Positional plagiocephaly following ventriculoperitoneal shunting in neonates and infancy—how serious is it?

Purpose We test the hypothesis that ventriculoperitoneal (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 and 2013, noting laterality of shunt insertion and...

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Bibliographic Details
Published in:Child's nervous system 2017-02, Vol.33 (2), p.275-280
Main Authors: Roberts, Stuart A. G., Symonds, Joseph D., Chawla, Reema, Toman, Emma, Bishop, Jonathan, Solanki, Guirish A.
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Logistic Models
Male
Medicine
Medicine & Public Health
Neurosciences
Neurosurgery
Original Paper
Plagiocephaly, Nonsynostotic - surgery
Retrospective Studies
Sex Factors
Treatment Outcome
Ventriculoperitoneal Shunt - methods
Ventriculostomy
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Summary:Purpose We test the hypothesis that ventriculoperitoneal (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 and 2013, noting laterality of shunt insertion and frontal or occipital position. We ascertained the presence of post-operative 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.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-016-3275-z