OUTCOME OF TREATMENT OF 161 INFANTS WITH HYDROCEPHALUS

Objective: Data is provided on the outcome of children with isolated c ongenital hydrocephalus, hydrocephalus accompanied by spina bifida or encephaloceles, and neonatal hydrocephalus. This information should he lp those who have to inform parents of affected fetuses how hydrocepha lus and accompanying defects are likely to affect their child in the l ong term. Methods: One hundred sixty-one infants with hydrocephalus we re followed up for 3-14 years. Congenital hydrocephalus was due to aqu educt stenosis in 45, Arnold-Chiari malformation and myelomeningoceles in 40, Dandy-Walker complexes in 8, and hydrocephalus and encephaloce les in 6. Acquired hydrocephalus was due to intraventricular hemorrhag es in 60 premature infants, and neonatal meningitis in 2. Ventriculo-p eritoneal shunts were inserted. Mortality rates, head sizes, shunt rev ision rates, physical defects, seizure rates, and types of schools att ended were determined. Results: Only aqueduct stenosis caused head siz es larger than normal after 3 years of age. No child with hydrocephalu s and a myelomeningocele was grossly mentally retarded. Mental develop ment of children with Dandy-Walker complexes and aqueduct stenosis was the same; a similar proportion attended mainstream schools, schools f or the educationally subnormal, and training centers. Children with en cephaloceles had a poor prognosis compared with other categories; fewe r attended mainstream schools, and more were mentally and physically h andicapped. Intraventricular hemorrhages were the commonest cause of h ydrocephalus; the outlook was not as favorable as that of aqueduct ste nosis, Arnold-Chiari malformations, and Dandy-Walker complexes; they h ad higher death rates, poorer mainstream school attendance, and higher seizure rates. Conclusions: This series was highly selective; to be i ncluded, children had to have survived gestation and birth, and be ref erred by pediatricians. Even so, it provides information for parents s eeking advice about similarly affected fetuses and neonates.