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Effect of delayed intermittent ventricular drainage on ventriculomegaly and neurological deficits in experimental neonatal hydrocephalus

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Abstract

Purpose

Evidence-based guidelines do not indicate when ventricular reservoirs should be placed in children with neonatal hydrocephalus, and delayed intervention is common. We hypothesize that delayed ventricular drainage has adverse effects on structural development and functional outcomes.

Methods

Using a well-established animal model of kaolin-induced obstructive hydrocephalus, we evaluated neurologic deficit after early (~1 week post-kaolin) or late (~2 weeks post-kaolin) placement of ventricular reservoirs which were tapped according to strict neurologic criteria.

Results

Progressive ventriculomegaly was similar in early- and late-reservoir implantation groups. The average neurologic deficit scores (NDSs) over the experimental period were 0 (n = 6), 2.74 (n = 5), and 2.01 (n = 3) for the control, early-, and late-reservoir groups, respectively. At reservoir placement, early-group animals displayed enlarged ventricles without neurologic deficits (mean NDS = 0.17), while the late group displayed ventriculomegaly with clinical signs of hydrocephalus (mean NDS = 3.13). The correlation between ventriculomegaly severity and NDS in the early group was strongly positive in the acute (before surgery to 3 weeks post-reservoir placement) (R 2 = 0.65) and chronic (6 to 12 weeks post-reservoir placement) (R 2 = 0.65) phases, while the late group was less correlated (acute R 2 = 0.51; chronic R 2 = 0.19).

Conclusions

Current practice favors delaying reservoir implantation until signs of elevated intracranial pressure and neurologic deficit appear. Our results demonstrate that animals in early and late groups undergo the same course of ventriculomegaly. The findings also show that tapping reservoirs in these neonatal hydrocephalic animals based on neurologic deficit does not halt progressive ventricular enlargement and that neurologic deficit correlates strongly with ventricular enlargement.

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Acknowledgments

This work was supported in part by the Mentored Young Investigator award from the Hydrocephalus Association to RE. Implanted ventricular catheters and reservoirs were provided by Integra Scientific (Plainsboro, NJ) and Medtronic (Medtronic Inc USA, Minneapolis, MN). We would like to thank Kelley Deren-Lloyd, Kris Carlson, and Chase Bryan for their commitment to this project and Kristin Kraus for her help in editing this manuscript. We would also like to acknowledge Yunuen Coria, Liana Roberson, Reesha Dennis-Bishop, Jacqueline Brown, Brittani Delaney, Annette Rowberry, and Misty Seppi for their animal care and surgical assistance. The authors would also like to give special thanks to the entire veterinary staff and to Osama Abdullah for help throughout this project.

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Authors and Affiliations

  1. Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA

    Ramin Eskandari, Melissa Packer & James P. McAllister II

  2. Department of Comparative Medicine, University of Utah, Salt Lake City, UT, USA

    Eric C. Burdett

  3. Department of Physiology, University of Utah, Salt Lake City, UT, USA

    James P. McAllister II

  4. Department of Bioengineering, University of Utah, Salt Lake City, UT, USA

    James P. McAllister II

Authors
  1. Ramin Eskandari
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  2. Melissa Packer
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  3. Eric C. Burdett
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  4. James P. McAllister II
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Correspondence to James P. McAllister II.

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Eskandari, R., Packer, M., Burdett, E.C. et al. Effect of delayed intermittent ventricular drainage on ventriculomegaly and neurological deficits in experimental neonatal hydrocephalus. Childs Nerv Syst 28, 1849–1861 (2012). https://doi.org/10.1007/s00381-012-1848-z

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  • DOI: https://doi.org/10.1007/s00381-012-1848-z

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