Assessment of Brain Injury and Brain Volumes after Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled ELVIS Trial

Abstract

Background: There is accumulating evidence showing beneficial effects of early intervention on posthemorrhagic ventricular dilatation (PHVD) and neurologic outcomes. Objective:To compare the effect of early and late intervention for PHVD on brain injury and ventricular volume using term-equivalent age magnetic resonance imaging (TEA-MRI). Methods:In the ELVIS (Early versus Late Ventricular Intervention Study) trial 126 preterm infants ≤34 weeks gestation with PHVD after grade III-IV intraventricular hemorrhage were randomised to low threshold (LT, ventricular index (VI) > p97 and anterior horn width (AHW) > 6mm) or higher threshold (HT, VI > p97 + 4mm and AHW > 10mm). The Kidokoro Global Brain Abnormality Score and the frontal and occipital horn (FOH) ratio were measured. Automatic segmentation was used to perform volumetric measurements. Results:Of the 110 surviving infants, TEA-MRI was obtained in 88 (80%) infants, of which 44 were in the LT group and 44 in the HT group. The total Kidokoro score of the infants in the LT group was lower than in the HT group (median (interquartile range): 8 (5-12) vs 12 (9-17), respectively; p<0.001). When the groups were compared in terms of severity of the Kidokoro score, there were more infants in the LT group with a normal or mildly increased score, and more infants in the HT group with a moderately or severely increased score (46% vs. 11% and 89% vs. 54%, respectively; p=0.002). The FOH ratio was lower in the LT group, when compared with the HT group (0.42 (0.34-0.63) vs 0.48 (0.37-0.68), respectively; p=0.001). The ventricular CSF volumes were calculated in 47 infants and were smaller in the LT group (p=0.03). Conclusion:Our findings demonstrate more brain injury and larger ventricular CSF volumes in the HT group. These results contribute to the growing evidence for the positive effects of early intervention for PHVD.

Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation

“…Intervention consists of a variety of techniques to drain CSF, including external ventricular drains (EVD), lumbar punctures (LP), and ventricular taps (VT), among others. [11]. In comparison, many North American centres employ a later approach where treatment is initiated depending on the ventricular index and clinical signs (e.g., increased ICP, head circumference, ventricle size, tense fontanelle, etc.)…”

Cerebrospinal fluid NCAM-1 concentration is associated with neurodevelopmental outcome in post-hemorrhagic hydrocephalus of prematurity

“…Our group and others [7,9,64] have demonstrated that larger ventricle size at the time of neurosurgical intervention may be associated with worse neurodevelopmental outcome, though this remains controversial and is an area of active study [18,[64][65][66]. Notably, in the current study, the FOHR at temporization was high (0.7 ± 0.07), indicating substantial ventriculomegaly prior to intervention.…”

Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis

“…Equally, the ELVIS trial (20) has completed its recruitment and later neurodevelopmental outcomes are expected to be published soon. These results are eagerly awaited as a sub-study of the ELVIS trial has reported that, in the high-threshold group (LPs when the VI > p97 + 4 mm and anterior horn width >10 mm), there was more brain injury and higher ventricular volumes compared to the low-threshold groups (VI > p97 and anterior horn width >6 mm) (41). There is also interest surrounding stem cell treatment after sIVH; however, this has only been reported in phase 1 trial (42).…”