title: The effects of hydrocephalus on intelligence quotient in children with localized infratentorial ependymoma before and after focal radiation therapy.
abstract: OBJECTIVE
  The goal of this study was to determine the influence of hydrocephalus on intelligence quotient (IQ) in children with infratentorial ependymoma before and after the administration of focal radiation.
  
  
  METHODS
  Measurements of ventricular size, including Evans index (EI), cella media index (CMI), frontal horn diameter (FHD), and ventricular angle, were performed using magnetic resonance imaging at the time of diagnosis and again at 3, 6, 9, and 12 months after the initiation of radiation therapy. Of the 59 patients (median age at time of radiation treatment, 4.1 years), the clinical diagnosis established in 50 (85%) was hydrocephalus and 23 (39%) required placement of a cerebrospinal fluid (CSF) shunt. Extent of resection was gross or near total in 50 (85%). Before and after radiation treatment, IQ was measured using age-appropriate testing. The correlation between multiple ventricular measurements and IQ was investigated using standard regression techniques and a generalized linear model. Patients with a higher EI (p = 0.04), CMI (p = 0.001), and FHD (p = 0.0002) at the time of diagnosis were more likely to have lower IQ scores before radiation treatment. Patients with higher CMI (p = 0.04) and FHD (p = 0.01) at the time of diagnosis were more likely to exhibit an increase in IQ score after radiotherapy. The rate of change in IQ after radiation treatment was positively correlated with the CMI intercept (p = 0.015) and negatively correlated with the rate of FHD change (p = 0.006).
  
  
  CONCLUSIONS
  Changes in IQ score before and after radiation treatment are significantly influenced by the extent and treatment of hydrocephalus at the time of diagnosis. Hydrocephalus is an important factor to include when analyzing the effects of treatment. Patients who undergo a second surgery for ependymoma are more likely to require the placement of a CSF shunt (p = 0.0001).
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. thomas.merchant@stjude.org
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Heather
authors.initials: H
authors.lastname: Lee
authors.forename: Junhong
authors.initials: J
authors.lastname: Zhu
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Gregory
authors.initials: G
authors.lastname: Wheeler
authors.forename: Sean
authors.initials: S
authors.lastname: Phipps
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Boop
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sanford
mesh_terms: D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D004806:Ependymoma / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery; D007223:Infant; D015192:Infratentorial Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery; D007361:Intelligence Tests; D008297:Male; D019635:Neurosurgical Procedures; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects; D016896:Treatment Outcome