Corpus callosum injury after neurosurgical intervention for posthemorrhagic ventricular dilatation and association with neurodevelopmental outcome at 2 years

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  • 1 Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, and Utrecht University;
  • | 2 University Medical Center Utrecht, Utrecht Brain Center, Utrecht, The Netherlands;
  • | 3 Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto;
  • | 4 Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto;
  • | 5 Program in Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto;
  • | 6 Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto;
  • | 7 Institute of Biomedical Engineering, University of Toronto;
  • | 8 Department of Psychology, The Hospital for Sick Children, University of Toronto, Ontario, Canada;
  • | 9 Department of Neurosurgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, and Utrecht University, Utrecht; and
  • | 10 Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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OBJECTIVE

Direct injury to the corpus callosum (CC) due to neurosurgical interventions in infants with posthemorrhagic ventricular dilatation (PHVD) has not been reported in the literature. The authors observed a subset of infants who had suffered penetrating CC injury after neurosurgical interventions for PHVD and hypothesized that this pattern of injury may result in suboptimal CC maturation and neurodevelopmental impairment.

METHODS

In this multicenter, retrospective, observational study, 100 preterm and 17 full-term infants with PHVD were included and compared with 23 preterm controls. Both neonatal and postneonatal brain MRI scans were assessed for injury, and measurements were performed on postneonatal MRI scans at 2 years’ corrected age. Neurodevelopmental outcome was assessed at 2 years’ corrected age.

RESULTS

A total of 269 brain MRI scans of 140 infants were included. Of infants with PHVD, 48 (41%) had penetrating CC injury following neurosurgical interventions. The median (IQR) CC midsagittal surface area was smaller in infants with CC injury when compared with infants with PHVD who had intact CC and controls (190 mm [149–262 mm] vs 268 mm [206–318 mm] vs 289 mm [246–320 mm], respectively; p < 0.001). In the univariate analysis, the area of the CC was associated with cognitive Z score (coefficient 0.009 [95% CI 0.005–0.012], p < 0.001) and motor Z score (coefficient 0.009 [95% CI 0.006–0.012], p < 0.001). In the multivariable model, CC injury was not independently associated with cognitive and motor Z score after adjusting for gestational age and presence of periventricular hemorrhagic infarction (coefficient 0.04 [95% CI −0.36 to 0.46] and −0.37 [95% CI −0.83 to 0.09], p = 0.7 and 0.1, respectively).

CONCLUSIONS

CC injury was not uncommon following neurosurgical interventions for PHVD in both preterm and full-term infants. At the age of 2 years, the CC midsagittal surface area was smaller in infants with injury, but CC injury was not independently associated with cognitive and motor outcomes at 2 years’ corrected age.

ABBREVIATIONS

BSID-II = Bayley Scales of Infant Development, Second Edition; BSITD-III = Bayley Scales of Infant and Toddler Development, Third Edition; CC = corpus callosum; CP = cerebral palsy; GMDS = Griffiths Mental Development Scales; NDI = neurodevelopmental impairment; PHVD = posthemorrhagic ventricular dilatation; PVHI = periventricular hemorrhagic infarction; TEA = term-equivalent age; UMCU = University Medical Center Utrecht; VPS = ventriculoperitoneal shunt; VR = ventricular reservoir.

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