Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus

Mandell, Jason G.; Kulkarni, Abhaya V.; Warf, Benjamin C.; Schiff, Steven J.

doi:10.3171/2014.9.peds12427

Cited by 59 publications

(33 citation statements)

References 16 publications

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“…Previous studies 4–6,21,22,27,28 provided equipoise for our trial, which showed that the between-group differences in median BSID-3 outcomes were not significant and that the estimates of differences in the effects of the two treatments were no greater than 1 point on the BSID-3 scale, with 95% confidence intervals of no greater than 2 points in either direction (Table 2). …”

Section: Discussionmentioning

confidence: 62%

Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda

et al. 2017

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BACKGROUND Postinfectious hydrocephalus in infants is a major health problem in sub-Saharan Africa. The conventional treatment is ventriculoperitoneal shunting, but surgeons are usually not immediately available to revise shunts when they fail. Endoscopic third ventriculostomy with choroid plexus cauterization (ETV–CPC) is an alternative treatment that is less subject to late failure but is also less likely than shunting to result in a reduction in ventricular size that might facilitate better brain growth and cognitive outcomes. METHODS We conducted a randomized trial to evaluate cognitive outcomes after ETV–CPC versus ventriculoperitoneal shunting in Ugandan infants with postinfectious hydrocephalus. The primary outcome was the Bayley Scales of Infant Development, Third Edition (BSID-3), cognitive scaled score 12 months after surgery (scores range from 1 to 19, with higher scores indicating better performance). The secondary outcomes were BSID-3 motor and language scores, treatment failure (defined as treatment-related death or the need for repeat surgery), and brain volume measured on computed tomography. RESULTS A total of 100 infants were enrolled; 51 were randomly assigned to undergo ETV–CPC, and 49 were assigned to undergo ventriculoperitoneal shunting. The median BSID-3 cognitive scores at 12 months did not differ significantly between the treatment groups (a score of 4 for ETV–CPC and 2 for ventriculoperitoneal shunting; Hodges–Lehmann estimated difference, 0; 95% confidence interval [CI], −2 to 0; P = 0.35). There was no significant difference between the ETV–CPC group and the ventriculoperitoneal-shunt group in BSID-3 motor or language scores, rates of treatment failure (35% and 24%, respectively; hazard ratio, 0.7; 95% CI, 0.3 to 1.5; P = 0.24), or brain volume (z score, −2.4 and −2.1, respectively; estimated difference, 0.3; 95% CI, −0.3 to 1.0; P = 0.12). CONCLUSIONS This single-center study involving Ugandan infants with postinfectious hydrocephalus showed no significant difference between endoscopic ETV–CPC and ventriculoperitoneal shunting with regard to cognitive outcomes at 12 months. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01936272.)

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Section: Discussionmentioning

confidence: 62%

Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda

et al. 2017

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“…With the increased number of surgical epilepsy programs with access to CT in the developing world, 3,7,24,26 it is important to be able to use CT as a tool to aid in patient selection and evaluation for surgery. 18,19 In this study, we present data suggesting that temporal lobe and brain volumes measured on CT scans might be useful to discriminate seizure outcome following temporal lobe resection. Figure 3 shows a comparison of temporal lobe volumes by age.…”

Section: Discussionmentioning

confidence: 93%

“…In this third of the 3 companion papers, 18,19 we report the measurement of temporal lobe and total brain volumes in 10 pediatric patients treated with temporal lobe resection for TLE at the CURE Children's Hospital of Uganda (CCHU) and previously reported. 3 We then used linear discrimination analysis (LDA) to classify seizure outcome by temporal lobe volumes and normalized total brain volumes.…”

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confidence: 99%

Volumetric brain analysis in neurosurgery: Part 3. Volumetric CT analysis as a predictor of seizure outcome following temporal lobectomy

Mandell¹,

Hill

Nguyen³

et al. 2015

PED

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OBJECT The incidence of temporal lobe epilepsy (TLE) due to mesial temporal sclerosis (MTS) can be high in developing countries. Current diagnosis of MTS relies on structural MRI, which is generally unavailable in developing world settings. Given widespread effects on temporal lobe structure beyond hippocampal atrophy in TLE, the authors propose that CT volumetric analysis can be used in patient selection to help predict outcomes following resection. METHODS Ten pediatric patients received preoperative CT scans and temporal resections at the CURE Children's Hospital of Uganda. Engel classification of seizure control was determined 12 months postoperatively. Temporal lobe volumes were measured from CT and from normative MR images using the Cavalieri method. Whole brain and fluid volumes were measured using particle filter segmentation. Linear discrimination analysis (LDA) was used to classify seizure outcome by temporal lobe volumes and normalized brain volume. RESULTS Epilepsy patients showed normal to small brain volumes and small temporal lobes bilaterally. A multivariate measure of the volume of each temporal lobe separated patients who were seizure free (Engel Class IA) from those with incomplete seizure control (Engel Class IB/IIB) with LDA (p < 0.01). Temporal lobe volumes also separate normal subjects, patients with Engel Class IA outcomes, and patients with Class IB/IIB outcomes (p < 0.01). Additionally, the authors demonstrated that age-normalized whole brain volume, in combination with temporal lobe volumes, may further improve outcome prediction (p < 0.01). CONCLUSIONS This study shows strong evidence that temporal lobe and brain volume can be predictive of seizure outcome following temporal lobe resection, and that volumetric CT analysis of the temporal lobe may be feasible in lieu of structural MRI when the latter is unavailable. Furthermore, since the authors' methods are modality independent, these findings suggest that temporal lobe and normative brain volumes may further be useful in the selection of patients for temporal lobe resection when structural MRI is available.

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“…The association of brain volume (independent of ventricular volume) with cognitive outcomes is a subject of active research and will likely become even more important as a prognostic feature as automated imaging techniques yield more accurate volumetric measurements. (43) Postnatal surgery for CSF diversion is standard of care for VM due to hydrocephalus. In the 1980s, prenatal procedures, such as percutaneous cephalocentesis and in utero ventriculoamniotic shunting systems, were developed with discouraging initial results, and a voluntary moratorium on such procedures has been invoked pending further information on the natural history of the fetal VM.…”

Section: Parental Counselingmentioning

confidence: 99%

Complex Fetal Care: Implications of Fetal Ventriculomegaly: A Neurosurgical Perspective

Craig¹,

Lober²,

Grant³

2015

NeoReviews

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Fetal cerebral ventriculomegaly is diagnosed in utero when the atrial width of at least one lateral ventricle is greater than 10 mm. It is often associated with hydrocephalus, a condition of excessive intracranial cerebrospinal fluid, but can also be related to a decrease in the amount of normal brain tissue. Neurodevelopmental outcomes may correlate with severity of ventricle enlargement, with wide variation based on cause and the presence of other associated malformations. Ultrasonography and magnetic resonance imaging are sufficient to achieve an accurate diagnosis. This article considers the prognosis and management of fetal ventriculomegaly. Special emphasis is placed on discussing the utility of neuroimaging in the diagnosis, prenatal counseling, and treatment planning for this condition.Objectives After completing this article, readers should be able to:1. Define ventriculomegaly and hydrocephalus in the fetal context and their associated causes, risk factors, and diagnostic approaches. 2. Discuss prognosis, management, and outcomes. 3. Describe how neuroimaging can assist with diagnosis and treatment. 4. Review the role of the neonatologist in treatment and management.

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Volumetric brain analysis in neurosurgery: Part 2. Brain and CSF volumes discriminate neurocognitive outcomes in hydrocephalus

Cited by 59 publications

References 16 publications

Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda

Endoscopic Treatment versus Shunting for Infant Hydrocephalus in Uganda

Volumetric brain analysis in neurosurgery: Part 3. Volumetric CT analysis as a predictor of seizure outcome following temporal lobectomy

Complex Fetal Care: Implications of Fetal Ventriculomegaly: A Neurosurgical Perspective

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