ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2025
Asymptomatic ventriculomegaly in myelomeningocele: a matched cohort study of neuropsychological outcomes across institutions with varying shunt rates.
Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeHydrocephalus management in myelomeningocele (MMC) patients remains controversial. While most institutions recommend surgical intervention for enlarged ventricles, recent studies suggest asymptomatic ventriculomegaly may not require treatment. This study compared cognitive outcomes in MMC patients from different institutions with different hydrocephalus intervention rates.
methodsParticipants with MMC were recruited from two sites: Site 1 (Chicago area; N = 41; selective shunting protocol) and Site 2 (Houston and Toronto; N = 342; historical approach to hydrocephalus management). The 41 Site 1 patients were matched to 41 participants from Site 2 based on age, gender, lesion level, and race. Neuropsychological testing assessed various cognitive domains. Independent samples t-tests compared outcomes between sites.
resultsSite 1 had significantly lower shunt rates (55% shunt rate at Site 1; 83% shunt rate at Site 2). There were no significant differences in demographics or lesion levels between sites. Site 1 participants demonstrated significantly higher scores on several cognitive measures compared to Site 2, including the Purdue Pegboard (fine motor dexterity; p = 0.042), Stanford-Binet Quantitative Reasoning (quantitative reasoning to solve mathematical problems; p = 0.030), VMI (visuomotor integration; p = 0.034), WJ Letter-Word Identification (single-word reading; p = 0.026), and WJ Calculation subtests (math calculation problem-solving; p = 0.012).
conclusionNeuropsychological outcomes were either similar across cohorts from institutions with different shunt rates or favored the clinic with the lower shunting rate. These findings suggest asymptomatic ventriculomegaly may not be associated with worse functional outcomes, potentially informing guidelines for hydrocephalus intervention in the MMC population.
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