F T Mangano1,2, M Altaye3,2, C B Stevenson1,2, W Yuan4,2. 1. From the Division of Pediatric Neurosurgery (F.T.M., C.B.S.). 2. University of Cincinnati College of Medicine (F.T.M., M.A., C.B.S., W.Y.), Cincinnati, Ohio. 3. Division of Biostatistics and Epidemiology (M.A.). 4. Pediatric Neuroimaging Research Consortium (W.Y.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Weihong.Yuan@cchmc.org.
Abstract
BACKGROUND AND PURPOSE: There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients. MATERIALS AND METHODS: This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors. RESULTS: The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (P < .05) of CSF diversion surgery. The predictive value of the CSF diversion surgery index was also affected by fractional anisotropy in the posterior limb of the internal capsule and sex with marginal effect (.05<P < .10), but not by the fronto-occipital horn ratio (P > .10). The overall CSF diversion surgery index model fit the data well with statistical significance (eg, likelihood ratio: P < .001), with the performance (sensitivity = 78.6%; specificity = 86.5%, overall accuracy = 84.8%) superior to all individual indices in sensitivity and overall accuracy, and most of the individual indices in specificity. CONCLUSIONS: The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.
BACKGROUND AND PURPOSE: There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients. MATERIALS AND METHODS: This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors. RESULTS: The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (P < .05) of CSF diversion surgery. The predictive value of the CSF diversion surgery index was also affected by fractional anisotropy in the posterior limb of the internal capsule and sex with marginal effect (.05<P < .10), but not by the fronto-occipital horn ratio (P > .10). The overall CSF diversion surgery index model fit the data well with statistical significance (eg, likelihood ratio: P < .001), with the performance (sensitivity = 78.6%; specificity = 86.5%, overall accuracy = 84.8%) superior to all individual indices in sensitivity and overall accuracy, and most of the individual indices in specificity. CONCLUSIONS: The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.
Authors: Weihong Yuan; Karen Harpster; Blaise V Jones; Joshua S Shimony; Robert C McKinstry; Nicole Weckherlin; Stephanie S Powell; Holly Barnard; Jack Engsberg; Darren S Kadis; Jonathan Dodd; Mekibib Altaye; David D Limbrick; Scott K Holland; Sarah M Simpson; Sarah Bidwell; Francesco T Mangano Journal: Neuropediatrics Date: 2016-07-20 Impact factor: 1.947
Authors: Ueli Möhrlen; Nicole Ochsenbein-Kölble; Luca Mazzone; Franziska Kraehenmann; Margaret Hüsler; Barbara Casanova; Peter Biro; David Wille; Bea Latal; Ianina Scheer; Vera Bernet; Theres Moehrlen; Leonhard Held; Alan W Flake; Roland Zimmermann; Martin Meuli Journal: Fetal Diagn Ther Date: 2019-06-05 Impact factor: 2.587
Authors: A Rajagopal; J S Shimony; R C McKinstry; M Altaye; T Maloney; F T Mangano; D D Limbrick; S K Holland; B V Jones; S Simpson; D Mercer; W Yuan Journal: AJNR Am J Neuroradiol Date: 2013-09-26 Impact factor: 3.825
Authors: Michael A Williams; James P McAllister; Marion L Walker; Dory A Kranz; Marvin Bergsneider; Marc R Del Bigio; Laurel Fleming; David M Frim; Katrina Gwinn; John R W Kestle; Mark G Luciano; Joseph R Madsen; Mary Lou Oster-Granite; Giovanna Spinella Journal: J Neurosurg Date: 2007-11 Impact factor: 5.115
Authors: Francesco T Mangano; Mekibib Altaye; Robert C McKinstry; Joshua S Shimony; Stephanie K Powell; Jannel M Phillips; Holly Barnard; David D Limbrick; Scott K Holland; Blaise V Jones; Jonathan Dodd; Sarah Simpson; Deanna Mercer; Akila Rajagopal; Sarah Bidwell; Weihong Yuan Journal: J Neurosurg Pediatr Date: 2016-05-20 Impact factor: 2.375
Authors: Noel Tulipan; John C Wellons; Elizabeth A Thom; Nalin Gupta; Leslie N Sutton; Pamela K Burrows; Diana Farmer; William Walsh; Mark P Johnson; Larry Rand; Susan Tolivaisa; Mary E D'alton; N Scott Adzick Journal: J Neurosurg Pediatr Date: 2015-09-15 Impact factor: 2.375
Authors: John W Brock; John C Thomas; Laurence S Baskin; Stephen A Zderic; Elizabeth A Thom; Pamela K Burrows; Hanmin Lee; Amy J Houtrow; Cora MacPherson; N Scott Adzick Journal: J Urol Date: 2019-09-06 Impact factor: 7.450