title: The long-term psychological effects of surgical treatment using neuroendoscopic techniques and Orbis Sigma shunt implantation in children suffering from hydrocephalus.
abstract: BACKGROUND
  Hydrocephalus, which is the most common disease of the central nervous system in children, has a diverse etiology and clinical picture. Children suffering from hydrocephalus are often treated either by using a neuroendoscopic procedure or by Orbis Sigma shunt implantation.
  
  
  OBJECTIVE
  To evaluate the long-term psychological effects of neuroendoscopic surgical treatment on the mental development and cognitive abilities of children suffering from hydrocephalus, in comparison with the results following Orbis Sigma shunt implantation, and to assess the impact of the kind of hydrocephalus on the outcome of the treatment.
  
  
  METHODS
  The study involved 78 patients treated surgically for chronic noncommunicating hydrocephalus: 39 patients who had undergone neuroendoscopic surgery (average age: 12 years, SD +/- 7 years), and 39 who had undergone implantation of a ventriculo-peritoneal shunt (average age: 14 years +/- 5 years). The psychomotor development of the two groups was analyzed using psychomotor development tests including the Brunet-Lezine test, the Terman-Merrill test, Raven's Standard Progressive Matrices, Raven's Colored Progressive Matrices, the Benton Visual Retention Test, the Bender Visual Motor Gestalt Test, the Rey Fifteen-Item Memory Test, lateralization tests and a questionnaire.
  
  
  RESULTS
  In the shunt group there were statistically significant prevalences hydrocephalus diagnosed perinatally and in the first year of life (p = 0.0291), epileptic seizures (p = 0.0181), intellectual disability (p = 0.0049) and gait disturbances (p = 0.006). There were statistically significant differences between two groups in the relative changes of linear measurements of the cerebral ventricle depending on the type of treatment: Relative Frontal Horn Index (RFHI): 0.93 following endoscopy and 0.64 following shunt implantation; Relative Evans' ratio (RER): 0.93 following endoscopy and 0.62 after shunt implantation; Relative Frontal and Occipital Horn Ratio (RFOHR): 0.89 after endoscopy and 0.69 after shunt implantation. The time treatment was undertaken and the incidence of mental retardation did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  The analysis of cerebral ventricle enlargement expressed in linear ventricular enlargement measurements revealed statistically important differences in the intellectual, cognitive and motor development between the groups treated with the two neurosurgical techniques.
authors.affiliation: Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wiśniewska
authors.forename: Wanda
authors.initials: W
authors.lastname: Mikołajczyk-Wieczorek
authors.forename: Bartosz
authors.initials: B
authors.lastname: Polis
authors.forename: Lech
authors.initials: L
authors.lastname: Polis
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zakrzewski
authors.forename: Emilia
authors.initials: E
authors.lastname: Nowosławska
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D004867:Equipment Design; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D008607:Intellectual Disability / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D044583:Neuroendoscopy / Q000009:adverse effects*; D009483:Neuropsychological Tests; D011044:Poland; D011597:Psychomotor Performance; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation; D055815:Young Adult