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Long-Term Intellectual and Fine Motor Outcomes in Spina Bifida Are Related to Myelomeningocele Repair and Shunt Intervention History

Published online by Cambridge University Press:  15 November 2019

Ashley L. Ware Open the ORCID record for Ashley L. Ware [Opens in a new window] ,
Paulina A. Kulesz ,
Julian S. Orkisz ,
C. N. Arrington ,
Robin M. Bowman  and
Jack M. Fletcher
Ashley L. Ware*
Affiliation:
Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
Paulina A. Kulesz
Affiliation:
Department of Psychology and the Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, 4811 Cullen Blvd, Houston, TX 77204-6022, USA
Julian S. Orkisz
Affiliation:
Department of Psychology and the Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, 4811 Cullen Blvd, Houston, TX 77204-6022, USA
C. N. Arrington
Affiliation:
Department of Psychology, Georgia State University, 140 Decatur St. SE, Atlanta, GA30303, USA
Robin M. Bowman
Affiliation:
Division of Pediatric Neurosurgery, Children’s Memorial Hospital, Northwestern University Medical School, Chicago, IL60614, USA
Jack M. Fletcher
Affiliation:
Department of Psychology and the Texas Institute for Measurement, Evaluation, and Statistics (TIMES), University of Houston, 4811 Cullen Blvd, Houston, TX 77204-6022, USA
*
*Correspondence and reprint requests to: Ashley L. Ware, PhD, Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada. E-mail: [email protected]
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Abstract

Objective:

Lifespan outcomes of simultaneous versus sequential myelomeningocele repair and shunt placement or effects of repeated shunt revisions on specific domains of IQ or fine motor dexterity are largely unknown. The current study addressed these gaps in a large cohort of children and adults with spina bifida myelomeningocele (SBM).

Methods:

Participants between 7 and 44 years of age with SBM and shunted hydrocephalus were recruited from international clinics at two time points. Each participant completed a standardized neuropsychological evaluation that included estimates of IQ and fine motor dexterity. Simultaneous versus sequential surgical repair and number of shunt revisions were examined in relation to long-term IQ and fine motor scores.

Results:

Simultaneous myelomeningocele repair and shunting were associated with more frequent shunt revisions, as well as to lower Full Scale and verbal IQ scores, controlling for number of shunt revisions. More shunt revisions across study time points were associated with higher nonverbal IQ (NVIQ) scores. No effects were observed on fine motor dexterity.

Conclusions:

Findings indicate generally greater influence of surgery type over shunt revision history on outcomes in well-managed hydrocephalus. Findings supported apparent, domain-specific benefits of sequential compared to simultaneous surgery across the lifespan in SBM. Higher NVIQ scores with greater number of additional shunt revisions across surgery type supported positive outcomes with effective surgical management for hydrocephalus.

Keywords

Congenital hydrocephalusMyelomeningoceleSurgical shunt placementShunt revisionsIntelligenceFine motor dexterityIQSpina bifida
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 26 , Issue 4 , April 2020 , pp. 364 - 371
Copyright
Copyright © INS. Published by Cambridge University Press, 2019

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