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Published on: February 8, 2022
Ventriculomegaly in children: nocturnal ICP dynamics identify pressure-compensated but active paediatric
Sandra F Dias1,2, Elisabeth Jehli3, Karin Haas-Lude4
1Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany. sandrafs.dias12@gmail.com.
Insights
Asymptomatic paediatric ventriculomegaly may indicate active hydrocephalus with abnormal intracranial pressure (ICP) dynamics. Treating these children improves neurological outcomes, highlighting the need for ICP monitoring in such cases.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Medical Imaging
Background:
- Paediatric ventriculomegaly without overt symptoms is often misattributed to brain atrophy or resolved hydrocephalus.
- This study investigates the presence of abnormal intracranial pressure (ICP) signatures in asymptomatic children with ventriculomegaly.
Purpose of the Study:
- To determine if asymptomatic paediatric ventriculomegaly is associated with pathological ICP dynamics.
- To evaluate the impact of treating children with abnormal ICP dynamics on neurological development and ventricular size.
Main Methods:
- Overnight ICP monitoring (ONM) was performed on 37 children with ventriculomegaly but no clear signs of raised ICP.
- ICP parameters including amplitudes (AMP) and slow waves (SLOW) were analyzed.
- Ventricular width was measured at baseline and 1-year follow-up.
Main Results:
- Pathological ICP dynamics were found in 62% of children.
- Children with abnormal ICP dynamics (Group B) showed significantly higher ICP, AMP, and SLOW values compared to normal (Group A).
- Treatment of Group B children led to significant reduction in ventricular size and 100% positive neurological development.
Conclusions:
- Asymptomatic ventriculomegaly can be linked to active, pressure-compensated hydrocephalus with abnormal ICP dynamics.
- Prompt treatment based on ICP monitoring in these children leads to favorable neurological outcomes.
- Overnight ICP monitoring is crucial for diagnosing and managing paediatric ventriculomegaly presenting without overt symptoms.
Introduction:
Paediatric ventriculomegaly without obvious signs or symptoms of raised intracranial pressure (ICP) is often interpreted as resulting from either relative brain atrophy, arrested "benign" hydrocephalus, or "successful" endoscopic third ventriculostomy (ETV). We hypothesise that the typical ICP "signature" found in symptomatic hydrocephalus can be present in asymptomatic or oligosymptomatic children, indicating pressure-compensated, but active hydrocephalus.
Methods:
A total of 37 children fulfilling the mentioned criteria underwent computerised ICP overnight monitoring (ONM). Fifteen children had previous hydrocephalus treatment. ICP was analysed for nocturnal dynamics of ICP, ICP amplitudes (AMP), magnitude of slow waves (SLOW), and ICP/AMP correlation index RAP. Depending on the ONM results, children were either treated or observed. The ventricular width was determined at the time of ONM and at 1-year follow-up.
Results:
The recordings of 14 children (group A) were considered normal. In the 23 children with pathologic recordings (group B), all ICP values and dependent variables (AMP, SLOW) were significantly higher, except for RAP. In group B, 12 of 15 children had received a pre-treatment and 11 of 22 without previous treatment. All group B children received treatment for hydrocephalus and showed a significant reduction of frontal-occipital horn ratio at 1 year. During follow-up, a positive neurological development was seen in 74% of children of group A and 100% of group B.
Conclusion:
Ventriculomegaly in the absence of signs and symptoms of raised ICP was associated in 62% of cases to pathological ICP dynamics. In 80% of pre-treated cases, ETV or shunt failure was found. Treating children with abnormal ICP dynamics resulted in an outcome at least as favourable as in the group with normal ICP dynamics. Thus, asymptomatic ventriculomegaly in children deserves further investigation and, if associated with abnormal ICP dynamics, should be treated in order to provide a normalised intracranial physiology as basis for best possible long-term outcome.
