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Ventriculoatrial shunts in the treatment of hydrocephalus in children

The interest for the surgical treatment of hydrocephalus has considerably increased in the last decade owning to the continuos development of the techniques for ventriculo-venous shunts. However, the occurrence of several complications lowered the initial enthusiasm of some neurosurgeons regarding this particular technique. Due to this fact we embarked upon a study for evaluation of the results in a series of 136 hydrocephalic children, operated upon between December 1958 and December 1965. Up to the present time (December-1967) a total of 72 children are alive, showing a compensated hydrocephalus and 30 patients died, being impossible to obtain a follow-up of the 34 remaining cases. After the analysis of the operatory conditions, of the complications and of the results, the folloying conclusions are withdrawn: 1) the ocurrence of pulmonary tromboembolic complications is quite rare after ventriculoatrial shunts, justifying the use of this technique for the treatment of hydrocephaly till others forms of treatment are available; 2) periodic cardiologic examinations should be performed in patients submitted to ventriculo-venous shunts in order to prevent right cardiac insuficiency; 3) the prevention of infectious complications and selection of the cases are fundamental for better post-operative results; 4) the physician responsible for treatment of hydrocephalic patients should warn the parents regarding the possibility of new sirguical interventions and be ready to re-operate as many times as necessary; 5) there is not justifycable the replacement of the atrial tube when its extremity reaches the level of the fourth thoracic vertebra; 6) there is not correct the assertion that an shunt has to remain always with the drainage process working fully; 7) in order to evaluate the prognosis of the mental development of the hydrocephalic patients, a group of data has to be considered as a whole, namely the neurological examination, cranial transilumination, etiology of the disease, electroencephalo-graphic tracings, Gesell test and, if possible, the measurement of the cerebral mantle; 8) a normal psychological development (IQ greater than 85) can be expected in about 40% of the patients with controled hydrocephalus.


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