Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta

Kenzie Ongko Wijaya; Nunki Puspita Utomo; Arya Taksya Bagaskara; Endro Basuki Sadjiman

doi:doi:10.11648/j.ijn.20250902.11

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Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta

Kenzie Ongko Wijaya^*

, Nunki Puspita Utomo

, Arya Taksya Bagaskara

, Endro Basuki Sadjiman

Published in International Journal of Neurosurgery (Volume 9, Issue 2)

Received: 1 October 2025 Accepted: 14 October 2025 Published: 31 October 2025

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Abstract

Hydrocephalus is characterized by abnormal cerebrospinal fluid (CSF) accumulation in the brain’s ventricles, which can lead to significant morbidity and mortality without timely intervention. This retrospective cohort study aimed to evaluate the incidence, survival outcomes, and risk factors associated with hydrocephalus among patients treated at Bethesda Hospital Yogyakarta over a five-year period. Medical records of 203 patients diagnosed with hydrocephalus between 2019 and 2024 were reviewed, and patient demographics, hydrocephalus type, treatment modality, and comorbidities—assessed using the Charlson Comorbidity Index—were analyzed. Survival outcomes were examined using Kaplan-Meier analysis, and hazard ratios (HR) were calculated via Cox regression. Most patients were aged ≥60 years (60%) and male (53.2%), with non-communicating hydrocephalus being the most common type (43.8%). Infants (<1 year) demonstrated the highest five-year survival rate (100%), while patients aged 41–59 had the lowest (57.1%; HR: 13.8, p = 0.018). Surgical treatment, predominantly ventriculoperitoneal shunting, significantly improved survival (74.0%) compared with conservative management (60.2%; HR: 1.649, p = 0.05). Among hydrocephalus types, ex-vacuo presented the best prognosis (100% survival), whereas non-communicating hydrocephalus had the poorest (63.7%; HR: 14.4, p = 0.016). Higher comorbidity scores were associated with worse outcomes, particularly in acquired cases. Overall, hydrocephalus outcomes varied significantly by age, type, comorbidities, and treatment approach, with surgical intervention offering a clear survival advantage and reinforcing its role as the primary management strategy. Early diagnosis and personalized treatment planning are crucial to improving long-term outcomes in hydrocephalus patients.

Published in	International Journal of Neurosurgery (Volume 9, Issue 2)
DOI	10.11648/j.ijn.20250902.11
Page(s)	41-48
Creative Commons	This is an Open Access article, 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 or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Hydrocephalus, Retrospective Cohort Study, Survival Analysis, Ventriculoperitoneal Shunt, Kaplan-Meier Estimator, Comorbidities, Patient Outcomes

References

[1]	Koleva, M., & De Jesus, O. (2024). Hydrocephalus. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK560875/
[2]	Zaksaite, T., Loveday, C., Edginton, T., Spiers, H. J., & Smith, A. D. (2023). Hydrocephalus: A neuropsychological and theoretical primer. Cortex, 160, 67–99.
[3]	Hochstetler, A., Raskin, J., & Blazer-Yost, B. L. (2022). Hydrocephalus: Historical analysis and considerations for treatment. European Journal of Medical Research, 27(1), 168.
[4]	Devarapalli, L., Williams, K., & Oroszi, T. (2025). A comprehensive review of pediatric hydrocephalus. Open Journal of Pediatrics, 15, 21–37. https://doi.org/10.4236/ojped.2025.151003
[5]	Zhou, F., Yang, Z., Tang, Z., Zhang, Y., Wang, H., Sun, G., Zhang, R., Jiang, Y., Zhou, C., Hou, X., & Liu, L. (2023). Outcomes and prognostic factors of infantile acquired hydrocephalus: A single-center experience. BMC Pediatrics, 23(1), 260. https://doi.org/10.1186/s12887-023-04034-w
[6]	Tullberg, M., et al. (2024). Classification of chronic hydrocephalus in adults: A systematic review and analysis. World Neurosurgery, 183, 113–122. https://doi.org/10.1016/j.wneu.2023.12.094
[7]	Martinez, F., Rotter, J., Graffeo, C., & Lanzino, G. (2023). Congenital hydrocephalus diagnosed in a nonagenarian: Case report. Neuroradiology Journal, 36(6), 752–754. https://doi.org/10.1177/19714009221150850
[8]	Deopujari, C., Mohanty, C., Agrawal, H., Jain, S., & Chawla, P. (2021). A comparison of adult and pediatric hydrocephalus. Neurology India, 69(Suppl 2), S395.
[9]	Kahle, K. T., Kulkarni, A. V., Limbrick, D. D., & Warf, B. C. (2022). Hydrocephalus in children. The Lancet, 399(10319), 1341–1354. https://doi.org/10.1016/S0140-6736(21)02364-8
[10]	Cai, Y., Liu, Z., Jia, C., Zhao, J., Chai, S., Li, Z., et al. (2022). Comparison of sex differences in outcomes of patients with aneurysmal subarachnoid hemorrhage: A single-center retrospective study. Frontiers in Neurology, 13, 853513.
[11]	Peng, K., Koduri, S., Xia, F., Gao, F., Hua, Y., Keep, R. F., et al. (2021). Impact of sex differences on thrombin-induced hydrocephalus and white matter injury: The role of neutrophils. Fluids and Barriers of the CNS, 18, 38.
[12]	Zhang, Y., Li, Q., Wang, J., & Chen, X. (2022). Prognostic factors in patients with tumor-associated hydrocephalus: A retrospective cohort study. Journal of Neuro-Oncology, 158(1), 45–55. https://doi.org/10.1007/s11060-021-03892-7
[13]	Kanesen, D., Kandasamy, R., Wong, A. S. H., Tharakan, J., Lim, C. J., & Abdullah, J. M. (2021). Clinical outcome of tuberculous meningitis with hydrocephalus: A retrospective study. Malaysian Journal of Medical Sciences, 28(5), 82–93. https://doi.org/10.21315/mjms2021.28.5.8
[14]	Zhang, X., Li, P., Wen, J., Chang, J., Chen, Y., Yin, R., et al. (2023). Ventriculoperitoneal shunt for tuberculous meningitis-associated hydrocephalus: Long-term outcomes and complications. BMC Infectious Diseases, 23(1), 742.
[15]	Cuoco, J. A., Benko, M. J., Klein, B. J., Keyes, D. C., Patel, B. M., & Witcher, M. R. (2020). Idiopathic fourth ventricular outlet obstruction misdiagnosed as normal pressure hydrocephalus: A cautionary case. Journal of Clinical Neuroscience, 11, 305.
[16]	Rufus, P., Moorthy, R. K., Joseph, M., & Rajshekhar, V. (2021). Post-traumatic hydrocephalus: Incidence, pathophysiology and outcomes. Neurology India, 69(Suppl 2), S420–S428. https://doi.org/10.4103/0028-3886.332264
[17]	Deng, H., Goldschmidt, E., Nwachuku, E., Yue, J. K., Angriman, F., Wei, Z., Agarwal, N., Puccio, A. M., & Okonkwo, D. O. (2021). Hydrocephalus and cerebrospinal fluid analysis following severe traumatic brain injury: Evaluation of a prospective cohort. Neurology International, 13(4), 527–534. https://doi.org/10.3390/neurolint13040052
[18]	Svedung Wettervik, T., Lewén, A., & Enblad, P. (2022). Post-traumatic hydrocephalus – incidence, risk factors, treatment, and clinical outcome. British Journal of Neurosurgery, 36(3), 400–406.
[19]	Lindfors, M., Vehviläinen, J., Bendel, S., Reinikainen, M., Laitio, R., Ala-Kokko, T., et al. (2023). Incidence and risk factors of posttraumatic hydrocephalus and its association with outcome following intensive care unit treatment for traumatic brain injury: A multicenter observational study. Journal of Neurosurgery, 139(5), 1420–1429.
[20]	Reimagining durability of hydrocephalus treatment using conditional survival. (2025). Journal of Neurosurgery: Pediatrics. https://doi.org/10.3171/2024.10.PEDS24454

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APA Style

Wijaya, K. O., Utomo, N. P., Bagaskara, A. T., Sadjiman, E. B. (2025). Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. International Journal of Neurosurgery, 9(2), 41-48. https://doi.org/10.11648/j.ijn.20250902.11

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ACS Style

Wijaya, K. O.; Utomo, N. P.; Bagaskara, A. T.; Sadjiman, E. B. Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. Int. J. Neurosurg. 2025, 9(2), 41-48. doi: 10.11648/j.ijn.20250902.11

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AMA Style

Wijaya KO, Utomo NP, Bagaskara AT, Sadjiman EB. Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. Int J Neurosurg. 2025;9(2):41-48. doi: 10.11648/j.ijn.20250902.11

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@article{10.11648/j.ijn.20250902.11,
  author = {Kenzie Ongko Wijaya and Nunki Puspita Utomo and Arya Taksya Bagaskara and Endro Basuki Sadjiman},
  title = {Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta},
  journal = {International Journal of Neurosurgery},
  volume = {9},
  number = {2},
  pages = {41-48},
  doi = {10.11648/j.ijn.20250902.11},
  url = {https://doi.org/10.11648/j.ijn.20250902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20250902.11},
  abstract = {Hydrocephalus is characterized by abnormal cerebrospinal fluid (CSF) accumulation in the brain’s ventricles, which can lead to significant morbidity and mortality without timely intervention. This retrospective cohort study aimed to evaluate the incidence, survival outcomes, and risk factors associated with hydrocephalus among patients treated at Bethesda Hospital Yogyakarta over a five-year period. Medical records of 203 patients diagnosed with hydrocephalus between 2019 and 2024 were reviewed, and patient demographics, hydrocephalus type, treatment modality, and comorbidities—assessed using the Charlson Comorbidity Index—were analyzed. Survival outcomes were examined using Kaplan-Meier analysis, and hazard ratios (HR) were calculated via Cox regression. Most patients were aged ≥60 years (60%) and male (53.2%), with non-communicating hydrocephalus being the most common type (43.8%). Infants (<1 year) demonstrated the highest five-year survival rate (100%), while patients aged 41–59 had the lowest (57.1%; HR: 13.8, p = 0.018). Surgical treatment, predominantly ventriculoperitoneal shunting, significantly improved survival (74.0%) compared with conservative management (60.2%; HR: 1.649, p = 0.05). Among hydrocephalus types, ex-vacuo presented the best prognosis (100% survival), whereas non-communicating hydrocephalus had the poorest (63.7%; HR: 14.4, p = 0.016). Higher comorbidity scores were associated with worse outcomes, particularly in acquired cases. Overall, hydrocephalus outcomes varied significantly by age, type, comorbidities, and treatment approach, with surgical intervention offering a clear survival advantage and reinforcing its role as the primary management strategy. Early diagnosis and personalized treatment planning are crucial to improving long-term outcomes in hydrocephalus patients.},
 year = {2025}
}

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TY  - JOUR
T1  - Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta
AU  - Kenzie Ongko Wijaya
AU  - Nunki Puspita Utomo
AU  - Arya Taksya Bagaskara
AU  - Endro Basuki Sadjiman
Y1  - 2025/10/31
PY  - 2025
N1  - https://doi.org/10.11648/j.ijn.20250902.11
DO  - 10.11648/j.ijn.20250902.11
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 41
EP  - 48
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20250902.11
AB  - Hydrocephalus is characterized by abnormal cerebrospinal fluid (CSF) accumulation in the brain’s ventricles, which can lead to significant morbidity and mortality without timely intervention. This retrospective cohort study aimed to evaluate the incidence, survival outcomes, and risk factors associated with hydrocephalus among patients treated at Bethesda Hospital Yogyakarta over a five-year period. Medical records of 203 patients diagnosed with hydrocephalus between 2019 and 2024 were reviewed, and patient demographics, hydrocephalus type, treatment modality, and comorbidities—assessed using the Charlson Comorbidity Index—were analyzed. Survival outcomes were examined using Kaplan-Meier analysis, and hazard ratios (HR) were calculated via Cox regression. Most patients were aged ≥60 years (60%) and male (53.2%), with non-communicating hydrocephalus being the most common type (43.8%). Infants (<1 year) demonstrated the highest five-year survival rate (100%), while patients aged 41–59 had the lowest (57.1%; HR: 13.8, p = 0.018). Surgical treatment, predominantly ventriculoperitoneal shunting, significantly improved survival (74.0%) compared with conservative management (60.2%; HR: 1.649, p = 0.05). Among hydrocephalus types, ex-vacuo presented the best prognosis (100% survival), whereas non-communicating hydrocephalus had the poorest (63.7%; HR: 14.4, p = 0.016). Higher comorbidity scores were associated with worse outcomes, particularly in acquired cases. Overall, hydrocephalus outcomes varied significantly by age, type, comorbidities, and treatment approach, with surgical intervention offering a clear survival advantage and reinforcing its role as the primary management strategy. Early diagnosis and personalized treatment planning are crucial to improving long-term outcomes in hydrocephalus patients.
VL  - 9
IS  - 2
ER  -

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Author Information

Kenzie Ongko Wijaya

Neurosurgery Department, Bethesda Hospital Yogyakarta, Yogyakarta, Indonesia

Contact Email

http://orcid.org/0009-0004-5579-5928
Nunki Puspita Utomo

Neurosurgery Department, Udayana University, Bali, Indonesia

Contact Email

http://orcid.org/0000-0003-2688-5073
Arya Taksya Bagaskara

Neurosurgery Department, Udayana University, Bali, Indonesia

Contact Email

http://orcid.org/0009-0008-0423-7423
Endro Basuki Sadjiman

Neurosurgery Department, Bethesda Hospital Yogyakarta, Yogyakarta, Indonesia

http://orcid.org/0009-0001-1274-1346

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APA Style

Wijaya, K. O., Utomo, N. P., Bagaskara, A. T., Sadjiman, E. B. (2025). Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. International Journal of Neurosurgery, 9(2), 41-48. https://doi.org/10.11648/j.ijn.20250902.11

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ACS Style

Wijaya, K. O.; Utomo, N. P.; Bagaskara, A. T.; Sadjiman, E. B. Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. Int. J. Neurosurg. 2025, 9(2), 41-48. doi: 10.11648/j.ijn.20250902.11

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AMA Style

Wijaya KO, Utomo NP, Bagaskara AT, Sadjiman EB. Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta. Int J Neurosurg. 2025;9(2):41-48. doi: 10.11648/j.ijn.20250902.11

Copy | Download

@article{10.11648/j.ijn.20250902.11,
  author = {Kenzie Ongko Wijaya and Nunki Puspita Utomo and Arya Taksya Bagaskara and Endro Basuki Sadjiman},
  title = {Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta},
  journal = {International Journal of Neurosurgery},
  volume = {9},
  number = {2},
  pages = {41-48},
  doi = {10.11648/j.ijn.20250902.11},
  url = {https://doi.org/10.11648/j.ijn.20250902.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20250902.11},
  abstract = {Hydrocephalus is characterized by abnormal cerebrospinal fluid (CSF) accumulation in the brain’s ventricles, which can lead to significant morbidity and mortality without timely intervention. This retrospective cohort study aimed to evaluate the incidence, survival outcomes, and risk factors associated with hydrocephalus among patients treated at Bethesda Hospital Yogyakarta over a five-year period. Medical records of 203 patients diagnosed with hydrocephalus between 2019 and 2024 were reviewed, and patient demographics, hydrocephalus type, treatment modality, and comorbidities—assessed using the Charlson Comorbidity Index—were analyzed. Survival outcomes were examined using Kaplan-Meier analysis, and hazard ratios (HR) were calculated via Cox regression. Most patients were aged ≥60 years (60%) and male (53.2%), with non-communicating hydrocephalus being the most common type (43.8%). Infants (<1 year) demonstrated the highest five-year survival rate (100%), while patients aged 41–59 had the lowest (57.1%; HR: 13.8, p = 0.018). Surgical treatment, predominantly ventriculoperitoneal shunting, significantly improved survival (74.0%) compared with conservative management (60.2%; HR: 1.649, p = 0.05). Among hydrocephalus types, ex-vacuo presented the best prognosis (100% survival), whereas non-communicating hydrocephalus had the poorest (63.7%; HR: 14.4, p = 0.016). Higher comorbidity scores were associated with worse outcomes, particularly in acquired cases. Overall, hydrocephalus outcomes varied significantly by age, type, comorbidities, and treatment approach, with surgical intervention offering a clear survival advantage and reinforcing its role as the primary management strategy. Early diagnosis and personalized treatment planning are crucial to improving long-term outcomes in hydrocephalus patients.},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Five-Year Retrospective Cohort Study of Hydrocephalus Incidence and Patient Outcomes in Yogyakarta
AU  - Kenzie Ongko Wijaya
AU  - Nunki Puspita Utomo
AU  - Arya Taksya Bagaskara
AU  - Endro Basuki Sadjiman
Y1  - 2025/10/31
PY  - 2025
N1  - https://doi.org/10.11648/j.ijn.20250902.11
DO  - 10.11648/j.ijn.20250902.11
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 41
EP  - 48
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20250902.11
AB  - Hydrocephalus is characterized by abnormal cerebrospinal fluid (CSF) accumulation in the brain’s ventricles, which can lead to significant morbidity and mortality without timely intervention. This retrospective cohort study aimed to evaluate the incidence, survival outcomes, and risk factors associated with hydrocephalus among patients treated at Bethesda Hospital Yogyakarta over a five-year period. Medical records of 203 patients diagnosed with hydrocephalus between 2019 and 2024 were reviewed, and patient demographics, hydrocephalus type, treatment modality, and comorbidities—assessed using the Charlson Comorbidity Index—were analyzed. Survival outcomes were examined using Kaplan-Meier analysis, and hazard ratios (HR) were calculated via Cox regression. Most patients were aged ≥60 years (60%) and male (53.2%), with non-communicating hydrocephalus being the most common type (43.8%). Infants (<1 year) demonstrated the highest five-year survival rate (100%), while patients aged 41–59 had the lowest (57.1%; HR: 13.8, p = 0.018). Surgical treatment, predominantly ventriculoperitoneal shunting, significantly improved survival (74.0%) compared with conservative management (60.2%; HR: 1.649, p = 0.05). Among hydrocephalus types, ex-vacuo presented the best prognosis (100% survival), whereas non-communicating hydrocephalus had the poorest (63.7%; HR: 14.4, p = 0.016). Higher comorbidity scores were associated with worse outcomes, particularly in acquired cases. Overall, hydrocephalus outcomes varied significantly by age, type, comorbidities, and treatment approach, with surgical intervention offering a clear survival advantage and reinforcing its role as the primary management strategy. Early diagnosis and personalized treatment planning are crucial to improving long-term outcomes in hydrocephalus patients.
VL  - 9
IS  - 2
ER  -

Copy | Download