gms | German Medical Science

Objective: Pediatric ventriculomegaly without obvious signs/symptoms of raised intracranial pressure (ICP), is often interpreted as either resulting from relative brain atrophy, shunt independency or "successful" ETV. We hypothesised, that the typical ICP "signature" found in symptomatic hydrocephalus (increased ICP dynamics and decreased compliance) can be present in oligosymptomatic ventriculomegalic children, indicating chronic, but still active hydrocephalus. We aimed to study ICP and derived parameters in those children and in case of active hydrocephalus suspicion whether shunt implantation improved symptoms and child’s development.

Methods: 37 children with ventriculomegaly and suspicion of increased ICP underwent computerised ICP overnight monitoring (ONM). ICP and calculated dependent variables were analyzed for nocturnal ICP dynamics: ICP peak, "wave" and baseline pressures, ICP "wave" and baseline amplitudes, magnitude of slow waves and RAP index. Depending on ONM’s result, children were surgically treated or assigned to clinical observation. Measurements of ventricular width were performed at the time of ONM and last follow-up.

Results: The ONM recordings of 14 children (Group A) were considered normal with baseline ICP of 10.5 mmHg(95% CI 5.6, 15.3), ICP wave of 12.3 mmHg, RAP 0.44 and baseline AMP 1.13 mmHg. In the 23 children with pathologic measurements (Group B), all ICP values, AMP and slow wave were significantly higher. The RAP index did not varied significantly between both groups (p=0.13). Group A children had less nocturnal wave episodes compared to Group B (p=0.001). Group B children received treatment for hydrocephalus, with the frontal-occipital horn ratio being significantly lower after surgery (p=0.007). At follow up a positive neurological development was seen in 74% children of Group A and 96% of Group B.

Conclusion: Ventriculomegaly in absence of signs and symptoms of raised ICP was associated 62% of cases with significantly accelerated ICP dynamics and indices of low intracranial compliance, as typical in symptomatic children. After neurosurgical intervention, all but one child improved in development, as compared to 74% of those considered to have normal intracranial ICP dynamics. Asymptomatic ventriculomegaly in children needs further investigation and, if associated with abnormal ICP dynamics, should be treated in order to provide a normalized intracranial physiology as basis for best possible long-term outcome.