# Impact of Unilateral Selective Dorsal Rhizotomy (SDR) on Spasticity and Motor Function Improvement in Children With Hemiparetic Cerebral Palsy Caused by Intraventricular Hemorrhage

## TL;DR

This study shows that unilateral SDR surgery reduces spasticity and improves motor function in children with CP caused by brain hemorrhage, with no adverse effects.

## Contribution

The study evaluates the effectiveness of unilateral SDR in children with IVH-induced hemiparetic CP, focusing on both spasticity reduction and motor function improvement.

## Key findings

- All patients showed complete resolution of spasticity after surgery.
- Functional motor skills improved at 6 and 12 months post-surgery with no regression.
- IVH severity was not significantly linked to pre-surgery MAS scores or GMFCS levels.

## Abstract

Background

Selective dorsal rhizotomy (SDR) is an established surgical treatment for reducing spasticity in children with cerebral palsy (CP). However, its role in cases of hemiparetic spastic CP due to intraventricular hemorrhage (IVH) remains less well defined, especially regarding the potential benefit of unilateral SDR. Moreover, the majority of existing studies primarily focus on the effectiveness of SDR in reducing spasticity based on quantitative scoring systems, with no evaluation of clinically meaningful improvements in motor function. This study investigates the clinical outcomes of unilateral SDR in children with spastic hemiparetic CP resulting from IVH, with a particular focus on both the reduction of spasticity and improvements in motor function at 6 and 12 months following surgery.

Materials and methods

This retrospective monocentric study included 11 pediatric patients with IVH-induced hemiparetic CP who underwent a unilateral SDR between 2017 and 2023. IVH was classified using Volpe’s grading system. Pre- and postoperative assessments included the Gross Motor Function Classification System (GMFCS), Modified Ashworth Scale (MAS), as well as functional motor domains (sitting, standing, and walking) at 6 and 12 months after surgery. Furthermore, an additional analysis was conducted to assess the relationship between IVH severity and postoperative outcomes.

Results

All patients demonstrated complete resolution of spasticity following surgery, with postoperative MAS scores reduced to 0. In contrast, GMFCS levels remained unchanged in most patients, with improvement observed in only one case. Remarkably, all patients demonstrated improvements in functional motor skills at both the 6- and 12-month follow-ups, with no evidence of regression or recurrence of motor disability. No adverse events were observed. Notably, higher grades of IVH were not significantly associated with presurgical MAS scores (p=1.0) or GMFCS levels (p=0.45), and no meaningful correlation was observed between IVH severity and postoperative clinical outcomes.

Conclusion

Unilateral SDR is a promising and safe approach for children with hemisymptomatic CP resulting from IVH, leading to significant reductions in spasticity and sustained functional motor gains regardless of IVH severity. Further and larger prospective studies are needed to validate these findings.