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Efficacy of endoscopic third ventriculostomy to treat cognitive symptoms in adults with chronic obstructive hydrocephalus

University of British Columbia

Hydrocephalus is a neurological disease caused by an overaccumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. This produces expansion of the ventricles (ventriculomegaly) and compression of the surrounding brain tissue. Obstructive hydrocephalus is the result of a macroscopic blockage within the ventricular system distal to the arachnoid villi and can produce cognitive decline. Endoscopic third ventriculostomy (ETV) has been shown to be a safe surgical treatment in obstructive hydrocephalus, however the efficacy of ETV to improve cognition has limited evidence. In order to determine how ETV affects cognition in adults who have chronic obstructive hydrocephalus, this thesis had the following objectives: 1) to determine the sufficiency of primary ETV to safely improve global cognition in adults with chronic obstructive hydrocephalus, and 2) to determine which cognitive domains ETV produces clinically meaningful changes in adults with chronic obstructive hydrocephalus. To complete the first objective, we conducted a multicenter study using the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modality Test (SDMT), measures of global cognition and processing speed, before and twice after ETV at 5-months and 14-months follow-up. We found that global cognition was only clinically improved at 14-months follow-up and processing speed was unaffected. Global cognitive worsening was rare at both follow-up assessments. To complete the second objective, we conducted a single-center study using the RBANS to measure global cognition in better detail and five cognitive domains before and after ETV. We found patients with chronic obstructive hydrocephalus treated with ETV have a clinically and statistically significant improvement in global cognition, attention, and delayed memory domains at 4-months follow-up. Clinical worsening was rare in all domains except visuospatial/constructional, where although there was no statistical difference, 50% of patients had a clinical worsening post-ETV. Lastly, a potential predictor of post-ETV global cognitive improvement was discovered. The likelihood of global cognition improvement was 100% when the difference between immediate and delayed memory indexes were three points or less. Further validation of this predictor is required. Future studies should expand on the neurocognitive testing to include anatomical correlates to elucidate the mechanism of cognitive decline seen in chronic obstructive hydrocephalus.

Text

2020-08-12

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/75501

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/