Follow-up After Surgery for Managing Hydrocephalus in Children

Authors

Kemel Ahmed Ghotme, M.D.

James M. Drake, M.D.

Section Editor

Shlomi Constantini, M.D.

Editor in Chief

Rick Abbott, M.D.

Frequency of Office Visits

Patients managed with shunts

• Suture removal: A follow-up appointment in 7–10 days with the neurosurgical team or nursing is advisable if removable sutures were used to close skin. If absorbable sutures were used, or if sutures were already removed, a follow-up visit can be scheduled 4–6 weeks after surgery.
• Routine follow up: Typically patients are seen at 3 months, 1 year, and then annually or semiannually.

Patients managed with third ventriculostomies

• Same as patients managed with shunts: A patient who has had an ETV should be viewed in the same light as a patient with a shunt with regard to the need for follow-up. An ETV is not a curative procedure, and deaths have been reported in individuals whose ETV failed and for whom timely intervention did not occur (35, 36).
• Signs of failing ETV: In addition to obvious signs of increased ICP, the patient should be warned about the importance of reporting any persisting dullness or slowing in cognition, as this also can be a sign of a failed ETV.

Frequency of Imaging

Patients managed with shunts

• Baseline scan: An interim scan at 3 months and a baseline scan at 1 year, when the ventricles are usually at their smallest, should be obtained.
• Routine imaging follow-up: Annual scans and shunt series in asymptomatic patients are likely unnecessary, but the ideal frequency is undetermined.

Patients managed with third ventriculostomies

• Frequency: No imaging protocols offer guidance for how often scans should be done on patients not experiencing problems with their ETVs.  A baseline MRI scan should be done during the first 3–6 months after an ETV.
• Ventricular size: The ventricles may not change in size after an ETV.  Concern should be raised when an interval increase in ventricular size occurs in comparison to the baseline images obtained after an ETV has been performed.

Other Investigations Required

• Patient possession of images: The family or patient should be advised to carry a disc with them at all times (especially during vacations) containing the most recent head CT demonstrating the patient’s stable and baseline ventricular size. This imaging will be helpful to a neurosurgeon evaluating the patient if the patient should visit an ER away from home.