The purpose of the present study was to identify the main risk factors for poor outcome in children with shunted hydrocephalus, including the timing of the operation. The medical records of patients born between 1984 and 1992, who had undergone shunt operation for hydrocephalus before 1994, were analysed retrospectively. The following data were collected: aetiology of hydrocephalus, other pathology in addition to hydrocephalus, timing of drain implantation, number and indication of revisions and several outcome parameters such as school type, seizures and morbidity parameters. Children with a post-haemorrhagic hydrocephalus fared poorly. Children with hydrocephalus due to spina bifida or another congenital malformation had considerably better outcome scores. Pathology in addition to hydrocephalus negatively influenced the prognosis. Regarding the timing of drain implantation, we found a poorer mental and linguistic development in children operated more than 1 month after diagnosis. Patients with more than two revisions seem to have a higher chance of developing seizures. In conclusion, this study confirms earlier reports that peri- and postnatal haemorrhage is an important risk factor for poor outcome. More importantly, we found that delay in surgical treatment might also be a risk factor for poor outcome in hydrocephalic children.
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