Follow-up strategies for hydrocephalus patients

Abstract

A regular follow-up on patients is one of the fundamental and crucial parts of the medical care system. The value and the need for such a strict follow-up system are very well illustrated in the management plan of hydrocephalus (HC) patients. The sequelae and related and unrelated complications of such patient are innumerous. Hydrocephalus is not the problem of dilated ventricles only; it is a problem of the whole brain, what can be called the hydrocephalus brain! Therefore, the proper management of hydrocephalus should extend to all aspects of a hydrocephalus brain. The problems of the hydrocephalus may start intrauterine but continues lifelong. Therefore, the neurosurgical treating team is obliged to provide a long-term follow-up plan for each case according to the genetic profile, age, etiology of hydrocephalus, pathophysiology, method of treatment, and associated anomalies. Although the general belief in the principle of treatment of hydrocephalus seems straightforward (reduce pressure, optimize brain function and well-being of the patient), a long-term management can lead to some challenging brainteasers over time. In fact, sometimes, complications such as overdrainage or turning the patient to be shunt dependent may occur after insertion of the shunt or ETV performance. We recommend following up these patients in a multidisciplinary hydrocephalus and spina bifida outpatient clinic that can provide a comprehensive care from every different angles such as pediatric neurosurgery, pediatric neurology, psychology, orthopedic, urology, physiotherapy, rehabilitation, and social services all in one visit. The schedule and frequency of the follow-up visits may differ from center to center. We recommend that the first visit should be within 2 weeks from discharge and the second after 2-3 months. The long-term monitoring plan should be designed according to the needs and character of each case. Shunt-dependent patients should be scheduled for shunt revision before shunt malfunction appears. It is usually scheduled according to the rate of the growth of the child, which differs from one child to another (Colak et al., Pediatr Neurosurg 27:208-10, 1997; Lumenta and Skotarczak, Childs Nerv Syst 11:173-5, 1995; Rekate, Semin Pediatr Neurol 16:9-15, 2009; Sufianov et al., J Neurosurg Pediatr 5:392-401, 2010; Swain et al. J Neuropsychol 3:229-44, 2009; Takahashi, Childs Nerv Syst 22:1591-602, 2006; Vinchon et al., Fluids Barriers CNS 9:18, 2012; Yadav et al., BMC Res Notes 2:137, 2009).