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Evaluation of functional outcomes in congenital hydrocephalus
N K Venkataramana1, C R Mukundan
1Department of Neurosurgery, Advanced Neuro Science Institute, BGS Global Hospital, Bangalore, India.
Insights
Early cerebrospinal fluid (CSF) diversion in congenital hydrocephalus improves brain development. Reconstitution of cortical mantle thickness correlates with better functional outcomes, especially in children with spina bifida.
Area of Science:
- Pediatric Neurosurgery
- Developmental Neuroscience
- Clinical Neurology
Background:
- Congenital hydrocephalus is common, but long-term outcomes remain unclear.
- Predicting functional outcomes requires understanding clinical and radiological factors.
- This study investigates the correlation between brain structure changes and functional development.
Purpose of the Study:
- To correlate clinical and radiological parameters with regional brain functional outcomes in congenital hydrocephalus.
- To assess the impact of cerebrospinal fluid (CSF) diversion on brain development.
- To compare outcomes in children with hydrocephalus alone versus those with hydrocephalus and spina bifida.
Main Methods:
- Children were divided into two groups: hydrocephalus alone (Group A) and hydrocephalus with spina bifida (Group B).
- All patients underwent ventriculoperitoneal shunt surgery by the same surgeon.
- CT scans and neuropsychological assessments were performed pre- and post-shunt, with serial follow-ups.
Main Results:
- CSF diversion reduced ventricular dilatation and increased cortical mantle thickness.
- A significant correlation was observed between increased cortical mantle thickness and improved neuropsychological function.
- 80% of Group B (hydrocephalus with spina bifida) achieved near-normal development, compared to 33% in Group A.
Conclusions:
- Early CSF diversion benefits functional recovery in congenital hydrocephalus.
- Reconstitution of the cortical mantle in specific brain regions corresponds to functional improvements.
- Factors like large ventricles and shunt obstructions negatively impact long-term outcomes, but children with myelomeningocele can achieve significant neurodevelopmental benefits.
Aim:
The long term outcomes of congenital hydrocephalus are still not clearly known despite it being a common clinical condition. Several clinical, radiological factors were correlated to predict the functional outcomes. This study aimed to correlate the clinical, radiological parameters with the regional functional outcomes of the brain.
Materials And Methods:
Children with congenital hydrocephalus were divided into Group A with hydrocephalus alone and Group B hydrocephalus with spina bifida. Ventriculoperitoneal shunt surgery was performed by the same surgeon. CT scans and neuropsychological assessments were performed before and serially after the shunt. The clinical and the radiological findings were correlated with the developmental levels during the follow-up.
Results:
There were 25 children in Group A and 15 children in Group B; 72% in Group A and 93% in Group B were less than 6 months of age at the time of treatment. Forty percent in Group A and 92% in Group B had the signs of hydrocephalus at admission. Cerebrospinal fluid (CSF) diversion results in the reduction in ventricular dilatation and corresponding increase in the cortical mantle thickness. The ventricular size and the cortical mantle thickness were measured serially and correlated with the development in the neuropsychological function. In this study, 80% in Group B reached near normal development in comparison to 33% in Group A. We have noticed a significant correlation in the increase in the regional cortical mantle thickness with corresponding improvement in the functional development. This clearly ratifies the improvement in the frontal and parietal areas having their distinctive effect on the functional development of the child.
Conclusion:
Early CSF diversion and timely intervention seems to benefit functional recovery. It is interesting to note that reconstitution of cortical mantle in different areas of the brain showing corresponding improvement in their respective areas. Large ventricles (head circumference more than 50 cm) recurrent subdural collections and repeated shunt obstructions have a bad influence on the long-term outcome. Unlike the previous belief the children with myelomeningocele can have equal benefit in terms of neuropsychological development after the shunt surgery.
