Sasidhar Karuparti, Ashley Dunbar, Kaamya Varagur, Kavya Sudanagunta, Mark Mingo, Katherine H Bligard, Anthony Odibo, Jesse Vrecenak, Sean McEvoy, David Limbrick, Lindsay Peglar Marsala, Jagruti Anadkat, Ali Mian, Jennifer M Strahle
{"title":"接受产前与产后脊髓膜膨出手术患者脑积水治疗的预测因素和时机。","authors":"Sasidhar Karuparti, Ashley Dunbar, Kaamya Varagur, Kavya Sudanagunta, Mark Mingo, Katherine H Bligard, Anthony Odibo, Jesse Vrecenak, Sean McEvoy, David Limbrick, Lindsay Peglar Marsala, Jagruti Anadkat, Ali Mian, Jennifer M Strahle","doi":"10.3171/2023.10.PEDS23327","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%-85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatment differ between pre- and postnatal surgery for MMC. The goal of this study was to determine anatomical, clinical, and radiological characteristics that are associated with the need for and timing of hydrocephalus treatment in patients with MMC.</p><p><strong>Methods: </strong>The authors retrospectively identified patients from Barnes Jewish Hospital or St. Louis Children's Hospital between 2016 and 2021 who were diagnosed with MMC prenatally and underwent either pre- or postnatal repair. Imaging, clinical, and demographic data were examined longitudinally between treatment groups and hydrocephalus outcomes.</p><p><strong>Results: </strong>Fifty-eight patients were included (27 females, 46.6%), with a mean gestational age at birth of 36.8 weeks. Twenty-three patients (39.7%) underwent prenatal surgery. For the overall cohort, the ventricle size at prenatal ultrasound (HR 1.175, 95% CI 1.071-1.290), frontal-occipital horn ratio (FOHR) at birth > 0.50 (HR 3.603, 95% CI 1.488-8.720), and mean rate of change in head circumference (HC) in the first 90 days after birth (> 0.10 cm/day: HR 12.973, 95% CI 4.262-39.486) were identified as predictors of hydrocephalus treatment. The factors associated with hydrocephalus in the prenatal cohort were FOHR at birth > 0.50 (HR 27.828, 95% CI 2.980-259.846) and the rate of change in HC (> 0.10 cm/day: HR 39.414, 95% CI 2.035-763.262). The factors associated with hydrocephalus in the postnatal cohort were prenatal ventricle size (HR 1.126, 95% CI 1.017-1.246) and the mean rate of change in HC (> 0.10 cm/day: HR 24.202, 95% CI 5.119-114.431). FOHR (r = -0.499, p = 0.008) and birth HC (-0.409, p = 0.028) were correlated with time to hydrocephalus across both cohorts. For patients who underwent treatment for hydrocephalus, those in the prenatal surgery group were significantly more likely to develop hydrocephalus after 3 months than those treated with postnatal surgery, although the overall rate of hydrocephalus was significantly higher in the postnatal surgery group (p = 0.018).</p><p><strong>Conclusions: </strong>Clinical and imaging factors associated with hydrocephalus treatment differ between those receiving pre- versus postnatal MMC repair, and while the overall rate of hydrocephalus is lower, those undergoing prenatal repair are more likely to develop hydrocephalus after 3 months of age. This has implications for clinical follow-up timing for patients treated prenatally, who may live at a distance from the treatment site.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors and timing of hydrocephalus treatment in patients undergoing prenatal versus postnatal surgery for myelomeningocele.\",\"authors\":\"Sasidhar Karuparti, Ashley Dunbar, Kaamya Varagur, Kavya Sudanagunta, Mark Mingo, Katherine H Bligard, Anthony Odibo, Jesse Vrecenak, Sean McEvoy, David Limbrick, Lindsay Peglar Marsala, Jagruti Anadkat, Ali Mian, Jennifer M Strahle\",\"doi\":\"10.3171/2023.10.PEDS23327\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%-85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatment differ between pre- and postnatal surgery for MMC. The goal of this study was to determine anatomical, clinical, and radiological characteristics that are associated with the need for and timing of hydrocephalus treatment in patients with MMC.</p><p><strong>Methods: </strong>The authors retrospectively identified patients from Barnes Jewish Hospital or St. Louis Children's Hospital between 2016 and 2021 who were diagnosed with MMC prenatally and underwent either pre- or postnatal repair. Imaging, clinical, and demographic data were examined longitudinally between treatment groups and hydrocephalus outcomes.</p><p><strong>Results: </strong>Fifty-eight patients were included (27 females, 46.6%), with a mean gestational age at birth of 36.8 weeks. Twenty-three patients (39.7%) underwent prenatal surgery. For the overall cohort, the ventricle size at prenatal ultrasound (HR 1.175, 95% CI 1.071-1.290), frontal-occipital horn ratio (FOHR) at birth > 0.50 (HR 3.603, 95% CI 1.488-8.720), and mean rate of change in head circumference (HC) in the first 90 days after birth (> 0.10 cm/day: HR 12.973, 95% CI 4.262-39.486) were identified as predictors of hydrocephalus treatment. The factors associated with hydrocephalus in the prenatal cohort were FOHR at birth > 0.50 (HR 27.828, 95% CI 2.980-259.846) and the rate of change in HC (> 0.10 cm/day: HR 39.414, 95% CI 2.035-763.262). The factors associated with hydrocephalus in the postnatal cohort were prenatal ventricle size (HR 1.126, 95% CI 1.017-1.246) and the mean rate of change in HC (> 0.10 cm/day: HR 24.202, 95% CI 5.119-114.431). FOHR (r = -0.499, p = 0.008) and birth HC (-0.409, p = 0.028) were correlated with time to hydrocephalus across both cohorts. For patients who underwent treatment for hydrocephalus, those in the prenatal surgery group were significantly more likely to develop hydrocephalus after 3 months than those treated with postnatal surgery, although the overall rate of hydrocephalus was significantly higher in the postnatal surgery group (p = 0.018).</p><p><strong>Conclusions: </strong>Clinical and imaging factors associated with hydrocephalus treatment differ between those receiving pre- versus postnatal MMC repair, and while the overall rate of hydrocephalus is lower, those undergoing prenatal repair are more likely to develop hydrocephalus after 3 months of age. This has implications for clinical follow-up timing for patients treated prenatally, who may live at a distance from the treatment site.</p>\",\"PeriodicalId\":16549,\"journal\":{\"name\":\"Journal of neurosurgery. 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引用次数: 0
摘要
目的:尽管通过宫内手术治疗脊髓膜膨出症(MMC)降低了脑积水发生率,但仍有 40%-85% 的脊髓膜膨出症患儿会发展为脑积水。众所周知,产前脑室大小与日后脑积水的发展有关;但是,目前还不清楚预测措施或脑积水治疗时机在 MMC 产前和产后手术之间有何不同。本研究旨在确定与 MMC 患者脑积水治疗需求和时机相关的解剖学、临床和放射学特征:作者回顾性地确定了 2016 年至 2021 年期间巴恩斯犹太医院或圣路易斯儿童医院产前确诊为 MMC 并接受产前或产后修复的患者。对治疗组和脑积水结果之间的成像、临床和人口统计学数据进行了纵向研究:共纳入58名患者(27名女性,46.6%),出生时平均胎龄为36.8周。23名患者(39.7%)接受了产前手术。在整个队列中,产前超声检查时的脑室大小(HR 1.175,95% CI 1.071-1.290)、出生时的额枕角比值(FOHR)> 0.50(HR 3.603,95% CI 1.488-8.720)和出生后头 90 天内头围(HC)的平均变化率(> 0.10 厘米/天:HR 12.973,95% CI 4.262-39.486)被确定为脑积水治疗的预测因素。产前队列中与脑积水相关的因素是出生时 FOHR > 0.50(HR 27.828,95% CI 2.980-259.846)和 HC 变化率(> 0.10 厘米/天:HR 39.414,95% CI 2.035-763.262)。产后队列中与脑积水相关的因素是产前脑室大小(HR 1.126,95% CI 1.017-1.246)和 HC 的平均变化率(> 0.10 厘米/天:HR 24.202,95% CI 5.119-114.431)。在两个队列中,FOHR(r = -0.499,p = 0.008)和出生 HC(-0.409,p = 0.028)与脑积水发生时间相关。对于接受脑积水治疗的患者,产前手术组患者在3个月后发生脑积水的几率明显高于接受产后手术治疗的患者,尽管产后手术组患者的总体脑积水发生率明显更高(p = 0.018):与脑积水治疗相关的临床和影像学因素在接受产前和产后 MMC 修复术的患者之间存在差异,虽然脑积水的总体发病率较低,但接受产前修复术的患者更有可能在 3 个月后出现脑积水。这对产前接受治疗的患者的临床随访时间有影响,因为这些患者的居住地可能距离治疗地点较远。
Predictors and timing of hydrocephalus treatment in patients undergoing prenatal versus postnatal surgery for myelomeningocele.
Objective: Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%-85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatment differ between pre- and postnatal surgery for MMC. The goal of this study was to determine anatomical, clinical, and radiological characteristics that are associated with the need for and timing of hydrocephalus treatment in patients with MMC.
Methods: The authors retrospectively identified patients from Barnes Jewish Hospital or St. Louis Children's Hospital between 2016 and 2021 who were diagnosed with MMC prenatally and underwent either pre- or postnatal repair. Imaging, clinical, and demographic data were examined longitudinally between treatment groups and hydrocephalus outcomes.
Results: Fifty-eight patients were included (27 females, 46.6%), with a mean gestational age at birth of 36.8 weeks. Twenty-three patients (39.7%) underwent prenatal surgery. For the overall cohort, the ventricle size at prenatal ultrasound (HR 1.175, 95% CI 1.071-1.290), frontal-occipital horn ratio (FOHR) at birth > 0.50 (HR 3.603, 95% CI 1.488-8.720), and mean rate of change in head circumference (HC) in the first 90 days after birth (> 0.10 cm/day: HR 12.973, 95% CI 4.262-39.486) were identified as predictors of hydrocephalus treatment. The factors associated with hydrocephalus in the prenatal cohort were FOHR at birth > 0.50 (HR 27.828, 95% CI 2.980-259.846) and the rate of change in HC (> 0.10 cm/day: HR 39.414, 95% CI 2.035-763.262). The factors associated with hydrocephalus in the postnatal cohort were prenatal ventricle size (HR 1.126, 95% CI 1.017-1.246) and the mean rate of change in HC (> 0.10 cm/day: HR 24.202, 95% CI 5.119-114.431). FOHR (r = -0.499, p = 0.008) and birth HC (-0.409, p = 0.028) were correlated with time to hydrocephalus across both cohorts. For patients who underwent treatment for hydrocephalus, those in the prenatal surgery group were significantly more likely to develop hydrocephalus after 3 months than those treated with postnatal surgery, although the overall rate of hydrocephalus was significantly higher in the postnatal surgery group (p = 0.018).
Conclusions: Clinical and imaging factors associated with hydrocephalus treatment differ between those receiving pre- versus postnatal MMC repair, and while the overall rate of hydrocephalus is lower, those undergoing prenatal repair are more likely to develop hydrocephalus after 3 months of age. This has implications for clinical follow-up timing for patients treated prenatally, who may live at a distance from the treatment site.