Clinical predictors of developmental outcome in patients with cephaloceles

Clinical article

Benjamin W. Y. Lo Division of Neurosurgery, Department of Surgery, and
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;

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 M.D., M.SC.
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Abhaya V. Kulkarni Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada; and

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 M.D., Ph.D., F.R.C.S.C.
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James T. Rutka Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada; and

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 M.D., Ph.D., F.R.C.S.C.
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Andrew Jea Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

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James M. Drake Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada; and

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 M.B.B.CH., M.SC., F.R.C.S.C.
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Maria Lamberti-Pasculli Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada; and

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Peter B. Dirks Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada; and

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 M.D., Ph.D., F.R.C.S.C.
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Lehana Thabane Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton;

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 M.SC., Ph.D.
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Object

Cephaloceles represent primary axial mesodermal defects, occurring in 0.8–4 per 10,000 live births. Prior studies have reported posterior location, hydrocephalus, microcephaly, seizure, and presence of brain tissue as poor prognostic markers for neurological outcome. However, these studies were small and the results were analyzed using univariate tests. The purpose of this study was to investigate the potential risk factors for the occurrence of developmental delay in patients with cephaloceles, using both univariate and multivariable regression techniques.

Methods

This is a retrospective cohort study of cephalocele cases treated at the Hospital for Sick Children between 1990 and 2006. Two independent investigators collected the data from the Hospital for Sick Children Encephalocele Database and hospital charts. Developmental assessments were made by general pediatricians and neuropsychologists. Both univariate analysis (α = 0.10) and multivariable logistic regression analysis (α = 0.05) were performed.

Results

Eighty-five cases of cephaloceles were identified. The patient group consisted of 48 boys and 37 girls. Sixty-eight lesions were encephaloceles and 17 were meningoceles. The distribution was as follows: frontal (40 lesions), occipital (33), and parietal (12). Associated conditions included hydrocephalus (23), seizure disorder (17), microcephaly (6), corpus callosal abnormalities (15), heterotopias (9), cerebral dysgenesis (11), and myelomeningocele (1). Evaluation of long-term development revealed that 41 patients (48%) had normal development, 9 (11%) had mild delay, 14 (16%) had moderate delay, and 21 (25%) had severe delay. Hydrocephalus, seizure disorder, microcephaly, presence of associated intracranial abnormalities, and presence of brain tissue were significantly associated with poor outcome on univariate analysis. Multivariable analysis revealed hydrocephalus and presence of intracranial abnormalities to be statistically significant predictors of developmental delay.

Conclusions

To the authors' knowledge, this is one of the largest North American cephalocele series documented. Unlike prior studies, location of the cephaloceles is not a significant predictor of outcome. The multivariable regression analysis demonstrates hydrocephalus and the presence of associated intracranial abnormalities as variables with cumulative predictive effects for developmental delay.

Abbreviation used in this paper:

CSF = cerebrospinal fluid.
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