Ashley L Ware1, Paulina A Kulesz2, Julian S Orkisz2, C N Arrington3, Robin M Bowman4, Jack M Fletcher2. 1. Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada. 2. Department of Psychology and the Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, 4811 Cullen Blvd, Houston, TX 77204-6022, USA. 3. Department of Psychology, Georgia State University, 140 Decatur St. SE, Atlanta, GA30303, USA. 4. Division of Pediatric Neurosurgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL60614, USA.
Abstract
OBJECTIVE: Lifespan outcomes of simultaneous versus sequential myelomeningocele repair and shunt placement or effects of repeated shunt revisions on specific domains of IQ or fine motor dexterity are largely unknown. The current study addressed these gaps in a large cohort of children and adults with spina bifida myelomeningocele (SBM). METHODS: Participants between 7 and 44 years of age with SBM and shunted hydrocephalus were recruited from international clinics at two time points. Each participant completed a standardized neuropsychological evaluation that included estimates of IQ and fine motor dexterity. Simultaneous versus sequential surgical repair and number of shunt revisions were examined in relation to long-term IQ and fine motor scores. RESULTS: Simultaneous myelomeningocele repair and shunting were associated with more frequent shunt revisions, as well as to lower Full Scale and verbal IQ scores, controlling for number of shunt revisions. More shunt revisions across study time points were associated with higher nonverbal IQ (NVIQ) scores. No effects were observed on fine motor dexterity. CONCLUSIONS: Findings indicate generally greater influence of surgery type over shunt revision history on outcomes in well-managed hydrocephalus. Findings supported apparent, domain-specific benefits of sequential compared to simultaneous surgery across the lifespan in SBM. Higher NVIQ scores with greater number of additional shunt revisions across surgery type supported positive outcomes with effective surgical management for hydrocephalus.
OBJECTIVE: Lifespan outcomes of simultaneous versus sequential myelomeningocele repair and shunt placement or effects of repeated shunt revisions on specific domains of IQ or fine motor dexterity are largely unknown. The current study addressed these gaps in a large cohort of children and adults with spina bifida myelomeningocele (SBM). METHODS:Participants between 7 and 44 years of age with SBM and shunted hydrocephalus were recruited from international clinics at two time points. Each participant completed a standardized neuropsychological evaluation that included estimates of IQ and fine motor dexterity. Simultaneous versus sequential surgical repair and number of shunt revisions were examined in relation to long-term IQ and fine motor scores. RESULTS: Simultaneous myelomeningocele repair and shunting were associated with more frequent shunt revisions, as well as to lower Full Scale and verbal IQ scores, controlling for number of shunt revisions. More shunt revisions across study time points were associated with higher nonverbal IQ (NVIQ) scores. No effects were observed on fine motor dexterity. CONCLUSIONS: Findings indicate generally greater influence of surgery type over shunt revision history on outcomes in well-managed hydrocephalus. Findings supported apparent, domain-specific benefits of sequential compared to simultaneous surgery across the lifespan in SBM. Higher NVIQ scores with greater number of additional shunt revisions across surgery type supported positive outcomes with effective surgical management for hydrocephalus.
Entities:
Keywords:
Congenital hydrocephalus; Fine motor dexterity; IQ; Intelligence; Myelomeningocele; Shunt revisions; Spina bifida; Surgical shunt placement
Authors: Jonathan N Sellin; Jacob Cherian; James M Barry; Sheila L Ryan; Thomas G Luerssen; Andrew Jea Journal: J Neurosurg Pediatr Date: 2014-05-23 Impact factor: 2.375
Authors: Victoria J Williams; Jenifer Juranek; Karla K Stuebing; Paul T Cirino; Maureen Dennis; Robin M Bowman; Susan Blaser; Larry A Kramer; Jack M Fletcher Journal: J Neurosurg Pediatr Date: 2015-01-30 Impact factor: 2.375
Authors: Ellen L Air; Weihong Yuan; Scott K Holland; Blaise V Jones; Karin Bierbrauer; Mekibib Altaye; Francesco T Mangano Journal: J Neurosurg Pediatr Date: 2010-04 Impact factor: 2.375
Authors: E Hoppe-Hirsch; F Laroussinie; L Brunet; C Sainte-Rose; D Renier; G Cinalli; M Zerah; A Pierre-Kahn Journal: Childs Nerv Syst Date: 1998-03 Impact factor: 1.475