Abstract：
OBJECTIVE: This study aims to discuss the management challenges of huge hydrocephalus (HH), a severe subset of hydrocephalus, presenting predominantly in underprivileged backgrounds. Insights into the condition\'s characteristics, factors affecting outcomes, and associated morbidity are discussed.
METHODS: A retrospective review of all operated cases of hydrocephalus with head circumference greater than body length (HC>L) was conducted (January 2019-January 2023). Data on epidemiological parameters, associated cranial abnormalities, cortical mantle thickness, peri-conceptional folic acid intake, surgical interventions, age-appropriate milestones, and complications were collected. Follow-up was conducted for at least 12 months or until expiration.
RESULTS: The cohort consisted of 7 males and 5 females with age ranging from 3 to 48 months. 33% of them had associated neurological abnormalities, and 18 surgical interventions were needed for these 12 cases, including ventriculoperitoneal shunt or endoscopic diversion. A 17% wound breakdown rate requiring re-suturing was present, and 33% of cases had postoperative CSF infection, with 33% mortality, with only one case having age-appropriate development seen. The average hospital stay was 11.9 days, six times our center\'s average. All cases with an Evans index with an average of 0.7 expired within 12 months. None of the 12 mothers took peri-conceptional folic acid, and no case agreed to reduction cranioplasty.
CONCLUSIONS: Huge hydrocephalus is a rare cohort with significant management challenges and poor prognosis even after treatment. Factors such as delayed intervention and low socioeconomic status contribute to adverse outcomes. Prevention through peri-conceptual folic acid intake and addressing socioeconomic disparities is crucial in reducing disease burden and improving prognosis.
METHODS: A retrospective review of all operated cases of hydrocephalus with head circumference greater than body length (HC>L) was conducted (January 2019-January 2023). Data on epidemiological parameters, associated cranial abnormalities, cortical mantle thickness, peri-conceptional folic acid intake, surgical interventions, age-appropriate milestones, and complications were collected. Follow-up was conducted for at least 12 months or until expiration.
RESULTS: The cohort consisted of 7 males and 5 females with age ranging from 3 to 48 months. 33% of them had associated neurological abnormalities, and 18 surgical interventions were needed for these 12 cases, including ventriculoperitoneal shunt or endoscopic diversion. A 17% wound breakdown rate requiring re-suturing was present, and 33% of cases had postoperative CSF infection, with 33% mortality, with only one case having age-appropriate development seen. The average hospital stay was 11.9 days, six times our center\'s average. All cases with an Evans index with an average of 0.7 expired within 12 months. None of the 12 mothers took peri-conceptional folic acid, and no case agreed to reduction cranioplasty.
CONCLUSIONS: Huge hydrocephalus is a rare cohort with significant management challenges and poor prognosis even after treatment. Factors such as delayed intervention and low socioeconomic status contribute to adverse outcomes. Prevention through peri-conceptual folic acid intake and addressing socioeconomic disparities is crucial in reducing disease burden and improving prognosis.
摘要：
目的：本研究旨在讨论巨大脑积水（HH）的管理挑战，严重的脑积水,主要表现在贫困背景下。洞察条件的特点，影响结果的因素，并讨论了相关的发病率。
方法：对所有头围大于体长（HC>L）的脑积水手术病例进行了回顾性审查（2019年1月至2023年1月）。流行病学参数数据，相关的颅骨异常，皮层地幔厚度,周边概念叶酸摄入量，手术干预，适合年龄的里程碑，收集并发症。随访至少12个月或直到过期。
结果：该队列由7名男性和5名女性组成，年龄从3到48个月不等。其中33%有相关的神经系统异常，这12例需要18例手术干预，包括脑室-腹腔分流术或内镜下分流术.有17%的伤口破裂率需要重新缝合，33%的病例术后脑脊液感染，死亡率为33%,只有一个案例有适合年龄的发展。平均住院时间为11.9天,是我们中心平均水平的六倍。Evans指数平均为0.7的所有病例均在12个月内过期。这12位母亲都没有服用周生叶酸，没有病例同意复位颅骨成形术。
结论：巨大脑积水是一种罕见的队列，即使在治疗后也存在重大的管理挑战和不良预后。延迟干预和低社会经济地位等因素会导致不良后果。通过全概念叶酸摄入和解决社会经济差异进行预防对于减少疾病负担和改善预后至关重要。
方法：对所有头围大于体长（HC>L）的脑积水手术病例进行了回顾性审查（2019年1月至2023年1月）。流行病学参数数据，相关的颅骨异常，皮层地幔厚度,周边概念叶酸摄入量，手术干预，适合年龄的里程碑，收集并发症。随访至少12个月或直到过期。
结果：该队列由7名男性和5名女性组成，年龄从3到48个月不等。其中33%有相关的神经系统异常，这12例需要18例手术干预，包括脑室-腹腔分流术或内镜下分流术.有17%的伤口破裂率需要重新缝合，33%的病例术后脑脊液感染，死亡率为33%,只有一个案例有适合年龄的发展。平均住院时间为11.9天,是我们中心平均水平的六倍。Evans指数平均为0.7的所有病例均在12个月内过期。这12位母亲都没有服用周生叶酸，没有病例同意复位颅骨成形术。
结论：巨大脑积水是一种罕见的队列，即使在治疗后也存在重大的管理挑战和不良预后。延迟干预和低社会经济地位等因素会导致不良后果。通过全概念叶酸摄入和解决社会经济差异进行预防对于减少疾病负担和改善预后至关重要。
