Related Experiment Videos
Surgical treatment and long-term neurodevelopmental outcome for infants with idiopathic aqueductal stenosis
W C Hanigan1, A Morgan, A Shaaban
1Department of Neuroscience, University of Illinois College of Medicine, Peoria 61656-1649.
Insights
Idiopathic aqueductal stenosis (IAS) treatment in neonates shows guarded long-term neurodevelopmental prognosis. Postoperative frontal cortical mantle width (FCMW) is a key indicator of developmental outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Neurosurgery
Background:
- Idiopathic aqueductal stenosis (IAS) is a common cause of ventriculomegaly in infants.
- Evaluating in utero shunting necessitates understanding ex utero treatment outcomes for comparison.
- Long-term neurodevelopmental assessment is crucial for infants with IAS.
Purpose of the Study:
- To assess the neurodevelopmental outcomes of infants with IAS treated ex utero.
- To identify prognostic indicators for long-term neurodevelopment in this cohort.
- To correlate frontal cortical mantle width (FCMW) with developmental trajectories.
Main Methods:
- Retrospective analysis of 14 neonates diagnosed with IAS.
- Detailed developmental assessments conducted for at least 18 months post-treatment.
- Magnetic resonance imaging (MRI) used to measure preoperative and postoperative FCMW.
Main Results:
- Four out of 14 infants (28.6%) showed normal neurodevelopmental outcomes.
- Five out of 14 infants (35.7%) exhibited abnormal outcomes.
- Five out of 14 infants (35.7%) presented with minimally impaired outcomes.
- Postoperative FCMW below 30 mm correlated with impaired development; FCMW ≤21 mm was associated with abnormal development.
Conclusions:
- The long-term neurodevelopmental prognosis for infants with IAS, even with prompt treatment, is guarded.
- A majority of infants with IAS experience some degree of developmental delay.
- Postoperative FCMW is a reliable prognostic indicator for neurodevelopmental outcomes in infants with IAS.
Abstract:
Evaluation of in utero shunting for fetal ventriculomegaly requires an analysis of the ex utero treatment of a comparison population of infants with idiopathic aqueductal stenosis (IAS). In this study, 14 neonates with IAS were followed with detailed developmental assessment profiles for 18 months or longer. Using magnetic resonance imaging, the preoperative and postoperative frontal cortical mantle widths (FCMW) were determined for each patient. Four of 14 children demonstrated normal outcomes while 5 of 14 children showed abnormal outcomes. The remaining 5 children demonstrated minimally impaired outcomes. No child with a postoperative FCMW below 30 mm showed normal development on any scale, while all children with abnormal development demonstrated a postoperative FCMW of 21 mm or less. In conclusion, the prognosis for normal long-term neurodevelopment in infants with IAS, despite prompt ex utero treatment, is guarded; the majority of such children will show developmental delays of varying degrees. The FCMW serves as a reasonable prognostic indicator in this patient population.