Pediatric extreme hydrocephalus after shunting: preliminary findings of long-term follow-up

Introduction: Pediatric extreme hydrocephalus (PEH) is a complex condition with uncertain prognostic outcomes. Objectives:In this study, we analyze the long-term change in cerebral parenchymal thickness of pediatric patients with extreme hydrocephalus after shunting.Methods: A retrospective observational study was conducted on patients with PEH treated at the General Hospital of Mexico from 2009 to 2016.Cerebral parenchymal thickness was measured in computed tomography studies before surgical intervention, at 5 months, and 4 years post-surgery.The average change in thickness in millimeters was analyzed, and its normalized value was assessed using the Wilcoxon test and the R 2 of a linear function.Results: Twelve patients, including 5 females and 7 males, were studied.Nine cases were congenital, while the remaining 3 cases were 6 months, 7, and 10-years-old.At 5.2 months PostOp., patients showed an average increase of 160% in cerebral parenchymal thickness, which increased to 270% at 4.3 years.However, 4 cases (33.3%) had an increase of < 10% from the original thickness.One patient at 4.3 years exhibited a 594% increase compared to the baseline.In the congenital cases, pre-operative thickness had a good correlation (R 2 = 0.70) with post-operative thickness, but pre-operative age of patients did not correlate with post-operative thickness (R 2 = 0.03).Conclusions: In this study, 3 out of 12 cases of PEH showed a long-term increase of > 200% compared to preoperative thickness.Even in cases of extreme hydrocephalus, significant long-term improvement can occur.Rapid treatment of these cases is crucial to increase the likelihood of improvement.