Top

Open Access 07-05-2024 | Hydrocephalus | Research

Intracranial volumetric evaluation in postnatally repaired myelomeningocele infants

Authors: Hiroaki Hashimoto, Naoki Irizato, Osamu Takemoto, Yasuyoshi Chiba

Abstract

Introduction

Most myelomeningocele (MMC) cases present with ventriculomegaly or hydrocephalus, yet a comprehensive volumetric assessment of MMC intracranial structures is lacking. This study aimed to provide baseline data on intracranial structural volumes immediately after birth in MMC infants who underwent repair surgeries after birth (postnatal repair).

Methods

In this retrospective single-center study, we analyzed 52 MMC infants undergoing postnatal repair, utilizing head computed tomography scans at birth for volumetric assessment. Intracranial volume (ICV), lateral ventricles volume (LVV), choroid plexus volume (CPV), and posterior cranial fossa volume (PCFV) were measured. Hydrocephalus was classified into no hydrocephalus, progressive hydrocephalus, and hydrocephalus at birth. Comparative analysis employed the Wilcoxon rank-sum test. Receiver operating characteristic (ROC) analysis discriminated cases with and without ventriculoperitoneal shunt (VPS).

Results

The median values were 407.50 mL for ICV, 33.18 mL for LVV, 0.67 mL for CPV, and 21.35 mL for PCFV. Thirty-seven cases (71.15%) underwent VPS. ROC analysis revealed an LVV cut-off value of 6.74 mL for discriminating cases with and without VPS. Progressive hydrocephalus showed no significant difference in ICV but significantly larger LVV compared to no hydrocephalus. Hydrocephalus at birth demonstrated statistically larger ICV and LVV compared to the other two types.

Conclusion

Baseline volumetric data were provided, and volumetric analysis exhibited statistical differences among three hydrocephalus types. These findings enhance our understanding of intracranial volumetric changes in MMC, facilitating more objective assessments of MMC cases.

Available only for authorised users

Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM (2015) Spina bifida. Nat Rev Dis Primers 1:15007. https://doi.org/10.1038/nrdp.2015.7CrossRefPubMedPubMedCentral

Tortori-Donati P, Rossi A, Cama A (2000) Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 42:471–491. https://doi.org/10.1007/s002340000325CrossRefPubMed

Blount JP, Hopson BD, Johnston JM, Rocque BG, Rozzelle CJ, Oakes JW (2023) What has changed in pediatric neurosurgical care in spina bifida? A 30-year UAB/Children’s of Alabama observational overview. Childs Nerv Syst 39:1791–1804. https://doi.org/10.1007/s00381-023-05938-9CrossRefPubMed

Stein SC, Schut L (1979) Hydrocephalus in myelomeningocele. Pediatr Neurosurg 5:413–419. https://doi.org/10.1159/000119836CrossRef

Tamburrini G, Frassanito P, Iakovaki K, Pignotti F, Rendeli C, Murolo D, Di Rocco C (2013) Myelomeningocele: the management of the associated hydrocephalus. Childs Nerv Syst 29:1569–1579. https://doi.org/10.1007/s00381-013-2179-4CrossRefPubMed

Ntimbani J, Kelly A, Lekgwara P (2020) Myelomeningocele - A literature review. Interdiscip Neurosurg 19:100502. https://doi.org/10.1016/j.inat.2019.100502CrossRef

McCarthy DJ, Sheinberg DL, Luther E, McCrea HJ (2019) Myelomeningocele-associated hydrocephalus: nationwide analysis and systematic review. Neurosurg Focus 47:E5. https://doi.org/10.3171/2019.7.FOCUS19469CrossRefPubMed

Van Roost D, Solymosi L, Funke K (1995) A characteristic ventricular shape in myelomeningocele-associated hydrocephalus? A CT stereology study. Neuroradiology 37:412–417. https://doi.org/10.1007/BF00588025CrossRefPubMed

Krogness K, Nyland H (1978) Posterior fossa measurements II. Size of the posterior fossa in myelomeningocele. Pediatr Radiol 6:198–202. https://doi.org/10.1007/BF00975536CrossRefPubMed

10.

Calandrelli R, Pilato F, Massimi L, Panfili M, Di Rocco C, Colosimo C (2020) Posterior cranial fossa maldevelopment in infants with repaired open myelomeningoceles: double trouble or a dynamic process of posterior cranial fossa abnormalities? World Neurosurg 141:e989–e997. https://doi.org/10.1016/j.wneu.2020.06.106CrossRefPubMed

11.

Phillips BC, Gelsomino M, Pownall AL, Ocal E, Spencer HJ, O’Brien MS, Albert GW (2014) Predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele: Clinical article. J Neurosurg Pediatr 14:167–172. https://doi.org/10.3171/2014.4.PEDS13470CrossRefPubMed

12.

Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Nakamura H, Ushio Y (2023) The association between diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and the outcome following mechanical thrombectomy of anterior circulation occlusion. Interdiscip Neurosurg 33:101758. https://doi.org/10.1016/j.inat.2023.101758CrossRef

13.

Hashimoto H, Maruo T, Kimoto Y, Nakamura M, Fujinaga T, Ushio Y (2023) Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma. World Neurosurg: X 19:100204. https://doi.org/10.1016/j.wnsx.2023.100204CrossRefPubMed

14.

Hashimoto H, Takemoto O, Nishimoto K, Moriguchi G, Nakamura M, Chiba Y (2023) Normal growth curve of choroid plexus in children: implications for assessing hydrocephalus due to choroid plexus hyperplasia. J Neurosurg Pediatr 32:627–637. https://doi.org/10.3171/2023.7.PEDS23218CrossRefPubMed

15.

Hashimoto H, Takemoto O, Chiba Y (2023) Growth patterns and ratios of posterior cranial fossa structures in the Japanese pediatric population: a study utilizing CT scans. Neuroradiology 65:1835–1844. https://doi.org/10.1007/s00234-023-03229-3CrossRefPubMed

16.

Adzick NS, Thom EA, Spong CY, Sutton LN et al (2011) A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993–1004. https://doi.org/10.1056/NEJMoa1014379CrossRefPubMedPubMedCentral

17.

Clemmensen D, Rasmussen MM, Mosdal C (2010) A retrospective study of infections after primary VP shunt placement in the newborn with myelomeningocele without prophylactic antibiotics. Childs Nerv Syst 26:1517–1521. https://doi.org/10.1007/s00381-010-1113-2CrossRefPubMed

18.

Tulipan N, Wellons JC, Thom EA, Rand L et al (2015) Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613–620. https://doi.org/10.3171/2015.7.PEDS15336CrossRefPubMedPubMedCentral

19.

Alexiou GA, Zarifi MK, Georgoulis G, Prodromou N et al (2011) Cerebral abnormalities in infants with myelomeningocele. Neurol Neurochir Pol 45:18–23. https://doi.org/10.1016/s0028-3843(14)60055-4CrossRefPubMed

20.

Talamonti G, D’Aliberti G, Collice M (2007) Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg Pediatr 107:368–386. https://doi.org/10.3171/PED-07/11/368CrossRef

21.

Alatas I, Canaz G, Kayran NA, Kara N, Canaz H (2018) Shunt revision rates in myelomeningocele patients in the first year of life: a retrospective study of 52 patients. Childs Nerv Syst 34:919–923. https://doi.org/10.1007/s00381-017-3663-zCrossRefPubMed

22.

Gualberto IJN, Medeiros GA, Santos MV, da Silva LL, Machado HR, Sbragia L (2022) Is there a role in the central nervous system development for using corticosteroids to treat meningomyelocele and hydrocephalus? Childs Nerv Syst 38:1849–1854. https://doi.org/10.1007/s00381-022-05615-3CrossRefPubMed

23.

Flanders TM, Heuer GG, Madsen PJ, Adzick NS et al (2020) Detailed analysis of hydrocephalus and hindbrain herniation after prenatal and postnatal myelomeningocele closure: report from a single institution. Neurosurgery 86:637–645. https://doi.org/10.1093/neuros/nyz302CrossRefPubMed

24.

Nagaraj UD, Bierbrauer KS, Stevenson CB, Peiro JL, Lim F-Y, Zhang B, Kline-Fath BM (2018) Myelomeningocele versus myelocele on fetal mr images: are there differences in brain findings? Am J Roentgenol 211:1376–1380. https://doi.org/10.2214/ajr.18.20088CrossRef

25.

Rintoul NE, Sutton LN, Hubbard AM, Cohen B, Melchionni J, Pasquariello PS, Adzick NS (2002) A new look at myelomeningoceles: functional level, vertebral level, shunting, and the implications for fetal intervention. Pediatrics 109:409–413. https://doi.org/10.1542/peds.109.3.409CrossRefPubMed

26.

McLone DG, Knepper PA (1989) The cause of Chiari II malformation: a unified theory. Pediatr Neurosurg 15:1–12CrossRef

27.

George E, MacPherson C, Pruthi S, Glenn OA et al (2023) Long-Term Imaging Follow-up from the Management of Myelomeningocele Study. Am J Neuroradiol 44:861–866. https://doi.org/10.3174/ajnr.A7926CrossRefPubMed

28.

Williams H (2008) A unifying hypothesis for hydrocephalus, Chiari malformation, syringomyelia, anencephaly and spina bifida. Cerebrospinal Fluid Res 5:7. https://doi.org/10.1186/1743-8454-5-7CrossRefPubMedPubMedCentral

29.

Choi JD, Moon Y, Kim H-J, Yim Y, Lee S, Moon W-J (2022) Choroid plexus volume and permeability at brain mri within the alzheimer disease clinical spectrum. Radiology 304:635–645. https://doi.org/10.1148/radiol.212400CrossRefPubMed

30.

Egorova N, Gottlieb E, Khlif MS, Spratt NJ, Brodtmann A (2019) Choroid plexus volume after stroke. Int J Stroke 14:923–930. https://doi.org/10.1177/1747493019851277CrossRefPubMed

Title: Intracranial volumetric evaluation in postnatally repaired myelomeningocele infants
Authors: Hiroaki Hashimoto
Naoki Irizato
Osamu Takemoto
Yasuyoshi Chiba
Publication date: 07-05-2024
Publisher: Springer Berlin Heidelberg
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
Computed Tomography
Computed Tomography
Published in: Child's Nervous System
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-024-06444-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intracranial volumetric evaluation in postnatally repaired myelomeningocele infants

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content