CSF shunting in myelomeningocele-related hydrocephalus and the role of prenatal imaging.
Dysraphism
Prenatal diagnosis, Prenatal MRI, Surveillance imaging
Prenatal hydrocephalus
Spina bifida
Journal
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
ISSN: 1433-0350
Titre abrégé: Childs Nerv Syst
Pays: Germany
ID NLM: 8503227
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
09
04
2021
accepted:
13
05
2021
pubmed:
3
6
2021
medline:
19
11
2021
entrez:
2
6
2021
Statut:
ppublish
Résumé
Hydrocephalus is commonly associated with myelomeningocele (MMC). Indication and timing of cerebrospinal fluid (CSF) shunting are still a topic of discussion. The aim of this study was to investigate whether the analysis of prenatal cerebral imaging studies could provide information that is predictive of the necessity of CSF shunting in the postnatal period. Among 73 infants operated on because of MMC between January 2003 and June 2020, 50 had undergone prenatal and postnatal MRI studies and were considered for analysis. For each patient, frontal horn width, atrial ventricle diameter, third ventricle diameter, and subarachnoid spaces (sinocortical width, craniocortical width, and the interhemispheric width) have been measured on prenatal, postnatal, and a follow-up MRI study. The need of CSF shunting device placement in relation to prenatal and early postnatal MRI data was investigated. Of the 50 infants, 31 (62%) developed a progressive hydrocephalus. Of these, 30 needed a CSF shunt and the majority of them (n=29) was operated on within 28 days after birth. One patient needed CSF shunt implantation at 45 days after birth and one child developed a late progressive hydrocephalus, successfully treated by ETV alone, at 14.2 months of age. All patients with an atrial ventricle diameter greater than 1.9 cm and a 3rd ventricle diameter larger than 0.3 cm on antenatal third trimester imaging have undergone CSF shunting within 1 month after birth. Conversely, all the children that did not undergo a CSF shunt placement showed an atrial cerebral ventricle diameter inferior to 1.2 cm and a 3rd ventricle width < 0.3 cm on antenatal imaging. Frontal horn width and subarachnoid CSF spaces' evolution did not seem to play a role. The prenatal MRI assessment of the associated prenatal ventriculomegaly in MMC provides parameters that have a predictive value heralding the probability of a CSF diversion procedure after birth. In the same way, the analysis of intrauterine MRI studies may identify those subjects that are less at risk of developing a progressive hydrocephalus after birth, therefore encouraging a more cautious attitude towards the early implantation of CSF shunting devices in the current clinical practice.
Identifiants
pubmed: 34076708
doi: 10.1007/s00381-021-05217-5
pii: 10.1007/s00381-021-05217-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3417-3428Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Beuriat P-A, Poirot I, Hameury F et al (2018) Postnatal management of myelomeningocele: outcome with a multidisciplinary team experience. World Neurosurg 110:e24–e31. https://doi.org/10.1016/j.wneu.2017.09.169
doi: 10.1016/j.wneu.2017.09.169
pubmed: 28987842
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.FOCUS19469
doi: 10.3171/2019.7.FOCUS19469
pubmed: 31574479
Chakraborty A, Crimmins D, Hayward R, Thompson D (2008) Toward reducing shunt placement rates in patients with myelomeningocele. J Neurosurg Pediatr 1:361–365. https://doi.org/10.3171/PED/2008/1/5/361
doi: 10.3171/PED/2008/1/5/361
pubmed: 18447669
Beuriat P-A, Poirot I, Hameury F et al (2019) Low level myelomeningoceles: do they need prenatal surgery? Childs Nerv Syst 35:957–963. https://doi.org/10.1007/s00381-019-04123-1
doi: 10.1007/s00381-019-04123-1
pubmed: 30915531
Beuriat P-A, Szathmari A, Hameury F et al (2017) Changes in the epidemiology of spina bifida in France in the last 30 years. Neurochirurgie 63:109–111. https://doi.org/10.1016/j.neuchi.2017.01.003
doi: 10.1016/j.neuchi.2017.01.003
pubmed: 28502564
Guibaud L (2009) Fetal cerebral ventricular measurement and ventriculomegaly: time for procedure standardization. Ultrasound Obstet Gynecol 34:127–130. https://doi.org/10.1002/uog.6456
doi: 10.1002/uog.6456
pubmed: 19644945
Pisapia JM, Sinha S, Zarnow DM et al (2017) Fetal ventriculomegaly: diagnosis, treatment, and future directions. Childs Nerv Syst 33:1113–1123. https://doi.org/10.1007/s00381-017-3441-y
doi: 10.1007/s00381-017-3441-y
pubmed: 28510072
Lam WW, Ai VH, Wong V, Leong LL (2001) Ultrasonographic measurement of subarachnoid space in normal infants and children. Pediatr Neurol 25:380–384. https://doi.org/10.1016/s0887-8994(01)00349-6
doi: 10.1016/s0887-8994(01)00349-6
pubmed: 11744312
International Society of Ultrasound in Obstetrics & Gynecology Education Committee (2007) Sonographic examination of the fetal central nervous system: guidelines for performing the “basic examination” and the “fetal neurosonogram”. Ultrasound Obstet Gynecol 29:109–116. https://doi.org/10.1002/uog.3909
doi: 10.1002/uog.3909
Williams H (2008) A unifying hypothesis for hydrocephalus, Chiari malformation, syringomyelia, anencephaly and spina bifida. Cerebrospinal Fluid Res 5:7. https://doi.org/10.1186/1743-8454-5-7
doi: 10.1186/1743-8454-5-7
pubmed: 18405364
pmcid: 2365936
McLone DG, Knepper PA (1989) The cause of Chiari II malformation: a unified theory. Pediatr Neurosci 15:1–12. https://doi.org/10.1159/000120432
doi: 10.1159/000120432
pubmed: 2699756
Norkett W, McLone DG, Bowman R (2016) Current management strategies of hydrocephalus in the child with open spina bifida. Top Spinal Cord Inj Rehabil 22:241–246. https://doi.org/10.1310/sci2204-241
doi: 10.1310/sci2204-241
pubmed: 29339864
pmcid: 5108507
Adzick NS, Thom EA, Spong CY 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/NEJMoa1014379
doi: 10.1056/NEJMoa1014379
pubmed: 21306277
pmcid: 3770179
Moldenhauer JS, Adzick NS (2017) Fetal surgery for myelomeningocele: after the Management of Myelomeningocele Study (MOMS). Semin Fetal Neonatal Med 22:360–366. https://doi.org/10.1016/j.siny.2017.08.004
doi: 10.1016/j.siny.2017.08.004
pubmed: 29031539
Guibaud L (2009) Contribution of fetal cerebral MRI for diagnosis of structural anomalies. Prenat Diagn 29:420–433. https://doi.org/10.1002/pd.2171
doi: 10.1002/pd.2171
pubmed: 19156685
Vonzun L, Winder FM, Meuli M et al (2020) Prenatal sonographic head circumference and cerebral ventricle width measurements before and after open fetal myelomeningocele repair-prediction of shunting during the first year of life. Ultraschall Med 41:544–549. https://doi.org/10.1055/a-0756-8417
doi: 10.1055/a-0756-8417
pubmed: 30347419
Seaman RD, Cassady CI, Yepez Donado MC et al (2020) Postoperative imaging following fetal open myelomeningocele repair: the clinical utility of magnetic resonance imaging and sonographic amniotic fluid volumes in detecting suspected hysterotomy scar dehiscence. Prenat Diagn 40:66–70. https://doi.org/10.1002/pd.5565
doi: 10.1002/pd.5565
pubmed: 31600420
Hanak BW, Bonow RH, Harris CA, Browd SR (2017) Cerebrospinal fluid shunting complications in children. Pediatr Neurosurg 52:381–400. https://doi.org/10.1159/000452840
doi: 10.1159/000452840
pubmed: 28249297
Al-Hakim S, Schaumann A, Schneider J et al (2018) Experience in shunt management on revision free survival in infants with myelomeningocele. Childs Nerv Syst 34:1375–1382. https://doi.org/10.1007/s00381-018-3781-2
doi: 10.1007/s00381-018-3781-2
pubmed: 29582171
Tuli S, Tuli J, Drake J, Spears J (2004) Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg 100:442–446. https://doi.org/10.3171/ped.2004.100.5.0442
doi: 10.3171/ped.2004.100.5.0442
pubmed: 15287452