Authors: Diego Martin Morales; DAVID LIMBRICK, MD, PhD; JEANETTE KENLEY, BSE; TARA SMYSER, MSE; DIEGO MORALES, MS; JOSHUA SHIMONY, MD, PhD; CHRISTOPHER SMYSER, MD (Saint Louis, MO)
There are conflicting data on the risk of progressive ventricular distension on neurological outcomes in preterm infants with post-hemorrhagic hydrocephalus (PHH). The objectives of this study were to use resting state functional connectivity MRI (rs-fMRI) to define the effects of PHH on resting state networks (RSNs) of affected infants and to determine how ventricular decompression modifies these relationships.
High-quality rs-fMRI data were acquired at term equivalent age in very preterm infants (< 32 weeks gestational age) with no brain injury (VPT controls, n=25), intraventricular hemorrhage (IVH) without PHH (n=14), and PHH (n=27, including 12 who underwent imaging within 7 days before and after cerebrospinal fluid shunt implantation). Composite correlation measures were determined for canonical RSNs and compared across groups. For PHH subjects with both pre- and post-operative imaging, RSN measures were compared within subjects using paired observations.
Compared with VPT controls and those with IVH alone, the infants with PHH demonstrated prominent alterations in motor, default mode network (DMN), and visual RSNs. Ventricular decompression via shunting augmented RSN composite correlation values for motor RSN (0.40 ± 0.04 and 0.56 ± 0.03, pre- and post-operative, respectively, p=0.07), DMN (0.07±0.01 and 0.17±0.01, p=0.03), and visual RSNs (0.48±0.10 and 0.78±0.02, p<0.01).
These data indicate that PHH is associated with impaired functional connectivity of canonical RSNs and that ventricular decompression via shunting may mitigate these deficits. While the long-term significance of these findings remains unknown, rs-fMRI may provide an important tool to address long-standing, unanswered questions regarding the impact of ventricular decompression on outcomes in PHH and a method to facilitate clinical trials evaluating the timing of neurosurgical intervention in PHH.