Evaluation of academic performance and social integration of children operated for hydrocephalus in Cameroon.

BACKGROUND: Low intelligence quotient (IQ) and delayed psychomotor development (DPD) are formidable complications of hydrocephalus. The aim of this study was to evaluate the academic performance and social integration of children operated on for hydrocephalus in Cameroon. METHOD: The authors present a cross-sectional study with retrospective data collection from January 2010 to May 2020. All children less than 10 years of age who had undergone surgery for a ventriculo-peritoneal shunt indicated for hydrocephalus with a post-operative evolution of 7 to 10 years and who were attending school were included. Academic performance was assessed using the Wechsler Intelligence Scale for Children IV (WISC IV), and social integration was assessed using the Vineland II score. RESULTS: Of the 45 children aged 7 to 10 years who attended school and were followed-up, the sex ratio was 1.25 in favor of males. 77.8% of these children had a malformation with paralysis being the most common functional sequela (29%). 73.3% of our patients had good social integration. Fifty-three percent of patients had reduced academic performance, with non-verbal performance being the most frequent (62.2%). Long-term memory was the most impaired, with 73.3% having a very low speed of information processing. Non-verbal performance was the most affected (62.2%) particularly long-term memory. Forty percent had an IQ below 70. The statistically significant determinants of social integration were age, sex, malformative etiology, and good psychomotor development, and the statistically significant determinants of educational delay were age, malformative etiology, IQ below 70, and time to care. Academic performance was reduced in more than half of our patients, but most of them had good social integration. CONCLUSION: Early diagnosis and management improve the chances of good psychomotor development and IQ.

Use of Dental Bisphenol A-Glycidyl Methacrylate Composite to Repair Refractory Cerebrospinal Fluid Leaks Associated With Large-Scale Anterior Skull Base Defects.

ABSTRACT: Treatment of refractory cerebrospinal fluid (CSF) leaks, particularly those associated with large skull base defects, is challenging. A variety of synthetic biomaterial-based systems have been investigated in experimental models and/or humans for reconstructing cranial base defects. A widely used dental composite (bisphenol A-glycidyl methacrylate [bis-GMA]) has been shown to be effective for reconstruction of anterior skull base defects in animal models. Here, we report 4 patients who underwent reconstruction of large anterior skull base defects (1405.8 ±â€Š511 mm2) secondary to tumor resection and traumatic injury using the dental bis-GMA resin-based composite. A vascularized pericranial flap with fibrin glue was initially performed in all patients with concurrent use of dental bis-GMA during the primary surgery in 2 patients, and later use (in a repeat surgery) in other 2 cases. In these latter 2, CSF rhinorrhea persisted after the initial surgery (in the absence of bis-GMA use) despite external CSF drainage with lumbar drain. Following treatment with bis-GMA, rigid structural support and watertight closure of the defect were successfully achieved. At the follow-up, CSF leak did not recur and none of the patients had any complications related to the surgery or the composite. The results obtained from this series are promising, and dental bis-GMA resin seems to provide an effective and feasible material for the treatment and prevention of CSF leaks related to large-scale anterior skull base defects. However, further studies with longer clinical follow-up and larger number of patients are required to prove the safety and efficacy of this matrix in the long run.