Hidrocefalia infantil resultados tardios em 102 pacientes e importância da neuro -sonografia

Machado, Hélio R.; Martelli, Nelson; Assirati Jr, João A.; Colli, Benedito O.; Carlotti Jr, Carlos G.; Boullosa, José L. R.; Funayama, Carolina; Machado, Yara M. Nunes; Martins, M. Angélica O.; Almeida, Sueli

doi:10.1590/S0004-282X1990000100012

Resumos

Os autores apresentam sua experiência em 102 crianças com hidrocefalia de diversas etiologias, acompanhadas por 5 1/2 anos. Cerca de 80% dessas crianças tinham idade inferior a dois anos, o que possibilitou seu acompanhamento com a ultra-sonografia craniana (4,4 exames por paciente). Os resultados a longo prazo são comparáveis aos obtidos na literatura com redação ao número de procedimentos por paciente (1,66), índice de infecqões (5,2%), mortalidade (6,8%) e desenvolvimento intelectual. A ultra-sonografia mostrou-se útil porque é inócua, tem baixo custo operacional, é comparável à tomografia computadorizada nessa faixa etária, podendo ser repetida rotineiramente e permitindo um relacionamento entre o médico, a criança e sua mãe que afetam favoravelmente o diagnóstico precoce de complicações e a melhor compreensão da patologia pelos pais.

A personal series (in 94% of the cases) of 102 children who underwent 170 procedures (1.66 procedures/patient) for hydrocephalus has been followed for 5 1/2 years (Jan-S3 to Jun-88). Most of the children were under two years of age (80%) and in these cases brain sonography was the examination of choice for both diagnosis and follow-up (307 examinations, 4.4 per patient). Only occasionally was computed tomography necessary for better study in these cases. Our results suggest that there was no significant difference between our cases and those published in the litterature concerning the number of procedures/patient (1.66)., infection rate (5.2%), mortality rate (6.8%) and intellectual performance. We recommend the use of brain sonography both in diagnosis and follow-up studies for hydrocephalic children since this examination is innocuous, inexpensive and easy to perform by neurosurgeons. Also it provides a good interaction between the examiner, the child and the parents, which is of utmost importance for the comprehension of the disease by the parents and early diagnosis of complications by the neurosurgeon.

Hélio R. Machado^I; Nelson Martelli^I; João A. Assirati Jr.^I; Benedito O. Colli^I; Carlos G. Carlotti Jr.^I; José L. R. Boullosa^I; Carolina Funayama^II; Yara M. Nunes Machado^III; M. Angélica O. Martins^III; Sueli Almeida^IV

^INeurocirurgião - Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) e Centro Integrado de Neurocirurgia (Hospital São Francisco, Ribeirão Preto)

^IINeurologista - Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) e Centro Integrado de Neurocirurgia (Hospital São Francisco, Ribeirão Preto)

^IIIPsicóloga - Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) e Centro Integrado de Neurocirurgia (Hospital São Francisco, Ribeirão Preto)

^IVPediatra - Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRPUSP) e Centro Integrado de Neurocirurgia (Hospital São Francisco, Ribeirão Preto)

RESUMO

Os autores apresentam sua experiência em 102 crianças com hidrocefalia de diversas etiologias, acompanhadas por 5 1/2 anos. Cerca de 80% dessas crianças tinham idade inferior a dois anos, o que possibilitou seu acompanhamento com a ultra-sonografia craniana (4,4 exames por paciente). Os resultados a longo prazo são comparáveis aos obtidos na literatura com redação ao número de procedimentos por paciente (1,66), índice de infecqões (5,2%), mortalidade (6,8%) e desenvolvimento intelectual. A ultra-sonografia mostrou-se útil porque é inócua, tem baixo custo operacional, é comparável à tomografia computadorizada nessa faixa etária, podendo ser repetida rotineiramente e permitindo um relacionamento entre o médico, a criança e sua mãe que afetam favoravelmente o diagnóstico precoce de complicações e a melhor compreensão da patologia pelos pais.

SUMMARY

A personal series (in 94% of the cases) of 102 children who underwent 170 procedures (1.66 procedures/patient) for hydrocephalus has been followed for 5 1/2 years (Jan-S3 to Jun-88). Most of the children were under two years of age (80%) and in these cases brain sonography was the examination of choice for both diagnosis and follow-up (307 examinations, 4.4 per patient). Only occasionally was computed tomography necessary for better study in these cases. Our results suggest that there was no significant difference between our cases and those published in the litterature concerning the number of procedures/patient (1.66)., infection rate (5.2%), mortality rate (6.8%) and intellectual performance. We recommend the use of brain sonography both in diagnosis and follow-up studies for hydrocephalic children since this examination is innocuous, inexpensive and easy to perform by neurosurgeons. Also it provides a good interaction between the examiner, the child and the parents, which is of utmost importance for the comprehension of the disease by the parents and early diagnosis of complications by the neurosurgeon.

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Dr. Hélio Rubens Machado - Rua Rui Barbosa 1746 - 114015 Ribeirão Preto SP - Brasil

1. Amacher AL, Wellington J - Infantile hydrocephalus: long-term results of surgical therapy. Child's Brain 11:217, 1981.
2. Ambrosio A, Benvenuti L, Bianchi E, Briani S, Cagnoni G, Carteri A, Colangelo M, Fontana M, Gaini SM, Gerosa M, Giuffre R, Liguri G, Longati IL, Luccarelli G, Mazza C, Migliavacca F, Moise A, Occhipinti E, Palma L, Pasqualini A, Pezzotta G, Tomei G, Villani R - Cooperative study: long-term results of the operative treatment of hydrocephalus in children. In Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds): Advances in Neurosurgery 8. Springer, Berlin, 1980.
3. Choux M - Introduction. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.
4. Dandy WE - Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 68:569, 1918.
5. Dandy WE - An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 33:189, 1922.
6. Dennis M, Fitz CR, Netley CT, Sugar J, Harwood-Nash DC, Hendrick EB, Hoffman H, Humphreys RP - The intelligence of hydrocephalic children. Arch Neurol 38:607, 1981.
7. Foltz EL, Schurtleff DB - Five-year comparative study of hydrocephalus in children with and without operation (113 cases). J Neurosurg 20:1064, 1963.
8. Forjaz SV, Martelli N, Latuf NL - Hypothalamic ventriculostomy with catheter. J Neurosurg 29:655, 1968.
9. Griebal R, Khan M, Tan L - Cerebrospinal fluid shunt complications: an analysis of contributory factors. Child's Nerv Syst 1:77, 1985.
10. Guidetti B, Occhipinti E, Riccio A - Ventriculo-atrial shunt in 200 cases of non-tumoral hydrocephalus: remarks on the diagnostic criteria, postoperative complications and long--term results. Acta Neurochir 21:295, 1969.
11. Guiot G - Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Acta Neurochir 28:275, 1973.
12. Harwood-Nash DC - Radiology of shunt complications in childhood hydrocephalus. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.
13. Hemmer R - Long-term results in the operative treatment of hydrocephalus in children. In Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds): Advances in Neurosurgery S. Springer, Berlin, 1980.
14. Machado HR, Contrera JD - Hidrocefalia: controle de derivação liquórica. In Prando A, Rocha DC, Prando D, Cerri GG (eds): Ultra-sonografia Extra-Abdominal. Sarvier, São Paulo, 1986.
15. Machado HR, Machado JC, Contrera JD, Assirati JA Jr, Martelli N - Ultra-sonografia cerebral em crianças no primeiro ano de vida: um método não invasivo para o diagnóstico e acompanhamento das dilatações ventriculares. Arq Neuro-Psiquiat (São Paulo) 40:385, 1982.
16. Machado HR, Machado JC, Contrera JD, Assirati JA Jr, Martelli N, Colli BO - Ultra-sonographic evaluation of infantile hydrocephalus before and after shunting:. Child's Nerv Syst 1:341, 1985.
17. Matsumoto S, Sato K, OI, S (eds) - Annual Review of Hydrocephalus 1985. Neuron, Tokyo, 1986.
18. McCullough DC, Kane JG, Presper JH, Wells M - Antibiotic prophylaxis in ventricular shunt surgery: I. Reduction of operative infection rates with methicillin. Child's Brain 7:182, 1980.
19. McLaurin RL, Aronin P, OppenheLmer S - Cranial sonographic findings in myelomeningocele. In Humphreys RP (ed): Concepts in Pediatric Neurosurgery 4. Karger, Basel, 1983.
20. McLone DG, Dias L, Kaplan WE, Sommers MW - Concepts in the management of spina bifida. In Humphreys RP (ed): Concepts in Pediatric Neurosurgery 5. Karger, Basel, 1985.
21. Milhorat TH - Hydrocephalus and the Cerebrospinal Fluid. Williams and Wilkins, Baltimore, 1972, pg 237.
22. Milhorat TH - Hydrocephalus: historical notes, etiology and clinical diagnosis. In Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons (eds): Pediatric Neurosurgery. Grune e Stratton, New York, 1982.
23. Nulsen FE, Rekate HL - Results of treatment for hydrocephalus as a guide to future management. In Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons (eds): Pediatric Neurosurgery. Grune & Stratton, New York, 1982.
24. Nulsen FE, Spitz EB - Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 2:339, 1952.
25. Overton MC, Snodgrass SR - Ventriculo-venous shunts for infantile hydrocephalus: a review of five year's experience with this method. J Neurosurg 23:517, 1965.
26. Raimondi AJ, Soare P - Intellectual development in shunted hydrocephalic children. Am J Dis Child 127:664, 1974.
27. Renier D, Lacombe J, Pierre-Khan A, Sainte-Rose C, Hirsch JF - Factors causing acute shunt infection. J Neurosuig 61:1072, 1984.
28. Robinson JS, Kamamura K, Raimondi AJ - Complications of ventriculoperitonial shunting procedures. In McLaurin RL (ed): Myelomeningocele. Grune & Stratton, New York, 1977.
29. Rougerie J - Preface. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.
30. Shurtleff DB, Stuntz JT, Hayden PW - Experience with 1201 cerebrospinal fluid shunt procedures. Pediat Neurosci 12:49, 1986.
31. Sklar FH, Linder M - The role of the pressure-volume relationship of brain elasticity in the mechanics and treatment of hydrocephalus. In Shapiro K, Marmarou A, Portnoy H (eds): Hydrocephalus. Raven, New York, 1984.
32. Stookey B, Scarff J - Occlusion of the aqueduct of Sylvius by neoplastic and non--neoplastic process with a rational surgical treatment for relief of the resultant obstructive hydrocephalus. Bull Neurol Inst New York 5:348, 1936.
33. Storrs BB, Reid BS, Walker ML - Ultrasound evaluation of Chiari II malformation in infants. In Chapman PH (ed): Concepts in Pediatric Neurosurgery 6, 1985.
34. Torkildsen A - A new palliative operation in oases of inoperable occlusion of the Sylvian aqueduct. Acta Chir Scand 82:117, 1939.

Hidrocefalia infantil resultados tardios em 102 pacientes e importância da neuro -sonografia

Infantile hydrocephalus: long-term results in a series of 102 children with special emphasis on brain sonography.

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Mar 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Amacher AL, Wellington J - Infantile hydrocephalus: long-term results of surgical therapy. Child's Brain 11:217, 1981.

[2] 2. Ambrosio A, Benvenuti L, Bianchi E, Briani S, Cagnoni G, Carteri A, Colangelo M, Fontana M, Gaini SM, Gerosa M, Giuffre R, Liguri G, Longati IL, Luccarelli G, Mazza C, Migliavacca F, Moise A, Occhipinti E, Palma L, Pasqualini A, Pezzotta G, Tomei G, Villani R - Cooperative study: long-term results of the operative treatment of hydrocephalus in children. In Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds): Advances in Neurosurgery 8. Springer, Berlin, 1980.

[3] 3. Choux M - Introduction. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.

[4] 4. Dandy WE - Extirpation of the choroid plexus of the lateral ventricles in communicating hydrocephalus. Ann Surg 68:569, 1918.

[5] 5. Dandy WE - An operative procedure for hydrocephalus. Bull Johns Hopkins Hosp 33:189, 1922.

[6] 6. Dennis M, Fitz CR, Netley CT, Sugar J, Harwood-Nash DC, Hendrick EB, Hoffman H, Humphreys RP - The intelligence of hydrocephalic children. Arch Neurol 38:607, 1981.

[7] 7. Foltz EL, Schurtleff DB - Five-year comparative study of hydrocephalus in children with and without operation (113 cases). J Neurosurg 20:1064, 1963.

[8] 8. Forjaz SV, Martelli N, Latuf NL - Hypothalamic ventriculostomy with catheter. J Neurosurg 29:655, 1968.

[9] 9. Griebal R, Khan M, Tan L - Cerebrospinal fluid shunt complications: an analysis of contributory factors. Child's Nerv Syst 1:77, 1985.

[10] 10. Guidetti B, Occhipinti E, Riccio A - Ventriculo-atrial shunt in 200 cases of non-tumoral hydrocephalus: remarks on the diagnostic criteria, postoperative complications and long--term results. Acta Neurochir 21:295, 1969.

[11] 11. Guiot G - Ventriculo-cisternostomy for stenosis of the aqueduct of Sylvius. Acta Neurochir 28:275, 1973.

[12] 12. Harwood-Nash DC - Radiology of shunt complications in childhood hydrocephalus. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.

[13] 13. Hemmer R - Long-term results in the operative treatment of hydrocephalus in children. In Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds): Advances in Neurosurgery S. Springer, Berlin, 1980.

[14] 14. Machado HR, Contrera JD - Hidrocefalia: controle de derivação liquórica. In Prando A, Rocha DC, Prando D, Cerri GG (eds): Ultra-sonografia Extra-Abdominal. Sarvier, São Paulo, 1986.

[15] 15. Machado HR, Machado JC, Contrera JD, Assirati JA Jr, Martelli N - Ultra-sonografia cerebral em crianças no primeiro ano de vida: um método não invasivo para o diagnóstico e acompanhamento das dilatações ventriculares. Arq Neuro-Psiquiat (São Paulo) 40:385, 1982.

[16] 16. Machado HR, Machado JC, Contrera JD, Assirati JA Jr, Martelli N, Colli BO - Ultra-sonographic evaluation of infantile hydrocephalus before and after shunting:. Child's Nerv Syst 1:341, 1985.

[17] 17. Matsumoto S, Sato K, OI, S (eds) - Annual Review of Hydrocephalus 1985. Neuron, Tokyo, 1986.

[18] 18. McCullough DC, Kane JG, Presper JH, Wells M - Antibiotic prophylaxis in ventricular shunt surgery: I. Reduction of operative infection rates with methicillin. Child's Brain 7:182, 1980.

[19] 19. McLaurin RL, Aronin P, OppenheLmer S - Cranial sonographic findings in myelomeningocele. In Humphreys RP (ed): Concepts in Pediatric Neurosurgery 4. Karger, Basel, 1983.

[20] 20. McLone DG, Dias L, Kaplan WE, Sommers MW - Concepts in the management of spina bifida. In Humphreys RP (ed): Concepts in Pediatric Neurosurgery 5. Karger, Basel, 1985.

[21] 21. Milhorat TH - Hydrocephalus and the Cerebrospinal Fluid. Williams and Wilkins, Baltimore, 1972, pg 237.

[22] 22. Milhorat TH - Hydrocephalus: historical notes, etiology and clinical diagnosis. In Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons (eds): Pediatric Neurosurgery. Grune e Stratton, New York, 1982.

[23] 23. Nulsen FE, Rekate HL - Results of treatment for hydrocephalus as a guide to future management. In Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons (eds): Pediatric Neurosurgery. Grune & Stratton, New York, 1982.

[24] 24. Nulsen FE, Spitz EB - Treatment of hydrocephalus by direct shunt from ventricle to jugular vein. Surg Forum 2:339, 1952.

[25] 25. Overton MC, Snodgrass SR - Ventriculo-venous shunts for infantile hydrocephalus: a review of five year's experience with this method. J Neurosurg 23:517, 1965.

[26] 26. Raimondi AJ, Soare P - Intellectual development in shunted hydrocephalic children. Am J Dis Child 127:664, 1974.

[27] 27. Renier D, Lacombe J, Pierre-Khan A, Sainte-Rose C, Hirsch JF - Factors causing acute shunt infection. J Neurosuig 61:1072, 1984.

[28] 28. Robinson JS, Kamamura K, Raimondi AJ - Complications of ventriculoperitonial shunting procedures. In McLaurin RL (ed): Myelomeningocele. Grune & Stratton, New York, 1977.

[29] 29. Rougerie J - Preface. In Choux M (ed): Shunts and Problems in Shunts. Monogr Neural Sci 8. Karger, Basel, 1982.

[30] 30. Shurtleff DB, Stuntz JT, Hayden PW - Experience with 1201 cerebrospinal fluid shunt procedures. Pediat Neurosci 12:49, 1986.

[31] 31. Sklar FH, Linder M - The role of the pressure-volume relationship of brain elasticity in the mechanics and treatment of hydrocephalus. In Shapiro K, Marmarou A, Portnoy H (eds): Hydrocephalus. Raven, New York, 1984.

[32] 32. Stookey B, Scarff J - Occlusion of the aqueduct of Sylvius by neoplastic and non--neoplastic process with a rational surgical treatment for relief of the resultant obstructive hydrocephalus. Bull Neurol Inst New York 5:348, 1936.

[33] 33. Storrs BB, Reid BS, Walker ML - Ultrasound evaluation of Chiari II malformation in infants. In Chapman PH (ed): Concepts in Pediatric Neurosurgery 6, 1985.

[34] 34. Torkildsen A - A new palliative operation in oases of inoperable occlusion of the Sylvian aqueduct. Acta Chir Scand 82:117, 1939.