performed on 163 patients are shown. Here is a case of hydrocephalus, treatment, and follow-up. (Table 2) (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003eSurgical complications\u003c/h2\u003e\n \u003cp\u003eComplications were present in the series, including intraoperative complications, infection, and postoperative complications. Detailed complications are shown. (Table 3)\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe burden of pediatric hydrocephalus is significant: hydrocephalus can affect development as well as the overall quality of life. Hydrocephalus affects a disproportionate number of children who are admitted to hospitals [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. There are effective surgical treatments that can protect and improve quality of life; nevertheless, these do not come without risks and failures. The need for advancements in surgical interventions is generally recognized. It is recognized that, while hydrocephalus problems appear simple, they are highly complex [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nonetheless, there is agreement that current management may result in frequent complications, low shunt survival rates, and poor patient quality of life, resulting in disappointing outcomes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt present, we prefer shunt surgery as the first choice of surgical treatment in these patients. Given a choice between VA and VP, the authors still prefer VP. The reason was that VP (69.8%) had a much higher healing rate than VA (14.3%), even though the rate of surgery-associated complications was slightly higher in VP (25.6%) than in VA (12.9%), and the potential complications of VA are more serious [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], especially in those who are elderly and have multiple underlying diseases, heart-associated difficulties tend to be more dangerous. However, if the patient has contraindications to VP (such as ascites, cholecystitis), VA is undoubtedly an appropriate choice. In addition, patients who received both VP and VA had a higher percentage of patients who underwent more than one surgical treatment (18/38, 37.5%), and all of them healed, suggesting a shift to studies on the use of VP in combination with VA.\u003c/p\u003e \u003cp\u003eIn the past 10 years, our experience with ETV has accumulated, and the procedure is currently considered safe and easy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our observation, ETV showed the highest healing rate (76%) and the lowest rate of surgery-associated complications (9.1%) among the three surgical treatments we mainly used. The effectiveness and reliability of ETV suggest that we should make ETV a focus of future studies. Meanwhile, the combination of VP (VA) (11/50, 22%) after ineffective ETV treatment had a significant effect on patient healing, with all patients who had received ETV and VP (VA) sequentially healed. However, there is perhaps a greater risk of treatment with ETV after ineffective treatment with VP(VA) first, and the only death among 163 patients occurred in this case. For obstructive hydrocephalus, the efficiency of ETV is high, even up to 95% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Nevertheless, even in obstructive hydrocephalus, successful ETV does not mean a cure. There are a great many reports of occlusion of the stoma [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and some of these patients suddenly deteriorated [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. But ETV is not recommended for idiopathic NPH without considering its subtypes (e.g. InfinOH [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]). Clinicians should be careful not to settle for partial remission of symptoms after ETV and forgo treatment that might further improve symptoms.\u003c/p\u003e \u003cp\u003eThe complications of surgery and their corresponding management are the issues we pay the most attention to. The most common complication is shunt-related peritonitis or abdominal abscess, abdominal end obstruction (17/163, 10.4%), followed by shunt-related cerebrospinal fluid infection or meningitis (6/163, 3.7%). We have summarized the common surgical complications and their corresponding management as follows \u003cb\u003e(Table\u0026nbsp;4)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eIntraoperative complications, which only refer to the incorrect placement of the primary catheter during the operation, mainly occur at the ventricular end of the shunt [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The authors concluded that CT and abdominal X-ray films should be reviewed promptly after shunt surgery. When the catheter is poorly positioned, the catheter position should be adjusted as early as possible while the patient is generally well.\u003c/p\u003e \u003cp\u003eInfections associated with shunts can be divided into three categories: shunt colony formation, shunt-associated cerebrospinal fluid infection or meningitis, and shunt-associated peritonitis or abdominal abscess. The appearance of colonies around the shunt comes from the following: 1. Direct contact between the skin and the shunt before or during shunting; 2. During the process, skin flora was inserted from the wound site [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the skin protective film can prevent the former. At the same time, the latter can be avoided by increasing the speed of surgery, using some surgical techniques to reduce tissue damage, and applying the \"principle of nonmaleficence\" [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] (e.g. try to wait for the shunt to be used before opening the package).\u003c/p\u003e \u003cp\u003eIn general, as soon as a shunt colony forms, cerebrospinal fluid infection is bound to occur sooner or later [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], so once there is sufficient reason to suspect shunt colony formation in our department, even if there is no cerebrospinal fluid infection, meningitis, or general infection symptoms, we will remove the shunt promptly and then observe the prognosis of the patient to decide whether to perform shunt surgery again. For hunt-related cerebrospinal fluid infection or meningitis, if this occurs, our treatment is to remove the shunt promptly, drain the ventricle ipsilaterally or contralaterally, and swiftly perform a bacteriological examination of the cerebrospinal fluid and the tip of the shunt. Once the bacterial infection is identified, systemic and intrathecal antibiotics should be promptly applied according to the drug sensitivity.\u003c/p\u003e \u003cp\u003ePostoperative complications mainly include inadequate shunt, excessive shunt, and shunt dysfunction. In such cases, we can clarify the specific cause by imaging and palpating the shunt function and then replacing the part of the shunt device according to the situation. In recent years, our department has been using programmable shunt valves. For patients with inadequate shunt and excessive shunt, we can adjust the pressure of the shunt valve first, and if the patient's symptoms still do not improve, it is necessary to look for other causes of shunt dysfunction carefully.\u003c/p\u003e \u003cp\u003eWe can clarify their classification by preoperative CT, MRI, cerebrospinal fluid flow imaging, and cerebrospinal fluid tap tests for patients with hydrocephalus. For obstructive hydrocephalus, ETV is more efficient, safe, and easy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, ETV is not recommended for patients with NPH if they do not take their specific subtype (e.g., InfinOH) into consideration. The NPH occurs mainly in people aged 65 years or older, and its primary clinical features are ventricular enlargement (Evan's index\u0026thinsp;\u0026ge;\u0026thinsp;0.3) and Hakim's triad (walking instability, dementia, and urinary incontinence). Such patients can choose a lumbar puncture fluid release experiment for preoperative evaluation. Their surgical treatment is VP, and the shunting of cerebrospinal fluid is safe and effective, and about 75% of patients can be effective for a long time [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The best treatment outcome is achieved when the shunt is performed early in the disease [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, we should not blindly insist on a single surgical method of bypass or fistula for different patients but should consider the best surgical option after the failure of the preferred surgery. Early detection, timely surgical intervention, standardized surgical operation, and regular follow-up of discharged patients should be conducted to treat unrelieved symptoms and related complications after ETV and shunt surgery.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eThe evaluation of our given patient series may be less representative due to the relatively small group size due to a lack of cases for a brief period even in a large volume pediatric neurosurgery facility unit. Furthermore, due to the variability of the treated pediatric hydrocephalus and the small number of each histological entity, major inferences concerning long-term prognosis and survival cannot be drawn.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA single surgery can cure most patients, and in a few cases more than one surgery is required. For pediatric hydrocephalus, ETV is more efficient and has fewer surgical complications. However, the management of unrelieved symptoms and related complications after ETV surgery and bypass surgery should still be taken seriously.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVP = ventricular peritoneal shunt; ETV= endoscopic third ventriculostomy; VA= ventricle-right atrium shunt; NPH= normal pressure hydrocephalus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to express my gratitude to all those who helped us during the writing of this manuscript and thanks to all the peer reviewers for their opinions and suggestions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by National Natural Science Foundation of China (No. 82171347), the Scientific Research Project of Hunan Provincial Health Commission of China (No. 202204040024), and the Students Innovations in Central South University of China (No. S2021105330599, No. 2021105330046, No. XCX2021035).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research project was reviewed and approved by No. 20200312 of the Ethic Committee of the Xiangya Hospital of Central South University and was conducted from January 2016 to December 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the content and agree to submit this manuscript for publication consideration to your journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLY collected the related paper. YCW, CYZ, SKD, QC, JH, ZPZ, and JPL drafted and revised the manuscript. YCW and GLX participated in the design of the article and helped to draft and revise the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBouras, T. and S. Sgouros. (2012) Complications of endoscopic third ventriculostomy: a systematic review. \u003cem\u003eActa Neurochir Suppl\u0026nbsp;\u003c/em\u003e113:149-53. \u003ca href=\"https://doi.org/10.1007/978-3-7091-0923-6_30\"\u003ehttps://doi.org/10.1007/978-3-7091-0923-6_30\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eCapion, T., et al. (2020) Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey. \u003cem\u003eActa Neurochir (Wien)\u0026nbsp;\u003c/em\u003e162:1363-1370. \u003ca href=\"https://doi.org/10.1007/s00701-020-04317-6\"\u003ehttps://doi.org/10.1007/s00701-020-04317-6\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eChoux, M., J. Camboulives, and F. Rigaut. (1992) [Prevention of infections in ventriculoperitoneal shunts in children]. \u003cem\u003eAnn Fr Anesth Reanim\u0026nbsp;\u003c/em\u003e11:699-704. \u003ca href=\"https://doi.org/10.1016/s0750-7658(05)80793-2\"\u003ehttps://doi.org/10.1016/s0750-7658(05)80793-2\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eChung, D.Y., et al. (2017) Management of External Ventricular Drains After Subarachnoid Hemorrhage: A Multi-Institutional Survey. \u003cem\u003eNeurocrit Care\u0026nbsp;\u003c/em\u003e26:356-361. \u003ca href=\"https://doi.org/10.1007/s12028-016-0352-9\"\u003ehttps://doi.org/10.1007/s12028-016-0352-9\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eConnolly, E.S., Jr., et al. (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. \u003cem\u003eStroke\u0026nbsp;\u003c/em\u003e43:1711-37. \u003ca href=\"https://doi.org/10.1161/STR.0b013e3182587839\"\u003ehttps://doi.org/10.1161/STR.0b013e3182587839\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eCraven, C.L., et al. (2019) Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery : A Technical Note. \u003cem\u003eJ Korean Neurosurg Soc\u0026nbsp;\u003c/em\u003e62:123-129. \u003ca href=\"https://doi.org/10.3340/jkns.2017.0282\"\u003ehttps://doi.org/10.3340/jkns.2017.0282\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eFabbro, S., et al. (2020) Late-onset occlusion of the Monro foramina after endoscopic third ventriculostomy in adults: Case discussion and review of the literature. \u003cem\u003eSurg Neurol Int\u0026nbsp;\u003c/em\u003e11:326. \u003ca href=\"https://doi.org/10.25259/SNI_519_2020\"\u003ehttps://doi.org/10.25259/SNI_519_2020\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eFlannery, A.M. and L. Mitchell. (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. \u003cem\u003eJournal of Neurosurgery: Pediatrics\u0026nbsp;\u003c/em\u003e14:3-7.\u003c/li\u003e\n \u003cli\u003eHao, X. and D. Wei. (2019) The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. \u003cem\u003eMedicine (Baltimore)\u0026nbsp;\u003c/em\u003e98:e15970. \u003ca href=\"https://doi.org/10.1097/MD.0000000000015970\"\u003ehttps://doi.org/10.1097/MD.0000000000015970\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eHellwig, D., et al. (2005) Endoscopic third ventriculostomy for obstructive hydrocephalus. \u003cem\u003eNeurosurg Rev\u0026nbsp;\u003c/em\u003e28:1-34; discussion 35-8. \u003ca href=\"https://doi.org/10.1007/s10143-004-0365-2\"\u003ehttps://doi.org/10.1007/s10143-004-0365-2\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eHung, A.L., et al. (2017) Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus. \u003cem\u003eClin Neurol Neurosurg\u0026nbsp;\u003c/em\u003e157:1-6. \u003ca href=\"https://doi.org/10.1016/j.clineuro.2017.03.014\"\u003ehttps://doi.org/10.1016/j.clineuro.2017.03.014\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eKehler, U. and B. Eckert. (2008) INFINOH\u0026ndash;Infratentorieller intrazisternaler obstruktiver Hydrocephalus. Ein \u0026bdquo;neuer \u0026ldquo;Subtyp des kommunizierenden Hydrocephalus. \u003cem\u003eAktuelle Neurologie\u0026nbsp;\u003c/em\u003e35:P723.\u003c/li\u003e\n \u003cli\u003eLarsson, A., et al. (1991) Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. \u003cem\u003eActa Neurol Scand\u0026nbsp;\u003c/em\u003e84:475-82. \u003ca href=\"https://doi.org/10.1111/j.1600-0404.1991.tb04998.x\"\u003ehttps://doi.org/10.1111/j.1600-0404.1991.tb04998.x\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eLodha, K.G., et al. (2020) Endoscopic Third Ventriculostomy for Hydrocephalus in Infants: A Single-center Experience. \u003cem\u003eAsian J Neurosurg\u0026nbsp;\u003c/em\u003e15:302-305. \u003ca href=\"https://doi.org/10.4103/ajns.AJNS_17_20\"\u003ehttps://doi.org/10.4103/ajns.AJNS_17_20\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eLu, L., et al. (2019) Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: Meta-Analysis of Randomized Controlled Trials. \u003cem\u003eWorld Neurosurg\u0026nbsp;\u003c/em\u003e129:334-340. \u003ca href=\"https://doi.org/10.1016/j.wneu.2019.04.255\"\u003ehttps://doi.org/10.1016/j.wneu.2019.04.255\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eMori, E., et al. (2012) Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. \u003cem\u003eNeurol Med Chir (Tokyo)\u0026nbsp;\u003c/em\u003e52:775-809. \u003ca href=\"https://doi.org/10.2176/nmc.52.775\"\u003ehttps://doi.org/10.2176/nmc.52.775\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eMurphy, M., et al. (1998) Consensus development methods, and their use in clinical guideline development. \u003cem\u003eHealth Technology Assessment (Winchester, England)\u0026nbsp;\u003c/em\u003e2:i-88.\u003c/li\u003e\n \u003cli\u003eNakajima, M., et al. (2021) Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus. \u003cem\u003eNeurol Med Chir (Tokyo)\u0026nbsp;\u003c/em\u003e61:63-97. \u003ca href=\"https://doi.org/10.2176/nmc.st.2020-0292\"\u003ehttps://doi.org/10.2176/nmc.st.2020-0292\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003ePande, A., et al. (2021) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. \u003cem\u003eNeurosurg Rev\u0026nbsp;\u003c/em\u003e44:1227-1241. \u003ca href=\"https://doi.org/10.1007/s10143-020-01320-4\"\u003ehttps://doi.org/10.1007/s10143-020-01320-4\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eRelkin, N., et al. (2005) Diagnosing idiopathic normal-pressure hydrocephalus. \u003cem\u003eNeurosurgery\u0026nbsp;\u003c/em\u003e57:S4-16; discussion ii-v. \u003ca href=\"https://doi.org/10.1227/01.neu.0000168185.29659.c5\"\u003ehttps://doi.org/10.1227/01.neu.0000168185.29659.c5\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eSarfo, F.S., et al. (2020) Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study. \u003cem\u003eJ Neurol Sci\u0026nbsp;\u003c/em\u003e418:117158. \u003ca href=\"https://doi.org/10.1016/j.jns.2020.117158\"\u003ehttps://doi.org/10.1016/j.jns.2020.117158\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eTamber, M.S., et al. (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: Management of cerebrospinal fluid shunt infection. \u003cem\u003eJ Neurosurg Pediatr\u0026nbsp;\u003c/em\u003e14 Suppl 1:60-71. \u003ca href=\"https://doi.org/10.3171/2014.7.PEDS14328\"\u003ehttps://doi.org/10.3171/2014.7.PEDS14328\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eTan, C., et al. (2021) The Pathogenesis Based on the Glymphatic System, Diagnosis, and Treatment of Idiopathic Normal Pressure Hydrocephalus. \u003cem\u003eClin Interv Aging\u0026nbsp;\u003c/em\u003e16:139-153. \u003ca href=\"https://doi.org/10.2147/cia.S290709\"\u003ehttps://doi.org/10.2147/cia.S290709\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eTaylor, R.M. (2013) Ethical principles and concepts in medicine. \u003cem\u003eHandb Clin Neurol\u0026nbsp;\u003c/em\u003e118:1-9. \u003ca href=\"https://doi.org/10.1016/B978-0-444-53501-6.00001-9\"\u003ehttps://doi.org/10.1016/B978-0-444-53501-6.00001-9\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eVinas Rios, J.M., et al. (2018) Predictors of hydrocephalus as a complication of non-traumatic subarachnoid hemorrhage: a retrospective observational cohort study in 107 patients. \u003cem\u003ePatient Saf Surg\u0026nbsp;\u003c/em\u003e12:13. \u003ca href=\"https://doi.org/10.1186/s13037-018-0160-6\"\u003ehttps://doi.org/10.1186/s13037-018-0160-6\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eVirta, J.J., et al. (2020) One-Year Outcome After Aneurysmal Subarachnoid Hemorrhage in Elderly Patients. \u003cem\u003eWorld Neurosurg\u0026nbsp;\u003c/em\u003e143:e334-e343. \u003ca href=\"https://doi.org/10.1016/j.wneu.2020.07.127\"\u003ehttps://doi.org/10.1016/j.wneu.2020.07.127\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eWan, S., et al. (2021) Cerebrospinal Fluid from Aneurysmal Subarachnoid Hemorrhage Patients Leads to Hydrocephalus in Nude Mice. \u003cem\u003eNeurocrit Care\u0026nbsp;\u003c/em\u003e34:423-431. \u003ca href=\"https://doi.org/10.1007/s12028-020-01031-0\"\u003ehttps://doi.org/10.1007/s12028-020-01031-0\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eWan, Y., et al. (2020) Effects of aging on hydrocephalus after intraventricular hemorrhage. \u003cem\u003eFluids Barriers CNS\u0026nbsp;\u003c/em\u003e17:8. \u003ca href=\"https://doi.org/10.1186/s12987-020-0169-y\"\u003ehttps://doi.org/10.1186/s12987-020-0169-y\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eWang, C., et al. (2021) Novel therapeutics for hydrocephalus: Insights from animal models. \u003cem\u003eCNS Neuroscience \u0026amp; Therapeutics\u0026nbsp;\u003c/em\u003e27:1012-1022.\u003c/li\u003e\n \u003cli\u003eWang, Y.-C., et al. (2021) Hydrocephalus after aneurysmal subarachnoid hemorrhage: epidemiology, pathogenesis, diagnosis, and management.\u003c/li\u003e\n \u003cli\u003eWilliams, M.A., et al. (2007) Priorities for hydrocephalus research: report from a National Institutes of Health\u0026ndash;sponsored workshop. \u003cem\u003eJournal of Neurosurgery: Pediatrics\u0026nbsp;\u003c/em\u003e107:345-357.\u003c/li\u003e\n \u003cli\u003eYengo-Kahn, A.M., et al. (2021) Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network. \u003cem\u003eJ Neurosurg Pediatr\u003c/em\u003e:1-9. \u003ca href=\"https://doi.org/10.3171/2020.11.Peds20806\"\u003ehttps://doi.org/10.3171/2020.11.Peds20806\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eZhan, C., et al. (2020) Decreased MiR-30a promotes TGF-\u0026beta;1-mediated arachnoid fibrosis in post-hemorrhagic hydrocephalus. \u003cem\u003eTransl Neurosci\u0026nbsp;\u003c/em\u003e11:60-74. \u003ca href=\"https://doi.org/10.1515/tnsci-2020-0010\"\u003ehttps://doi.org/10.1515/tnsci-2020-0010\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"tables","content":"\u003cp\u003eTables 1 to 4 xlsx are available in the Supplemental Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hydrocephalus, Pediatric hydrocephalus, Surgical treatment, Complication, Outcome","lastPublishedDoi":"10.21203/rs.3.rs-1401292/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1401292/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e Surgical treatment is the preferred treatment for pediatric hydrocephalus. The analysis of the outcome of pediatric hydrocephalus surgery and its complications is limited by the lack of available data. Our goal was to better understand the effectiveness of surgery and to explore better surgical treatment methods and management of complications.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003e163 patients with pediatric hydrocephalus were included. A retrospective chart review was performed on all patients. Data collected included surgical techniques, number of surgical treatments, complications, and basic demographics.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e There were 163 patients in this group including 103 males and 60 females. Among the patients, 106 (106/163, 65.0%) patients received ventricular peritoneal shunt (VP), 7 (7/163, 4.3%) patients received ventricle-right atrium shunt (VA) and 50 (50/163, 30.7%) patients received endoscopic third ventriculostomy (ETV). Among the patients who received VP, 74 (74/163, 45.4%) patients were cured and 32 (32/163, 19.6%) patients underwent surgery again. Among the patients who received VA, 38 (38/163, 23.3%) patients were cured and 12 (12/163, 7.4%) patients underwent surgery again. Among the patients who received ETV, 3 (3/163, 1.8%) patients were cured and 4 (4/163, 2.5%) patients underwent surgery again. The most common complication is shunt-related peritonitis or abdominal abscess, abdominal end obstruction (17/163，10.4%).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e A single surgery can cure most patients, and sometimes more than one surgery is required. For pediatric hydrocephalus, ETV is more efficient and has fewer surgical complications. However, the management of unrelieved symptoms and related complications after ETV surgery and bypass surgery should still be taken seriously.\u003c/p\u003e","manuscriptTitle":"Surgical Treatment for Pediatric Hydrocephalus: a Report of 163 Clinical Cases in a Single Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-03-10 19:58:55","doi":"10.21203/rs.3.rs-1401292/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b3b7d1c-bc8f-4a7d-a1d5-62bd1d20a83d","owner":[],"postedDate":"March 10th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-04-28T19:35:23+00:00","versionOfRecord":[],"versionCreatedAt":"2022-03-10 19:58:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1401292","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1401292","identity":"rs-1401292","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}