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Natural history of hydrocephalus in children with spinal open neural tube defect.

Elgamal EA - Surg Neurol Int (2012)

Bottom Line: The shunts were revised or replaced in 10 (19.6%) patients due to obstruction or infection.Primary ETV failed in 3/8 patients, and treated by VPS.Children with SONTD should routinely undergo MRI examination of brain and craniocervical junction to clarify ventricular size, and the presence of CM II.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgery Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

ABSTRACT

Background: The long-term prognosis of patients with Spinal Open Neural Tube Defect (SONTD)-associated hydrocephalus is not well known. This study was conducted to ascertain the incidence and natural history of hydrocephalus in patients with SONTD.

Methods: All 82 patients with SONTD referred to Neurosurgery/Spina Bifida Clinics at King Khalid University Hospital, Riyadh, Saudi Arabia (January 1995 - July 2010) were studied and followed for a period of 1-16 years. Patients were divided into three groups: Group "A" with active hydrocephalus treated with ventriculoperitoneal shunt (VPS), or endoscopic third ventriculostomy (ETV); Group "B" with compensated hydrocephalus; and Group "C" with no hydrocephalus. Timing of shunt insertion, complications of treatment and status of hydrocephalus were analyzed.

Results: The mean age of the 82 patients was 7.4 years (range 1-16 years). Group "A" included 59 (72%) patients, Group "B" 7 (8.5%) patients, and Group "C" 16 (19.5%) patients. Chiari malformation type II was found in 71 (86.6%) patients, 57 of whom (80%) were in Group "A" with active hydrocephalus. They were treated by VPS (51 patients) and ETV (8 patients). The shunts were revised or replaced in 10 (19.6%) patients due to obstruction or infection. Primary ETV failed in 3/8 patients, and treated by VPS. None of those in Groups "B" or "C" required treatment for hydrocephalus during the follow up.

Conclusion: Hydrocephalus affects the majority of patients with SONTD who have Myelomeningocele (MMC) and CM II and requires close surveillance and prompt management. Children with SONTD should routinely undergo MRI examination of brain and craniocervical junction to clarify ventricular size, and the presence of CM II.

No MeSH data available.


Related in: MedlinePlus

Sagittal T2WI of the lumbar spine for a child, soon after birth, showing a large myelomeningocele, and low lying cord (a). There was evidence of CM II in the craniocervical junction cuts (b). A cranial MRI showed normal ventricles (not shown). The patient did not develop hydrocephalus as shown in MRI obtained after 2 years (c)
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Figure 6: Sagittal T2WI of the lumbar spine for a child, soon after birth, showing a large myelomeningocele, and low lying cord (a). There was evidence of CM II in the craniocervical junction cuts (b). A cranial MRI showed normal ventricles (not shown). The patient did not develop hydrocephalus as shown in MRI obtained after 2 years (c)

Mentions: Chiari Malformation type II was the main cause of hydrocephalus in 71 (86.6%) patients. Fifty seven of them (80.3%) received treatment for active hydrocephalus (in two patients of Group “A”, hydrocephalus was secondary to aqueductal stenosis, and they had no evidence of CM II). All the 7 patients in Group “B” with compensated hydrocephalus had CM II, whereas 7 out of the 16 patients with no hydrocephalus in Group “C” had CM II [Figure 6, Table 1].


Natural history of hydrocephalus in children with spinal open neural tube defect.

Elgamal EA - Surg Neurol Int (2012)

Sagittal T2WI of the lumbar spine for a child, soon after birth, showing a large myelomeningocele, and low lying cord (a). There was evidence of CM II in the craniocervical junction cuts (b). A cranial MRI showed normal ventricles (not shown). The patient did not develop hydrocephalus as shown in MRI obtained after 2 years (c)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475879&req=5

Figure 6: Sagittal T2WI of the lumbar spine for a child, soon after birth, showing a large myelomeningocele, and low lying cord (a). There was evidence of CM II in the craniocervical junction cuts (b). A cranial MRI showed normal ventricles (not shown). The patient did not develop hydrocephalus as shown in MRI obtained after 2 years (c)
Mentions: Chiari Malformation type II was the main cause of hydrocephalus in 71 (86.6%) patients. Fifty seven of them (80.3%) received treatment for active hydrocephalus (in two patients of Group “A”, hydrocephalus was secondary to aqueductal stenosis, and they had no evidence of CM II). All the 7 patients in Group “B” with compensated hydrocephalus had CM II, whereas 7 out of the 16 patients with no hydrocephalus in Group “C” had CM II [Figure 6, Table 1].

Bottom Line: The shunts were revised or replaced in 10 (19.6%) patients due to obstruction or infection.Primary ETV failed in 3/8 patients, and treated by VPS.Children with SONTD should routinely undergo MRI examination of brain and craniocervical junction to clarify ventricular size, and the presence of CM II.

View Article: PubMed Central - PubMed

Affiliation: Neurosurgery Division, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

ABSTRACT

Background: The long-term prognosis of patients with Spinal Open Neural Tube Defect (SONTD)-associated hydrocephalus is not well known. This study was conducted to ascertain the incidence and natural history of hydrocephalus in patients with SONTD.

Methods: All 82 patients with SONTD referred to Neurosurgery/Spina Bifida Clinics at King Khalid University Hospital, Riyadh, Saudi Arabia (January 1995 - July 2010) were studied and followed for a period of 1-16 years. Patients were divided into three groups: Group "A" with active hydrocephalus treated with ventriculoperitoneal shunt (VPS), or endoscopic third ventriculostomy (ETV); Group "B" with compensated hydrocephalus; and Group "C" with no hydrocephalus. Timing of shunt insertion, complications of treatment and status of hydrocephalus were analyzed.

Results: The mean age of the 82 patients was 7.4 years (range 1-16 years). Group "A" included 59 (72%) patients, Group "B" 7 (8.5%) patients, and Group "C" 16 (19.5%) patients. Chiari malformation type II was found in 71 (86.6%) patients, 57 of whom (80%) were in Group "A" with active hydrocephalus. They were treated by VPS (51 patients) and ETV (8 patients). The shunts were revised or replaced in 10 (19.6%) patients due to obstruction or infection. Primary ETV failed in 3/8 patients, and treated by VPS. None of those in Groups "B" or "C" required treatment for hydrocephalus during the follow up.

Conclusion: Hydrocephalus affects the majority of patients with SONTD who have Myelomeningocele (MMC) and CM II and requires close surveillance and prompt management. Children with SONTD should routinely undergo MRI examination of brain and craniocervical junction to clarify ventricular size, and the presence of CM II.

No MeSH data available.


Related in: MedlinePlus