[A novel strategy for the diagnosis and treatment of complex hydrocephalus in children: A staged surgical management protocol].

OBJECTIVES: Current strategies for the diagnosis and treatment of complex hydrocephalus in children remain inadequate. Patients often undergo multiple surgeries due to recurrent complications, resulting in poor therapeutic outcomes. This study aims to establish a novel surgical management protocol to reduce the number of surgeries and improve long-term prognosis in patients with complex hydrocephalus.

METHODS: A retrospective analysis was conducted on the clinical data of pediatric patients with complex hydrocephalus admitted to the Diagnosis and Treatment Center for Hydrocephalus of Xiangya Hospital, Central South University, from June 2018 to June 2025. Complex hydrocephalus was defined as hydrocephalus requiring multiple surgical interventions, post-hemorrhagic hydrocephalus, post-infectious hydrocephalus, multiloculated hydrocephalus, congenital hydrocephalus in preterm low birth weight infants, aqueductal stenosis, Dandy-Walker malformation, and other complex conditions. Patients treated with the staged surgical management protocol were included in the new-strategy group, while those treated with the conventional management protocol were included in the traditional-strategy group. Surgical treatment characteristics, as well as short-term and long-term outcomes, were compared between the two groups. Based on representative cases and a review of the literature, a new diagnostic and therapeutic strategy for pediatric complex hydrocephalus was developed.

RESULTS: A total of 137 pediatric patients with complex hydrocephalus were included, comprising 49 in the new-strategy group and 88 in the traditional-strategy group. There were no statistically significant differences in gender, age, or complexity factors between the two groups (all P>0.05). A total of 74 surgical procedures were performed in the new-strategy group and 283 in the traditional-strategy group. The number of surgeries per patient was significantly lower in the new-strategy group than in the traditional-strategy group (1.51±0.77 vs 3.22±1.40; t=7.879, P<0.001). In the new-strategy group, clinical symptoms were relieved in 49 patients, and ventricular size returned to normal in 35 patients. In the traditional-strategy group, clinical symptoms improved in 82 patients, and ventricular size normalized in 53 patients. There were no statistically significant differences between the two groups in terms of symptom relief or ventricular size recovery (all P>0.05). Regarding long-term outcomes, in the new-strategy group, 45 patients had clear cognition, 42 had good development, 41 had normal function, 11 developed complications, 10 required reoperation, and the survival rate was 100%. In the traditional-strategy group, 66 patients had clear cognition, 59 had good development, 59 had normal function, and 80 developed complications requiring reoperation, with a survival rate of 92.05%. All long-term outcome indicators showed statistically significant differences between the two groups (all P<0.05). A novel strategy for the diagnosis and treatment of pediatric complex hydrocephalus, namely, a staged surgical management protocol, was established, consisting of elimination of complexity factors in the first stage and treatment of hydrocephalus in the second stage.

CONCLUSIONS: Hydrocephalus in preterm low birth weight infants, hydrocephalus caused by intracranial hemorrhage and/or infection, multiloculated hydrocephalus, hydrocephalus requiring repeated surgeries, and other special forms should be defined as complex hydrocephalus in children. The staged surgical management protocol not only reduces the number of surgeries but also improves long-term prognosis in pediatric patients with complex hydrocephalus.