Mikkelsen Rebecka, Rødevand Linn Nilsen, Wiig Ulrikke Straume, Zahl Sverre Morten, Berntsen Torhild, Skarbø Anne-Britt, Egge Arild, Helseth Eirik, Andersson Stein, Wester Knut
Department of Psychology, University of Oslo, Oslo, Norway.
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
Childs Nerv Syst. 2017 Jan;33(1):91-99. doi: 10.1007/s00381-016-3267-z. Epub 2016 Nov 15.
Long-term impact of benign external hydrocephalus (BEH) on cognition is largely unknown, and indication for neurosurgical CSF diversion procedure is debated. This study reports neuropsychological and psychosocial function in operated and non-operated BEH children.
Eighty-six children (76 males) between 8 and 18 years (mean 13.9) diagnosed with BEH before 12 months were included, of whom 30.2 % were operated. Participants completed neuropsychological tests and questionnaires covering quality of life (PedsQL) and executive function (BRIEF).
Both operated and non-operated BEH children performed significantly below normative means on several neuropsychological tests. The children scored themselves higher than the norm average on PedsQL; however, the parents reported life quality comparable to other children. Operated children performed poorer compared with non-operated children on tests of psychomotor speed, attention span, executive function, motor speed and coordination, and on the BRIEF subscale Monitoring. Operated children, but not their parents, reported more problems on PedsQL subscale School than non-operated children.
Children with BEH display long-term subtle neurocognitive difficulties. Non-operated children performed significantly better on some neuropsychological measures and reported less psychosocial problems. This difference may be caused by a selection bias: neurosurgical intervention was more likely in children with clinically more pronounced symptoms.
良性外部性脑积水（BEH）对认知的长期影响在很大程度上尚不清楚，神经外科脑脊液分流手术的适应症也存在争议。本研究报告了接受手术和未接受手术的BEH患儿的神经心理和社会心理功能。
纳入86名在12个月前被诊断为BEH的8至18岁儿童（76名男性），其中30.2%接受了手术。参与者完成了神经心理测试以及涵盖生活质量（儿童生活质量量表）和执行功能（简明精神状态检查表）的问卷。
在多项神经心理测试中，接受手术和未接受手术的BEH患儿的表现均显著低于正常水平。患儿在儿童生活质量量表上给自己的评分高于正常平均水平；然而，家长报告的生活质量与其他儿童相当。在心理运动速度、注意力广度、执行功能、运动速度和协调性测试以及简明精神状态检查表的监控子量表上，接受手术的患儿比未接受手术的患儿表现更差。在儿童生活质量量表的学校相关子量表上，接受手术的患儿（而非其家长）报告的问题比未接受手术的患儿更多。
BEH患儿存在长期的轻微神经认知困难。未接受手术的患儿在一些神经心理指标上表现明显更好，且报告的社会心理问题更少。这种差异可能是由选择偏倚导致的：临床症状更明显的患儿更有可能接受神经外科干预。
