Jessica R Lane1, Paddy Ssentongo2,3, Mallory R Peterson2, Joshua R Harper2, Edith Mbabazi-Kabachelor4, John Mugamba4, Peter Ssenyonga4,5, Justin Onen4,5, Ruth Donnelly6, Jody Levenbach7, Venkateswararao Cherukuri8, Vishal Monga8, Abhaya V Kulkarni6, Benjamin C Warf9, Steven J Schiff1,2,10. 1. 1Department of Neurosurgery, Penn State College of Medicine, Hershey. 2. 2Center for Neural Engineering, Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park. 3. 3Department of Public Health Sciences, Penn State College of Medicine, Hershey. 4. 4CURE Children's Hospital of Uganda, Mbale. 5. 5Mulago National Referral Hospital, Kampala, Uganda. 6. 6Division of Neurosurgery, University of Toronto, Hospital for Sick Children, Toronto. 7. 7Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; and. 8. 8School of Electrical Engineering and Computer Science, The Pennsylvania State University, University Park. 9. 9Department of Neurosurgery, Boston Children's Hospital and Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 10. 10Department of Physics, The Pennsylvania State University, University Park, Pennsylvania.
Abstract
OBJECTIVE: This study investigated the incidence of postoperative subdural collections in a cohort of African infants with postinfectious hydrocephalus. The authors sought to identify preoperative factors associated with increased risk of development of subdural collections and to characterize associations between subdural collections and postoperative outcomes. METHODS: The study was a post hoc analysis of a randomized controlled trial at a single center in Mbale, Uganda, involving infants (age < 180 days) with postinfectious hydrocephalus randomized to receive either an endoscopic third ventriculostomy plus choroid plexus cauterization or a ventriculoperitoneal shunt. Patients underwent assessment with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III; sometimes referred to as BSID-III) and CT scans preoperatively and then at 6, 12, and 24 months postoperatively. Volumes of brain, CSF, and subdural fluid were calculated, and z-scores from the median were determined from normative curves for CSF accumulation and brain growth. Linear and logistic regression models were used to characterize the association between preoperative CSF volume and the postoperative presence and size of subdural collection 6 and 12 months after surgery. Linear regression and smoothing spline ANOVA were used to describe the relationship between subdural fluid volume and cognitive scores. Causal mediation analysis distinguished between the direct and indirect effects of the presence of a subdural collection on cognitive scores. RESULTS: Subdural collections were more common in shunt-treated patients and those with larger preoperative CSF volumes. Subdural fluid volumes were linearly related to preoperative CSF volumes. In terms of outcomes, the Bayley-III cognitive score was linearly related to subdural fluid volume. The distribution of cognitive scores was significantly different for patients with and those without subdural collections from 11 to 24 months of age. The presence of a subdural collection was associated with lower cognitive scores and smaller brain volume 12 months after surgery. Causal mediation analysis demonstrated evidence supporting both a direct (76%) and indirect (24%) effect (through brain volume) of subdural collections on cognitive scores. CONCLUSIONS: Larger preoperative CSF volume and shunt surgery were found to be risk factors for postoperative subdural collection. The size and presence of a subdural collection were negatively associated with cognitive outcomes and brain volume 12 months after surgery. These results have suggested that preoperative CSF volumes could be used for risk stratification for treatment decision-making and that future clinical trials of alternative shunt technologies to reduce overdrainage should be considered.
OBJECTIVE: This study investigated the incidence of postoperative subdural collections in a cohort of African infants with postinfectious hydrocephalus. The authors sought to identify preoperative factors associated with increased risk of development of subdural collections and to characterize associations between subdural collections and postoperative outcomes. METHODS: The study was a post hoc analysis of a randomized controlled trial at a single center in Mbale, Uganda, involving infants (age < 180 days) with postinfectious hydrocephalus randomized to receive either an endoscopic third ventriculostomy plus choroid plexus cauterization or a ventriculoperitoneal shunt. Patients underwent assessment with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III; sometimes referred to as BSID-III) and CT scans preoperatively and then at 6, 12, and 24 months postoperatively. Volumes of brain, CSF, and subdural fluid were calculated, and z-scores from the median were determined from normative curves for CSF accumulation and brain growth. Linear and logistic regression models were used to characterize the association between preoperative CSF volume and the postoperative presence and size of subdural collection 6 and 12 months after surgery. Linear regression and smoothing spline ANOVA were used to describe the relationship between subdural fluid volume and cognitive scores. Causal mediation analysis distinguished between the direct and indirect effects of the presence of a subdural collection on cognitive scores. RESULTS: Subdural collections were more common in shunt-treated patients and those with larger preoperative CSF volumes. Subdural fluid volumes were linearly related to preoperative CSF volumes. In terms of outcomes, the Bayley-III cognitive score was linearly related to subdural fluid volume. The distribution of cognitive scores was significantly different for patients with and those without subdural collections from 11 to 24 months of age. The presence of a subdural collection was associated with lower cognitive scores and smaller brain volume 12 months after surgery. Causal mediation analysis demonstrated evidence supporting both a direct (76%) and indirect (24%) effect (through brain volume) of subdural collections on cognitive scores. CONCLUSIONS: Larger preoperative CSF volume and shunt surgery were found to be risk factors for postoperative subdural collection. The size and presence of a subdural collection were negatively associated with cognitive outcomes and brain volume 12 months after surgery. These results have suggested that preoperative CSF volumes could be used for risk stratification for treatment decision-making and that future clinical trials of alternative shunt technologies to reduce overdrainage should be considered.
Authors: J F Martínez-Lage; M A Pérez-Espejo; M J Almagro; J Ros de San Pedro; F López; C Piqueras; J Tortosa Journal: Neurocirugia (Astur) Date: 2005-04 Impact factor: 0.553
Authors: Abdullah Bin Zahid; David Balser; Rebekah Thomas; Margaret Y Mahan; Molly E Hubbard; Uzma Samadani Journal: J Neurosurg Date: 2018-12-01 Impact factor: 5.115
Authors: Venkateswararao Cherukuri; Peter Ssenyonga; Benjamin C Warf; Abhaya V Kulkarni; Vishal Monga; Steven J Schiff Journal: IEEE Trans Biomed Eng Date: 2017-12-13 Impact factor: 4.538