Abstract
Purpose The aim of this study was to provide granular descriptions of aetiologies of hydrocephalus and concurrent conditions. Furthermore, to describe the short-term effect of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) on preoperative symptoms and to estimate the risks of shunt revision, conversion of ETV to shunt, and the risks of complications. Methods A retrospective, single-centre study was performed among children who underwent shunt insertion or ETV for hydrocephalus between December 1st, 2016 and December 31st, 2021. Information regarding course of disease, surgical treatments, and comorbidities were registered from the digital patient records. The risks of conversion of treatment modality and shunt revision were estimated as cumulative incidences (CI’s) after 30-days, 3-, and 12 months. Results A total of 89 children with either obstructive (OH) (65%) or communicating (CH) (35%) hydrocephalus were surgically treated with VPS or ETV. Neurological disorders (CH 29%, OH 26%) and genetic conditions (CH 36%, OH 16%) were frequent concurrent conditions. Increased head size (74%) and symptoms of elevated intracranial pressure (57%) were the most common preoperative symptoms. Treatment with VPS entailed a 13.7% failure rate for OH and 9.7% for CH, whereas ETV displayed 14.3% failure rate, all reflecting failure of alleviating the preoperative clinical symptoms. The cumulative 1-year risk of shunt revision was 67%, most often due to valve dysfunction (28%), disconnection (14%), and shunt displacements (12%). Conclusion The considerable risks of treatment failure and complications call for improvements in treatment based on a better understanding of the heterogenic mechanisms of disease.