Assessment of Ventricular Size and Neurocognitive Outcomes in Children with Postnatal Closure of Myelomeningocele.

Autor: Lai GY; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA; Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, NE. Electronic address: glai@childrensnebraska.org., Pfeifle GB; Department of Pediatrics, University of California San Francisco, San Francisco, CA., Castillo H; Division of Developmental Medicine, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE., Harvey J; UCSF Benioff Children's Hospital, San Francisco, CA., Farless C; UCSF Benioff Children's Hospital, San Francisco, CA., Davis T; Department of Pediatrics, University of California San Francisco, San Francisco, CA., Castillo J; Division of Developmental Medicine, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE., Gupta N; Department of Neurological Surgery, University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2024 Nov; Vol. 274, pp. 114167. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1016/j.jpeds.2024.114167
Abstrakt: Objective: To assess if ventricular size before shunting is correlated with neurodevelopmental outcomes in children with postnatal myelomeningocele closure.
Study Design: This retrospective review included children with postnatal surgical closure of myelomeningocele and neuropsychological testing between 2018 and 2023 at the University of California, San Francisco. Frontal-occipital horn ratio (FOHR) was measured immediately before shunt placement or on the first study that reported ventricular stability for nonshunted patients. The primary outcome was full scale IQ (FSIQ) on the Weschler Intelligence Scale. Secondary outcomes included indices of the Weschler scale, the Global Executive Composite from the Behavior Rating Inventory of Executive Function, and the general adaptive composite from the Adaptive Behavior Assessment Scale. Univariable and multivariable regression was used to determine if FOHR was correlated with neuropsychological scores.
Results: Forty patients met the inclusion criteria; 26 (65%) had shunted hydrocephalus. Age at neuropsychological testing was 10.9 ± 0.6 years. FOHR was greater in the shunted group (0.64 vs 0.51; P < .001). There were no differences in neuropsychological results between shunted and nonshunted groups. On univariable analysis, greater FOHR was associated with lower FSIQ (P = .025) and lower Visual Spatial Index scores (P = .013), which remained significant on multivariable analysis after adjusting for gestational age at birth, lesion level, shunt status, and shunt revision status (P = .049 and P = .006, respectively). Separate analyses by shunt status revealed that these effects were driven by the shunted group.
Conclusions: Greater FOHR before shunting was correlated with lower FSIQ and the Visual Spatial Index scores on the Weschler Intelligence Scales. Larger studies are needed to explore further the relationship between ventricle size, hydrocephalus, and neurodevelopmental outcomes.
Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. Funding: There was no funding for this study.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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