| Abstract | Hidrocefalus je definiran kao poremećaj u stvaranju, protoku te apsorpciji cerebrospinalnog likvora (CSL) koji dovodi do povećanja volumena tekućine u prostorima središnjeg živčanog sustava na račun moždane mase. Kliničke karakteristike ovise o dobi djeteta u kojoj se stanje prezentira te o razvoju lubanje. Primarni cilj liječenja je osigurati normalan razvoj djeteta. Ovisno o pacijentu, primjenjuju se metode vanjske te unutarnje drenaže ili farmakološki tretman. Cilj rada bio je istražiti terapijski pristup i komplikacije hidrocefalusa u djece liječene u Klinici za pedijatriju KBC-a Rijeka te usporediti dobivene rezultate s dostupnom literaturom. Što se pak, metoda i ispitanika tiče, retrospektivno je analizirana cjelokupna medicinska dokumentacija djece hospitalizirane u KBC Rijeka sa dijagnozom hidrocefalusa. U šestogodišnjem razdoblju (2012.- 2017.godine) bilo je 15 bolesnika (M=11, Ž=4). Ukupno je bilo 12 nedonoščadi, te troje terminske djece, a gestacijska dob od 24. do 39. tjedna. Prosječna porođajna težina bila je 1416 g (570g – 3310g). Hidrocefalus je klasificiran kao kongenitalni ili stečeni. Analizirane su dijagnostičke metode kojima je potvrđena dijagnoza prije daljnje terapije (UZV, CT ili MR mozga) te terapijski postupci koji su podijeljeni u 3 skupine: farmakološki, neurokirurški zahvati i/ili kombinirani. Analizirane su pojavnosti komplikacija s obzirom na terapijski pristup i konačan ishod. Rezultati su bili sljedeći. U našoj kohorti ispitanika uredan Apgar indeks zabilježen je u 5/15 (33%), dok je u 10/15 (67%) Apgar indeks ≤ 6. U 13 ispitanika (87%) radilo se o stečenom hidrocefalusu, a u dvoje prisutan je bio kongenitalni hidrocefalus. U svih ispitanika dijagnoza je postavljena transfontanelarnim UZV - om. Dodatne neuroslikovne metode uključivale su CT mozga u 6 (40%) te MR mozga u 9 ispitanika (60%). Farmakološkom liječenju acetazolamidom pristupalo se u 4 (27%) ispitanika, od čega u dvoje kao isključivo liječenje. U 10 ispitanika hidrocefalus je neurokirurški liječen, od čega u 3 (30%) isključivo vanjskom drenažom CSL-a, dok se u ostalih pristupalo kombinirano. VPA je postavljena u 6 (60%) kirurški liječenih ispitanika - uvijek nakon vanjske drenaže. Od svih navedenih komplikacija najviše su bile zastupljene shunt infekcije u 4 (33%). Slijedila je opstrukcija u 3 (25%), promjena valvule (17%), overdrenaža kod 1 (8%) i sekrecija likvora uz ventrikulostomu u 1 (8%) slučaja. Zaključno svemu terapijski pristup te učestalost komplikacija u našem istraživanju uvelike su podudarni sa dostupnom medicinskom literaturom. Važno je prema postojećim komorbiditetima procijeniti stanje djeteta te odabrati terapiju sukladno njegovom stanju. |
| Abstract (english) | Hydrocephalus is defined as a disorder in the formation, flow and absorption of cerebrospinal fluid (CSF), which leads to an increase in fluid volume in the central nervous system spaces as well as an enlargement in brain mass. Clinical characteristics depend on the age of the child in which the condition is presented and the development of the skull. The primary goal of the treatment is to ensure the normal development of the child. Depending on the patient, the methods of external and internal drainage or pharmacological treatment are applied. The aim of the study was to investigate the therapeutic approach and complications of hydrocephalus in children treated at the KBC Rijeka Pediatric Clinic and compare the obtained results with available literature. As for the method and the examinees, the complete medical documentation of children hospitalized in KBC Rijeka with hydrocephalus diagnosis was retrospectively analyzed. In the six-year period (2012-2017) there were 15 patients (M = 11, Ž = 4). There were altogether 12 pre - term, and three term children with a gestational age of 24 to 39 weeks. The average birth weight was 1416 g (570 g - 3310 g). Hydrocephalus was classified as congenital or acquired. Analyzed diagnostic procedures were the ones used prior to further therapy (ultrasound, CT or MRI) and therapeutic procedures were divided into three groups: pharmacological, neurosurgical, and / or combined. Complications have been analyzed with regard to therapeutic approach and final outcome. The results were the following. In our sample normal Apgar score was found in 5/15 (33%), while the Apgar score in 10/15 (67%) was ≤ 6. In 13 subjects (87%) acquired hydrocephalus was found, and in the 2 congenital hydrocephalus was present. All subjects were diagnosed with transfontanellar ultrasound. Additional neurological methods included CT in 6 (40%) and MRI in 9 subjects (60%). Pharmacological treatment with acetazolamide was initiated in 4 (27%) subjects, from which 2 patients had it administered as the only therapy choice. In 10 subjects hydrocephalus was neurosurgicaly treated, 3 of which (30%) exclusively with external CSL drainage, while with the other patients the treatment was combined. The VPA was set in 6 (60%) patients - always after external drainage. Of all the above mentioned complications, most common ones were infections in 4 (33%). They were followed by drainage obstruction in 3 (25%), shunt change (17%), overdrainage in 1 (12%), and CSF ventricular secretion in 1 (12%) case. In conclusion, the therapeutic approach and the frequency of complications in our research largely coincides with available medical literature. It is important to evaluate the state of the child according to the existing comorbidities and choose therapy according to its condition. |
