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Child's Nervous System

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01-04-2016 | Review Paper

Congenital myotonic dystrophy: ventriculomegaly and shunt considerations for the pediatric neurosurgeon

Authors: Ian S. Mutchnick, Meena A. Thatikunta, William C. Gump, Dan L. Stewart, Thomas M. Moriarty

Published in: Child's Nervous System | Issue 4/2016

Abstract

Purpose

Ventriculomegaly in infants with congenital myotonic dystrophy (CDM) is common, and the neurosurgical determination of shunting is complex. The natural history of CDM-associated ventriculomegaly from prenatal to natal to postnatal stages is poorly known. The relationship between macrocephaly and ventriculomegaly, incidence of shunt necessity, and early mortality outcomes lack pooled data analysis. This study aims to review clinical features and pathophysiology of CDM, with emphasis on ventriculomegaly progression, ventriculomegaly association with macrocephaly, and incidence of shunting.

Methods

This is a literature review with pooled data analysis and case report.

Results

One hundred four CDM patients were reviewed in 13 articles that mentioned CDM with ventriculomegaly and/or head circumference. Data was very limited: only 7 patients had data on the presence or absence of prenatal ventriculomegaly, 97 on ventriculomegaly at birth, and 32 on whether or not the ventricles enlarged post-natally. Three patients of 7 (43 %) had pre-natally diagnosed ventriculomegaly, 43 of 97 (44 %) had ventriculomegaly at birth, and only 5 of 32 (16 %) had progressive enlargement of ventricles post-natally. Only 5 of 104 patients had a documented shunt placement: 1 for obstructive, 1 for a post-hemorrhagic communicating, 2 for a communicating hydrocephalus without hemorrhage, and 1 with unknown indication. Of 13 macrocephalic patients with data about ventricular size, 12 had ventriculomegaly.

Conclusions

Ventriculomegaly occurs regularly with CDM but most often does not require CSF diversion. Decisions regarding neurosurgical intervention will necessarily be based on limited information, but shunting should only occur once dynamic data confirms hydrocephalus.

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Title: Congenital myotonic dystrophy: ventriculomegaly and shunt considerations for the pediatric neurosurgeon
Authors: Ian S. Mutchnick
Meena A. Thatikunta
William C. Gump
Dan L. Stewart
Thomas M. Moriarty
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 4/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-015-2993-y

At a glance: The STEP trials

Springer Medicine

Congenital myotonic dystrophy: ventriculomegaly and shunt considerations for the pediatric neurosurgeon

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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