Long-term complications of hydrocephalus.

Problems may still occur for patients treated for infantile hydrocephalus who graduate to become adults, including unsatisfactory follow-up. We have continued the supervision in an adult institution of 70 children originally treated in the Birmingham Children's Hospital between 1974 and 1978. In these patients, 33 (16.4%) of a total of 201 shunt revision procedures and 5 of the 8 subtemporal decompressions for slit ventricle syndrome were performed after the age of 16 years. Similarly, 7 shunt infections occurred in this age group. Two patients died from a blocked shunt. Other late complications included blindness (n = 1), endocarditis (n = 1), and renal and heart failure requiring consideration of organ transplantation (n = 1). Also 2 patients developed clinical features of arachnoiditis following earlier lumboperitoneal shunting. An overall good long-term outcome was observed. The majority of children graduated from a normal school (63%) or a school for physically handicapped children (21%). 67% of the patients are socially independent, but live at home with their parents. A further 16% have left their parents' home and live either on their own (10%) or with their partners (6%). It is clear that although a good social and educational outcome is expected, significant clinical problems do arise during adulthood for patients shunted in infancy, even after a long period of apparent stability. Regular follow-up by surgeons familiar with these problems is essential.