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.

中文翻译：

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非感染性脑积水儿童脑室腹膜分流放置后的神经发育结局：一项荟萃分析

背景

当累积量的脑脊髓液（CSF）无法在心室系统中循环和/或吸收时，就诊断为脑积水。根据病因，脑积水可分为传染性和非传染性脑积水。在儿童中，非感染性脑积水包括先天性脑积水，出血后脑积水，神经管缺陷相关脑积水和肿瘤相关脑积水。无论原因如何，都应放置CSF转移装置，以将多余的液体从心室转移到腹膜腔中。其中，迄今为止，心腹腹腔（VP）分流器可以说是最常用的CSF转移装置。迄今为止，尚不清楚VP分流放置对非感染性脑积水患者的长期神经发育影响。

目的

这项研究旨在评估非传染性脑积水并进行VP分流的儿童的神经发育结局。

材料和方法

使用PubMed，Google Scholar，Scopus数据库和参考列表进行系统搜索。符合纳入标准的出版物包括在荟萃分析中。应用Mantel-Haezel风险比（RR）进行计算，并使用异质性指数（I ²）检验评估所有研究中异质性的存在。根据纽卡斯尔-渥太华量表（NOS）的标准评估偏倚风险。

结果

在1929年确定的研究中，有12篇出版物被认为符合纳入标准。荟萃分析的结果表明，已经有VP分流放置的非感染性脑积水患儿（被分流的非感染性脑积水，S-NIH）患脑瘫，视觉和听觉障碍，癫痫或癫痫发作的风险明显更高。与健康对照相比。对智商（IQ）和智力发育指数（MDI）的荟萃分析表明，S-NIH儿童的智商较低，并有患智力发育延迟的风险。在运动发育方面，与对照组相比，S-NIH儿童运动得分较低，运动发育延迟的风险明显更高。尽管与S-NIH儿童相比，正常儿童倾向于具有更多的内在化行为，

结论

S-NIH儿童有更高的残疾风险以及智力和运动发育迟缓的风险；因此，为已经感染了VP分流器的非感染性脑积水的儿童制定持续康复计划对于获得他们的最佳潜能和生活质量很重要。