Neurodevelopmental outcomes after ventriculoperitoneal shunt placement in children with non-infectious hydrocephalus: a meta-analysis

Abstract

Background

Hydrocephalus is diagnosed when an accumulating amount of cerebrospinal fluid (CSF) fails to circulate and/or absorbed in the ventricular system. Based on its etiology, hydrocephalus can be classified into infectious and non-infectious hydrocephalus. In children, non-infectious hydrocephalus includes congenital hydrocephalus, posthemorrhagic hydrocephalus, neural tube defect–related hydrocephalus, and tumor-related hydrocephalus. Regardless of the cause, a CSF diversion device is placed to divert the excess fluid from the ventricles into peritoneal cavity. Among all, ventriculoperitoneal (VP) shunt is arguably the most commonly used CSF diversion device to date. Until now, the long-term neurodevelopmental impact of VP shunt placement in non-infectious hydrocephalus patients remained unclear.

Objective

This study aims to evaluate the neurodevelopmental outcomes in children with non-infectious hydrocephalus who had VP shunt placement.

Materials and methods

Systematic searches were performed using PubMed, Google Scholar, Scopus databases, and reference lists. Publications that fulfilled the inclusion criteria were included in the meta-analysis. Calculation of Mantel-Haezel risk ratio (RR) was applied, and heterogeneity index (I2) test was used to evaluate the existence of heterogeneity in all studies. Risk of bias was assessed based on the criteria from the Newcastle-Ottawa Scale (NOS).

Results

Of the 1929 studies identified, 12 publications were concluded to have fulfilled the inclusion criteria. Results from the meta-analysis showed that the risks of cerebral palsy, visual and hearing impairment, epilepsy, or seizures are significantly higher in children with non-infectious hydrocephalus who already had VP shunt placement (shunted non-infectious hydrocephalus, S-NIH) compared to that of the healthy control. The meta-analysis on intelligent quotient (IQ) and mental development index (MDI) showed that S-NIH children tend to score lower IQ and acquire risk of having mental development delay. On motoric development, S-NIH children scored lower motoric score and have significantly higher risk of motor development delay compared to control. Although normal children tend to have more internalizing behavior compared to S-NIH children, overall assessment on the risk of behavioral abnormalities showed that the differences between these two groups are insignificant.

Conclusion

S-NIH children have significantly higher risks of disabilities and mental and motoric development delays; thus, planning on continuous rehabilitation for children with non-infectious hydrocephalus who already had placement of VP shunt is important to acquire their optimum potentials and quality of life.

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Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgements

We would like to extend our appreciation to Prof. Kyu-Chang Wang from the Department of Neurosurgery at the National Cancer Center in Seoul, South Korea, for revising the manuscript.

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Contributions

Dr Sobana conceptualized and designed the study, did the literature screening, assessed study eligibility and quality, directed the discussion, and reviewed and revised the manuscript.

Dr Halim conceptualized and designed the study, did the literature screening, analyzed the data, assessed study eligibility and quality, directed the discussion, wrote, and reviewed and revised the manuscript.

Ms Aviani did the literature screening, assessed study eligibility and quality, carried out the statistical analysis, and reviewed and revised the manuscript.

Dr Gamayani conceptualized and designed the study, and wrote, reviewed, and revised the manuscript.

Dr Achmad conceptualized and designed the study, directed the discussion, wrote, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Mirna Sobana or Tri Hanggono Achmad.

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Sobana, M., Halim, D., Aviani, J.K. et al. Neurodevelopmental outcomes after ventriculoperitoneal shunt placement in children with non-infectious hydrocephalus: a meta-analysis. Childs Nerv Syst (2021). https://doi.org/10.1007/s00381-021-05051-9

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Keywords

  • Non-infectious hydrocephalus
  • Ventriculoperitoneal shunt
  • Disability
  • Mental development
  • Motoric development
  • Behavioral abnormalities
  • Meta-analysis