Neurocognitive outcome and ventricular volume in children with myelomeningocele treated for hydrocephalus in Uganda.
OBJECTIVE
Despite lower failure and infection rates compared with shunt placement, it has not been known whether endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) might be inferior in regard to neurocognitive development. This study is the first to describe neurocognitive outcome and ventricle volume in infants with hydrocephalus due to myelomeningocele that was treated primarily by ETV/CPC.


METHODS
The modified Bayley Scales of Infant Development (BSID-III) test was administered to 93 children with spina bifida who were 5-52 months of age. Fifty-five of these children had been treated by ETV/CPC, 19 received ventriculoperitoneal (VP) shunts, and 19 had required no treatment for hydrocephalus. Raw scores were converted to scaled scores for comparison with age-corrected norms. Ventricular volume was assessed by frontal/occipital horn ratio (FOR) calculated from late postoperative CT scans. The mean values between and among groups of patients were compared using independent samples t-test and ANOVA. The comparison of mean values to population normal means was performed using the single-sample t-test. Linear regression analyses were performed using BSID scores as the dependent variables, with treatment group and ventricular size (FOR) as the independent variables. Probability values < 0.05 were considered significant.


RESULTS
There was no significant difference in mean age at assessment among groups (p = 0.8). The mean scale scores for untreated patients were no different from normal (all p > 0.27) in all portions of the BSID (excluding gross motor), and were generally significantly better than those for both VP shunt-treated and ETV/CPC groups. The ETV/ CPC-treated patients had nonsignificantly better mean scores than patients treated with VP shunts in all portions of the BSID (all p > 0.06), except receptive communication, which was significantly better for the ETV/CPC group (p = 0.02). The mean FOR was similar among groups, with no significant difference between the untreated group and either the VP shunt or ETV/CPC groups. The FOR did not correlate with performance.


CONCLUSIONS
The ETV/CPC and VP shunt groups had similar neurocognitive outcomes. Neurocognitive outcomes for infants not requiring treatment for hydrocephalus were normal and significantly better than in those requiring treatment. The mean ventricular volume was similar among all 3 groups, and significantly larger than normal. There was no association between FOR and performance. Stable mild-to-moderate ventriculomegaly alone should not trigger intervention in asymptomatic infants with spina bifida.
Warf
Benjamin
B
Department of Neurosurgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, Massachusetts 02115, USA. benjamin.warf@childrens.harvard.edu
Ondoma
Solomon
S
Kulkarni
Abhaya
A
Donnelly
Ruth
R
Ampeire
Miriam
M
Akona
Joan
J
Kabachelor
Collin R
CR
Mulondo
Ronald
R
Nsubuga
Brian Kaaya
BK
D002425:Cautery; D002657:Child Development; D002831:Choroid Plexus / Q000601:surgery*; D003071:Cognition; D003906:Developing Countries; D004724:Endoscopy; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D007223:Infant; D008591:Meningomyelocele / Q000150:complications*; D009420:Nervous System / Q000503:physiopathology*; D009929:Organ Size; D011184:Postoperative Period; D011877:Radionuclide Imaging; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014454:Uganda; D017287:Ventriculoperitoneal Shunt; D014696:Ventriculostomy