Abstract
The management of children with benign external hydrocephalus (BEH) remains controversial. Most BEH children do well in the long-term, but a substantial number have temporary or permanent psychomotor delays. The study aims to assess the prevalence and pattern of neurodevelopmental delay in a cohort of children with BEH. We conducted a cohort study of 42 BEH children (30 boys and 12 girls, aged 6 to 38 months). A pediatric neurosurgeon performed a first clinical evaluation to confirm/reject the diagnosis according to the clinical features and neuroimaging studies. Two trained evaluators assessed the child's psychomotor development using the third edition of the Bayley Scales of Infant and Toddler Development (Bayley-III). Developmental delay was defined as a scaled score < 7 according to the simple scale and/or a composite score < 85. Eighteen children (43%) presented statistically lower scores in the gross motor and composite motor of the Bayley-III scales compared to their healthy peers. In BEH, it is important to establish a diagnostic algorithm that helps to discriminate BEH patients that have self-limiting delays from those at risk of a persistent delay that should be referred for additional studies and/or interventions that might improve the natural evolution of a disease with high impact on the children and adult's quality of life.
Highlights
The management of children with benign external hydrocephalus (BEH) remains controversial
The criteria used to diagnose BEH were from birth to 42 months of age [1]; head circumference (HC) above the 97.5th percentile according to Spanish population nomogram, or a rapidly increasing HC during the first year of life; and enlarged subarachnoid spaces, associated with normal ventricular size (Evans’ Index < 0.30) or mild ventriculomegaly (Evans’ Index ≥ 0.30 and ≤0.35) [8, 22] (Fig. 1)
Three children had a subdural hematoma detected after the BEH diagnosis, but none of these patients was excluded because the concomitant diagnosis was incidental, and they were evaluated several weeks after surgical treatment
Summary
Our goal was to provide information on the neurodevelopmental and neuropsychological features of BEH children, thereby increasing awareness among health practitioners and improving the detection of children with potential neurodevelopmental delay and screening of candidates for additional studies, such as for ICP monitoring
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