Quality of life in children with hydrocephalus treated with endoscopic third ventriculostomy.

Abstract

Introduction Treatment options for hydrocephalus in children improved vastly during the second half of the 20th Century, resulting in a great improvement in their life expectancy, such that there is now a growing interest in their quality of life. Hydrocephalus constitutes an aggression for the developing brain, and it is difficult to evaluate its consequences for the functional prognosis of the patient. Considering the current controversy surrounding the poorly defined definition of treatment success after endoscopic third ventriculostomy (ETV) in children with hydrocephalus and the difficulty this implies in certain cases, this study arose due to the need to clarify the clinical evolution and the health status objectively. The aims of this study were to determine the quality of life using the Hydrocephalus Outcome Questionnaire - Spanish version (HOQ-Sv) of a pediatric cohort with hydrocephalus treated by ETV and study the clinical and radiological factors associated with a better or worse functional status.

Methods This cross-sectional study was undertaken between September 2018 and December 2019. It comprised a series of 40 patients aged 5-18 years with hydrocephalus treated by ETV. ETV was considered to be successful if there was no need for surgery for the treatment of hydrocephalus after a minimum follow-up of 6 months. The clinical variables included gender; age at hydrocephalus diagnosis, at time of ETV and on completing the questionnaire; etiology and type of hydrocephalus (communicating or not); prior shunt; re-ETV; number of neurosurgical procedures; epileptic seizures; presenting signs; and follow-up time to last office revision. The radiological variables were the Evans Index and the pre- and post-treatment fronto-occipital horn ratio. An analysis was made of the association between all these variables and the various dimensions on the HOQ-Sv, completed by the parents of the patients via telephone or in the outpatient offices.

Results The mean age of the children at ETV was 7 years (7-194 months) and on completing the questionnaire 12 years (60-216 months). The HOQ scores were: overall 0.82, physical domain 0.85, social-emotional (SE) domain 0.83 and cognitive domain 0.75, and the Utility Score was 0.90. A history of epileptic crises was a predictive factor for a worse score overall and in the SE and cognitive domains. Factors related with a worse score in the physical domain were a previous shunt, number of procedures, the etiology and the type of hydrocephalus. The mean follow-up from ETV to the last office visit was 5 years (64.5 months). No association was found between the degree of ventricular reduction and the quality of life. Conclusions The factors related with a worse score in the different dimensions of the HOQ were a history of epileptic seizures, number of procedures, communicating hydrocephalus and having had a previous valve. No association was found between the reduction in ventricular size and the quality of life measured with the HOQ-Sv.