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Ventriculomegaly in children: nocturnal ICP dynamics identify pressure-compensated but active paediatric hydrocephalus

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Abstract

Introduction

Paediatric ventriculomegaly without obvious signs or symptoms of raised intracranial pressure (ICP) is often interpreted as resulting from either relative brain atrophy, arrested “benign” hydrocephalus, or “successful” endoscopic third ventriculostomy (ETV). We hypothesise that the typical ICP “signature” found in symptomatic hydrocephalus can be present in asymptomatic or oligosymptomatic children, indicating pressure-compensated, but active hydrocephalus.

Methods

A total of 37 children fulfilling the mentioned criteria underwent computerised ICP overnight monitoring (ONM). Fifteen children had previous hydrocephalus treatment. ICP was analysed for nocturnal dynamics of ICP, ICP amplitudes (AMP), magnitude of slow waves (SLOW), and ICP/AMP correlation index RAP. Depending on the ONM results, children were either treated or observed. The ventricular width was determined at the time of ONM and at 1-year follow-up.

Results

The recordings of 14 children (group A) were considered normal. In the 23 children with pathologic recordings (group B), all ICP values and dependent variables (AMP, SLOW) were significantly higher, except for RAP. In group B, 12 of 15 children had received a pre-treatment and 11 of 22 without previous treatment. All group B children received treatment for hydrocephalus and showed a significant reduction of frontal-occipital horn ratio at 1 year. During follow-up, a positive neurological development was seen in 74% of children of group A and 100% of group B.

Conclusion

Ventriculomegaly in the absence of signs and symptoms of raised ICP was associated in 62% of cases to pathological ICP dynamics. In 80% of pre-treated cases, ETV or shunt failure was found. Treating children with abnormal ICP dynamics resulted in an outcome at least as favourable as in the group with normal ICP dynamics. Thus, asymptomatic ventriculomegaly in children deserves further investigation and, if associated with abnormal ICP dynamics, should be treated in order to provide a normalised intracranial physiology as basis for best possible long-term outcome.

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Abbreviations

AMP:

Fundamental amplitude (1st harmonic) of ICP after Fourier trans-formation

CPC:

Choroid plexus cauterization

CSF:

Cerebrospinal fluid

ETV:

Endoscopic third ventriculostomy

FOHR:

Frontal-occipital horn ratio

ICP:

Intracranial pressure

IVH:

Intraventricular haemorrhage

LIAS:

Late onset idiopathic aqueduct stenosis

LOVA:

Long-standing overt ventriculomegaly

PC-MRI:

Phase-contrast magnetic resonance imaging

ONM:

Overnight monitoring

VP-shunt:

Ventriculoperitoneal shunt

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Authors and Affiliations

  1. Section of Paediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tübingen, Tübingen, Germany

    Sandra F. Dias, Humphrey Okechi, Julian Zipfel & Martin U. Schuhmann

  2. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland

    Sandra F. Dias & Elisabeth Jehli

  3. Department of Paediatric Neurology, University Children’s Hospital of Tübingen, Tübingen, Germany

    Karin Haas-Lude & Andrea Bevot

Authors
  1. Sandra F. Dias
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  2. Elisabeth Jehli
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  4. Andrea Bevot
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  5. Humphrey Okechi
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  6. Julian Zipfel
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  7. Martin U. Schuhmann
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Contributions

SFD and MUS: conception and design of the study, acquisition of data, descriptive and statistical analysis, interpretation of data, and drafting the article. EJ: acquisition of data and statistical analysis. MUS: in addition critical revision of all article versions. JZ, KH, AB and HO: collection of data. All authors critically reviewed the results and contributed to the final manuscript.

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Correspondence to Sandra F. Dias.

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None of the authors reports conflicts of interest with regards to this work. The authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Dias, S.F., Jehli, E., Haas-Lude, K. et al. Ventriculomegaly in children: nocturnal ICP dynamics identify pressure-compensated but active paediatric hydrocephalus. Childs Nerv Syst 37, 1883–1893 (2021). https://doi.org/10.1007/s00381-021-05164-1

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