The prognosis of hydrocephalus overt at birth

Abstract

✓ The clinical records of 79 infants with congenital hydrocephalus and excessive head size at birth were reviewed to determine the prognosis and results of surgical treatment. In 55 infants hydrocephalus was the principal malformation, and in 24 this condition occurred in association with a myelomeningocele. Follow-up was complete in 69 cases. Of 27 unoperated cases only two are living, and one of these, an achondroplastic dwarf, has normal intelligence. Only one of eight patients treated surgically before Holter valve shunts were introduced has survived, and he is moderately retarded. Of 34 infants treated by ventriculoatrial shunting, 15 have lived up to 15 years and an average of nearly 7 years; five of these survivors have normal intelligence, five are trainable, and six are grossly retarded. Ventricular shunting was accompanied by a significant persisting morbidity, and operative complications, especially sepsis, accounted for 42% of the deaths in this group. Relative head size determined at birth and the type of hydrocephalus demonstrated had no conclusive association with life or death among the uniformly megalocephalic cases. The results showed a positive correlation between early operation for hydrocephalus and survival in the group treated by ventriculoatrial shunting, and this treatment is recommended.