The utility of congenital cardiac status to predict endoscopic third ventriculostomy and ventriculoperitoneal shunt failure in hydrocephalic infants

View More View Less
  • 1 Department of Neurological Surgery, University of Miami; and
  • | 2 Department of Neurological Surgery, Nicklaus Children’s Hospital, Miami, Florida
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

The effect of congenital cardiac status on endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) failure in hydrocephalic infants is unknown. Because cardiac status in infants can impact central venous pressure (CVP), it is possible that congenital heart disease (CHD) and congenital cardiac anomalies may render these cerebrospinal fluid diversion interventions more susceptible to failure. Correspondingly, the aim of this study was to determine how CHD and congenital cardiac anomalies may impact the failure of these initial interventions.

METHODS

A retrospective review of the Nationwide Inpatient Sample (NIS) database was conducted. Infants (aged < 1 year) with known congenital cardiac status managed with either ETV or VPS were included. Quantitative data were compared using either parametric or nonparametric methods, and failure rates were modeled using univariable and multivariable regression analyses.

RESULTS

A total of 18,763 infants treated with ETV or VPS for hydrocephalus were identified in our search, with ETV used to treat 7657 (41%) patients and VPS used to treat 11,106 (59%). There were 6722 (36%) patients who presented with CHD at admission, and a total of 25 unique congenital cardiac anomalies were detected across the cohort. Overall, the most common anomaly was patent ductus arteriosus (PDA) in 4990 (27%) patients, followed by atrial septal defect (ASD) in 2437 (13%) patients and pulmonary hypertension in 810 (4%) patients. With respect to initial intervention failure, 3869 (21%) patients required repeat surgical intervention during admission. This was significantly more common in the ETV group than the VPS group (36% vs 10%, p < 0.01). In both the ETV and VPS groups, CHD (p < 0.01), including all congenital cardiac anomalies, was an independent and significant predictor of failure. ASD (p < 0.01) and PDA (p < 0.01) both significantly predicted ETV failure, and PDA (p < 0.01) and pulmonary hypertension (p = 0.02) both significantly predicted VPS failure.

CONCLUSIONS

These results indicate that congenital cardiac status predicts ETV and VPS failure in patients with infantile hydrocephalus. The authors hypothesized that this finding was primarily due to changes in CVP; however, this may not be completely universal across both interventions and all congenital cardiac anomalies. Future studies about optimization of congenital cardiac status with ETV and VPS are required to understand the practical significance of these findings.

ABBREVIATIONS

ASD = atrial septal defect; CHD = congenital heart disease; CSF = cerebrospinal fluid; CVP = central venous pressure; ETV = endoscopic third ventriculostomy; IVH = intraventricular hemorrhage; NIS = Nationwide Inpatient Sample; PDA = patent ductus arteriosus; VPS = ventriculoperitoneal shunt.

Supplementary Materials

    • Supplementary Tables 1-3 (PDF 579 KB)

Diagram from Behbahani et al. (pp 488–496).

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Flannery AM, Mitchell L. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. J Neurosurg Pediatr. 2014;14(suppl 1):37.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts. J Neurosurg Pediatr. 2012;9(3):242258.

  • 3

    Aschoff A, Kremer P, Hashemi B, Kunze S. The scientific history of hydrocephalus and its treatment. Neurosurg Rev. 1999;22(2-3):6795.

  • 4

    Kulkarni AV, Riva-Cambrin J, Holubkov R, et al. Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. 2016;18(4):423429.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Limbrick DD Jr, Baird LC, Klimo P Jr, Riva-Cambrin J, Flannery AM. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children. J Neurosurg Pediatr. 2014;14(suppl 1):3034.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Kulkarni AV, Sgouros S, Leitner Y, Constantini S. International Infant Hydrocephalus Study (IIHS): 5-year health outcome results of a prospective, multicenter comparison of endoscopic third ventriculostomy (ETV) and shunt for infant hydrocephalus. Childs Nerv Syst. 2018;34(12):23912397.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Appelgren T, Zetterstrand S, Elfversson J, Nilsson D. Long-term outcome after treatment of hydrocephalus in children. Pediatr Neurosurg. 2010;46(3):221226.

  • 8

    de Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG. Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst. 2007;23(5):527533.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr. 2011;7(2):143146.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Alvi MA, Bhandarkar AR, Daniels DJ, Miller KJ, Ahn ES. Factors associated with early shunt revision within 30 days: analyses from the National Surgical Quality Improvement Program. J Neurosurg Pediatr. 2021;29(1):2130.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Solomon BD. VACTERL/VATER Association.Orphanet J Rare Dis 2011;6:56.

  • 12

    Nomura ML, Barini R, De Andrade KC, et al. Congenital hydrocephalus: gestational and neonatal outcomes. Arch Gynecol Obstet. 2010;282(6):607611.

  • 13

    Linhart Y, Bashiri A, Maymon E, et al. Congenital anomalies are an independent risk factor for neonatal morbidity and perinatal mortality in preterm birth. Eur J Obstet Gynecol Reprod Biol. 2000;90(1):4349.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Dolk H, Loane M, Garne E. The prevalence of congenital anomalies in Europe. Adv Exp Med Biol. 2010;686:349364.

  • 15

    Shah AH, Ibrahim GM, Sasaki J, Ragheb J, Bhatia S, Niazi TN. Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure. J Neurosurg Pediatr. 2018;21(1):2530.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Christian EA, Jin DL, Attenello F, et al. Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010. J Neurosurg Pediatr. 2016;17(3):260269.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    HCUP NIS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). September 2008. Agency for Healthcare Research and Quality. Accessed January 26, 2022. http://www.hcup-us.ahrq.gov/db/vars/hosp_teach/nisnote.jsp

    • Search Google Scholar
    • Export Citation
  • 18

    Barradas DT, Wasserman MP, Daniel-Robinson L, et al. Hospital utilization and costs among preterm infants by payer: Nationwide Inpatient Sample, 2009. Matern Child Health J. 2016;20(4):808818.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Gonzalez DO, Mahida JB, Asti L, et al. Predictors of ventriculoperitoneal shunt failure in children undergoing initial placement or revision. Pediatr Neurosurg. 2017;52(1):612.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Cinalli G, Spennato P, Ruggiero C, et al. Complications following endoscopic intracranial procedures in children. Childs Nerv Syst. 2007;23(6):633644.

  • 21

    Drake J, Chumas P, Kestle J, et al. Late rapid deterioration after endoscopic third ventriculostomy: additional cases and review of the literature. J Neurosurg. 2006;105(2)(suppl):118126.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg. 2017;52(6):381400.

  • 23

    Miele VJ, Bendok B, Bloomfield SM, Ondra SL, Bailes JE. Ventriculoperitoneal shunt dysfunction in adults secondary to conditions causing a transient increase in intra-abdominal pressure: report of three cases. Neurosurgery. 2004;55(2):434.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Sommer RJ, Hijazi ZM, Rhodes JF Jr. Pathophysiology of congenital heart disease in the adult: part I: Shunt lesions. Circulation. 2008;117(8):10901099.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Browd SR, Ragel BT, Gottfried ON, Kestle JR. Failure of cerebrospinal fluid shunts: part I: Obstruction and mechanical failure. Pediatr Neurol. 2006;34(2):8392.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Cronqvist S, Granholm L, Lundström NR. Hydrocephalus and congestive heart failure caused by intracranial arteriovenous malformations in infants. J Neurosurg. 1972;36(3):249254.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Crevier-Sorbo G, Atkinson J, Di Genova T, Puligandla P, Dudley RWR. Hydrocephalus-induced neurogenic stunned myocardium and cardiac arrest in a child: completely reversed with CSF diversion. J Neurosurg Pediatr. 2019;24(1):3540.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 127 127 127
Full Text Views 39 39 39
PDF Downloads 64 64 64
EPUB Downloads 0 0 0