# Asymptomatic ventriculomegaly in myelomeningocele: a matched cohort study of neuropsychological outcomes across institutions with varying shunt rates

## TL;DR

A study found that lower shunt rates in myelomeningocele patients with asymptomatic enlarged brain ventricles were linked to better cognitive outcomes, suggesting treatment may not always be needed.

## Contribution

The study provides evidence that asymptomatic ventriculomegaly in myelomeningocele patients may not require surgical shunting, challenging current clinical practices.

## Key findings

- Patients from a clinic with a lower shunt rate showed significantly better cognitive and motor test scores.
- No significant demographic or lesion differences were found between the two clinics.
- Results suggest asymptomatic ventriculomegaly may not lead to worse functional outcomes.

## Abstract

Hydrocephalus management in myelomeningocele (MMC) patients remains controversial. While most institutions recommend surgical intervention for enlarged ventricles, recent studies suggest asymptomatic ventriculomegaly may not require treatment. This study compared cognitive outcomes in MMC patients from different institutions with different hydrocephalus intervention rates.

Participants with MMC were recruited from two sites: Site 1 (Chicago area; N = 41; selective shunting protocol) and Site 2 (Houston and Toronto; N = 342; historical approach to hydrocephalus management). The 41 Site 1 patients were matched to 41 participants from Site 2 based on age, gender, lesion level, and race. Neuropsychological testing assessed various cognitive domains. Independent samples t-tests compared outcomes between sites.

Site 1 had significantly lower shunt rates (55% shunt rate at Site 1; 83% shunt rate at Site 2). There were no significant differences in demographics or lesion levels between sites. Site 1 participants demonstrated significantly higher scores on several cognitive measures compared to Site 2, including the Purdue Pegboard (fine motor dexterity; p = 0.042), Stanford-Binet Quantitative Reasoning (quantitative reasoning to solve mathematical problems; p = 0.030), VMI (visuomotor integration; p = 0.034), WJ Letter-Word Identification (single-word reading; p = 0.026), and WJ Calculation subtests (math calculation problem-solving; p = 0.012).

Neuropsychological outcomes were either similar across cohorts from institutions with different shunt rates or favored the clinic with the lower shunting rate. These findings suggest asymptomatic ventriculomegaly may not be associated with worse functional outcomes, potentially informing guidelines for hydrocephalus intervention in the MMC population.