Merchant Thomas E, Lee Heather, Zhu Junhong, Xiong Xiaoping, Wheeler Gregory, Phipps Sean, Boop Frederick A, Sanford Robert A
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
J Neurosurg. 2004 Nov;101(2 Suppl):159-68. doi: 10.3171/ped.2004.101.2.0159.
The goal of this study was to determine the influence of hydrocephalus on intelligence quotient (IQ) in children with infratentorial ependymoma before and after the administration of focal radiation.
Measurements of ventricular size, including Evans index (EI), cella media index (CMI), frontal horn diameter (FHD), and ventricular angle, were performed using magnetic resonance imaging at the time of diagnosis and again at 3, 6, 9, and 12 months after the initiation of radiation therapy. Of the 59 patients (median age at time of radiation treatment, 4.1 years), the clinical diagnosis established in 50 (85%) was hydrocephalus and 23 (39%) required placement of a cerebrospinal fluid (CSF) shunt. Extent of resection was gross or near total in 50 (85%). Before and after radiation treatment, IQ was measured using age-appropriate testing. The correlation between multiple ventricular measurements and IQ was investigated using standard regression techniques and a generalized linear model. Patients with a higher EI (p = 0.04), CMI (p = 0.001), and FHD (p = 0.0002) at the time of diagnosis were more likely to have lower IQ scores before radiation treatment. Patients with higher CMI (p = 0.04) and FHD (p = 0.01) at the time of diagnosis were more likely to exhibit an increase in IQ score after radiotherapy. The rate of change in IQ after radiation treatment was positively correlated with the CMI intercept (p = 0.015) and negatively correlated with the rate of FHD change (p = 0.006).
Changes in IQ score before and after radiation treatment are significantly influenced by the extent and treatment of hydrocephalus at the time of diagnosis. Hydrocephalus is an important factor to include when analyzing the effects of treatment. Patients who undergo a second surgery for ependymoma are more likely to require the placement of a CSF shunt (p = 0.0001).
本研究的目的是确定在幕下室管膜瘤患儿中，局部放疗前后脑积水对智商（IQ）的影响。
在诊断时以及放疗开始后3、6、9和12个月，使用磁共振成像测量脑室大小，包括埃文斯指数（EI）、中脑室指数（CMI）、额角直径（FHD）和脑室角。在59例患者（放疗时的中位年龄为4.1岁）中，50例（85%）临床诊断为脑积水，23例（39%）需要放置脑脊液（CSF）分流管。50例（85%）的切除范围为肉眼全切或近全切。放疗前后，使用适合年龄的测试方法测量IQ。使用标准回归技术和广义线性模型研究多个脑室测量值与IQ之间的相关性。诊断时EI较高（p = 0.04）、CMI较高（p = 0.001）和FHD较高（p = 0.0002）的患者在放疗前更有可能IQ得分较低。诊断时CMI较高（p = 0.04）和FHD较高（p = 0.01）的患者在放疗后更有可能IQ得分增加。放疗后IQ的变化率与CMI截距呈正相关（p = 0.015），与FHD变化率呈负相关（p = 0.006）。
放疗前后IQ得分的变化受诊断时脑积水的程度和治疗的显著影响。脑积水是分析治疗效果时需要考虑的一个重要因素。接受室管膜瘤二次手术的患者更有可能需要放置CSF分流管（p = 0.0001）。
