Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy – how serious is it?
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Purpose
We test the hypothesis that ventriculo-peritoneal (VP) shunt insertion significantly increases contralateral positional plagiocephaly.
Methods
We reviewed 339 children who had a VP shunt inserted at Birmingham Children’s Hospital between 2006-2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of postoperative positional plagiocephaly using the cranial vault asymmetry index. Multinomial logistic regression modelling was used to examine relationships between plagiocephaly, shunt position, gender and age. Adjusted odds and risk ratios for effect of variables on plagiocephaly were calculated.
Results
Children with occipital VP shunts are at significant risk of developing contralateral positional plagiocephaly, particularly in the first 12 months of life.
Conclusions
We recommend careful follow-up and advice regarding head positioning following surgery. There should be consideration for active monitoring to avoid plagiocephaly, including physiotherapy and health visitor interventions. Endoscopic third ventriculostomy in selected cases or anterior shunt placement could be considered. A larger national study would be of interest to evaluate the extent of an otherwise correctable problem.
We test the hypothesis that ventriculo-peritoneal (VP) shunt insertion significantly increases contralateral positional plagiocephaly.
Methods
We reviewed 339 children who had a VP shunt inserted at Birmingham Children’s Hospital between 2006-2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of postoperative positional plagiocephaly using the cranial vault asymmetry index. Multinomial logistic regression modelling was used to examine relationships between plagiocephaly, shunt position, gender and age. Adjusted odds and risk ratios for effect of variables on plagiocephaly were calculated.
Results
Children with occipital VP shunts are at significant risk of developing contralateral positional plagiocephaly, particularly in the first 12 months of life.
Conclusions
We recommend careful follow-up and advice regarding head positioning following surgery. There should be consideration for active monitoring to avoid plagiocephaly, including physiotherapy and health visitor interventions. Endoscopic third ventriculostomy in selected cases or anterior shunt placement could be considered. A larger national study would be of interest to evaluate the extent of an otherwise correctable problem.
Date Issued
2016-11-15
Date Acceptance
2016-10-07
Citation
Child's Nervous System, 2016, 33 (2), pp.275-280
ISSN
0256-7040
Publisher
Springer
Start Page
275
End Page
280
Journal / Book Title
Child's Nervous System
Volume
33
Issue
2
Copyright Statement
© The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Subjects
Neurology & Neurosurgery
1103 Clinical Sciences
Publication Status
Published