Assessment of Ventricular Size and Neurocognitive Outcomes in Children with Postnatal Closure of Myelomeningocele.

OBJECTIVE: To assess if ventricular size before shunting is correlated with neurodevelopmental outcomes in children with postnatal myelomeningocele closure. STUDY DESIGN: This retrospective review included children with postnatal surgical closure of myelomeningocele and neuropsychological testing between 2018 and 2023 at the University of California, San Francisco. Frontal-occipital horn ratio (FOHR) was measured immediately before shunt placement or on the first study that reported ventricular stability for nonshunted patients. The primary outcome was full scale IQ (FSIQ) on the Weschler Intelligence Scale. Secondary outcomes included indices of the Weschler scale, the Global Executive Composite from the Behavior Rating Inventory of Executive Function, and the general adaptive composite from the Adaptive Behavior Assessment Scale. Univariable and multivariable regression was used to determine if FOHR was correlated with neuropsychological scores. RESULTS: Forty patients met the inclusion criteria; 26 (65%) had shunted hydrocephalus. Age at neuropsychological testing was 10.9 ± 0.6 years. FOHR was greater in the shunted group (0.64 vs 0.51; P < .001). There were no differences in neuropsychological results between shunted and nonshunted groups. On univariable analysis, greater FOHR was associated with lower FSIQ (P = .025) and lower Visual Spatial Index scores (P = .013), which remained significant on multivariable analysis after adjusting for gestational age at birth, lesion level, shunt status, and shunt revision status (P = .049 and P = .006, respectively). Separate analyses by shunt status revealed that these effects were driven by the shunted group. CONCLUSIONS: Greater FOHR before shunting was correlated with lower FSIQ and the Visual Spatial Index scores on the Weschler Intelligence Scales. Larger studies are needed to explore further the relationship between ventricle size, hydrocephalus, and neurodevelopmental outcomes.

Management of neurogenic bladder in patients with cerebral palsy.

Cerebral palsy (CP) is a non-progressive injury of the brain that affects muscle movement and coordination secondary to anoxia that occurred during the perinatal period. Babies who are premature, low birth weight, and those who sustained perinatal infection, seizure, or intracranial hemorrhage are at an increase risk of being affected. The injury mainly involves the motor control center of the brain; therefore, presents clinically with variable physical impairments, ranging from delayed gross or fine motor development to altered muscle tone and gait. With public awareness and research, the full spectrum of intelligence and capabilities of these children is now being appreciated. Studies have shown that with supportive caretakers, many of these children go on to enjoy near-normal adult lives. Therefore, it is imperative that their physical disabilities are identified and managed properly. In this review, we will focus primarily on urologic evaluation and management of patients with CP, with a brief review of normal bladder physiology and voiding pattern.