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Neurodevelopmental long-term outcome in children with hydrocephalus requiring neonatal surgical treatment
A Melot1, A Labarre2, C Vanhulle3
1Department of Neurosurgery, Marseille University Hospital, 13000 Marseille, France.
Insights
Children with neonatal hydrocephalus treated with shunts show variable long-term neurodevelopmental outcomes. While most achieve independent walking, cognitive function varies, with postoperative ventricular dilation predicting poorer results.
Area of Science:
- Pediatric Neurosurgery
- Neurodevelopmental Pediatrics
- Longitudinal Cohort Studies
Background:
- Hydrocephalus is a common condition in neonates requiring neurosurgical intervention.
- Neonatal hydrocephalus necessitates shunting procedures to manage cerebrospinal fluid pressure.
- Long-term neurodevelopmental outcomes in this population require comprehensive assessment.
Purpose of the Study:
- To evaluate the long-term neurodevelopmental trajectory of children treated for neonatal hydrocephalus.
- To identify factors influencing cognitive and motor development post-neurosurgical intervention.
- To provide data for counseling families regarding prognosis.
Main Methods:
- Prospective longitudinal population-based study of 43 infants with neonatal shunted hydrocephalus.
- Cognitive assessment using Wechsler scales and motor function evaluation with Gross Motor Function Classification System (GMFCS).
- Routine postoperative MRI for assessing ventricular dilation (Evans index).
Main Results:
- Mean follow-up was 10.4 years; mean total IQ was 73.3.
- 41.9% of evaluated children had an IQ of 85 or higher.
- 86% achieved independent walking (GMFCS ≤ 2).
- Severe postoperative ventricular dilation (Evans index > 0.37) was linked to unfavorable outcomes.
Conclusions:
- Neonatal hydrocephalus treated with shunts results in diverse neurodevelopmental outcomes.
- Cognitive and motor development vary, with a significant portion achieving functional independence.
- Postoperative ventricular dilation is a key predictor of neurodevelopmental prognosis.
Purpose:
To assess long-term neurodevelopmental outcome in children with hydrocephalus requiring neurosurgical treatment during the neonatal period.
Methods:
This prospective longitudinal population-based study included 43 children with neonatal shunted hydrocephalus. The 43 children were prospectively reviewed in the presence of their parents at the outpatient clinic. Cognitive and motor outcomes were assessed respectively using different Wechsler scales according to age and Gross Motor Function Classification System (GMFCS). Postoperative MRI was routinely performed.
Results:
The mean gestational age at birth of the 43 consecutive children with neonatal hydrocephalus (sex ratio M/F: 1.39) was 34.5±5.4 weeks of gestation. At mean follow-up of 10.4±4 years, mean total IQ was 73±27.7, with equivalent results in mean verbal and mean performance IQ. Of the 33 children with IQ evaluation, 18 presented an IQ≥85 (41.9%). Efficiency in walking without a mobility device (GMFCS≤2) was obtained in 37 children (86%). Only severity of postoperative ventricular dilation was significantly associated with unfavorable outcome (Evans index>0.37; odds ratio: 0.16, P=0.03).
Conclusion:
This information could be provided to those families concerned who often experience anxiety when multi-disciplinary management of neonatal hydrocephalus is required.
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