Rate of Head Circumference Growth as a Predictor of Shunt Dependency in Posthemorrhagic Hydrocephalus of Prematurity

Abstract

Objectives

The timing and indications for endoscopic third ventriculostomy (ETV) in pediatric hydrocephalus are debated. We evaluated head circumference growth as a predictor of ETV success in children with posthemorrhagic hydrocephalus (PHH).

Methods

We conducted a retrospective review of 303 patients who underwent ETV from 2012 to 2021, focusing on those with intraventricular hemorrhage (IVH) and PHH. Data were collected from electronic medical records. A univariate logistic regression analyzed predictors of ETV failure, with head circumference growth rate calculated from preoperative occipito-frontal circumference measurements.

Results

Among the 303 patients, 24 had IVH and PHH. Mean gestational age was 30 weeks, with 58% male, and a mean weight of 4.48 kg at surgery. Notably, 96% (n = 23) had choroid plexus cauterization, and 46% (n = 11) underwent ventriculosubgaleal shunt. Of the 24, 67% (n = 16) required eventual ventriculoperitoneal shunt (VPS) placement, indicating ETV failure. Corrected age at ETV was younger in the failure group (0.69 months) than in the success group (2.56 months, p = 0.020, odds ratio [OR]: 1.04). Mean weight at surgery was lower for the failure group (3.85 kg vs. 5.75 kg, p = 0.036). Duration of preoperative surveillance was 1.94 months for the failure group and 5.25 months for the success group (p = 0.004). Head circumference growth rate was 1.57 mm/day in the failure group compared to 0.85 mm/day in the success group (p = 0.009, OR: 39.9).

Conclusion

Younger corrected age, lower weight at surgery, shorter preoperative surveillance time, and faster head circumference growth rate were associated with ETV failure and ultimately VPS placement. Further analysis with a larger cohort may enhance predictions of ETV success rates.

Keywords

hydrocephalus - endoscopic third ventriculostomy - intraventricular hemorrhage - ventriculoperitoneal shunt - head circumference

This work was presented at the 2023 Pediatric Section Annual Meeting in Washington D.C., United States.

Publication History

Received: 14 April 2025

Accepted: 29 July 2025

Article published online:
13 August 2025

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