Obstructive Hydrocephalus in Children: Predictive factors of ventriculocisternostomy dysfunction at the CHU of Conakry.

Obstructive Hydrocephalus in Children: Predictive factors of ventriculocisternostomy dysfunction at the CHU of Conakry. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Obstructive Hydrocephalus in Children: Predictive factors of ventriculocisternostomy dysfunction at the CHU of Conakry. Ibrahima Sory Souare, Mohamed Lamine Sylla, Ibrahima Sory Jnr Souaré, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-277563/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Context and Objective: The treatment of hydrocephalus is surgical and uses two (2) main methods to date: ventriculoperitoneal shunt and endoscopic ventriculocisternostomy. The latter offers the advantage of avoiding the implantation of a foreign body (valve) in the body. However, there are sometimes dysfunctions that can lead to the evolutionary continuation of hydrocephalus. The objective of this study is to identify factors predictive of endoscopic ventriculocisternostomy dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center in Conakry. Methods and Materials: This is a mixed analytical study of 32 cases of children aged 0-15 years who received endoscopic ventriculocisternostomy during the study period. Outcomes were evaluated according to Drake and Canadian Pediatric Neurosurgery Group clinical criteria. Results: The hospital frequency was 17% and a sex ratio (M/F) of 1.13. Clinical signs were dominated by progressive macrocraniality (93.8%), bulging fontanel (84.4%), ectasia of scalp veins (68.8%). cerebrospinal fluid leakage (9.4%) was the most frequent post-operative complication. According to age, VCS was successful in 16 infants (55.2%) and dysfunction in 13 (44.8%) while 2 children (66.7%) were successful with VCS versus 1 (33.3%) with dysfunction. We recorded one case of death. Conclusion: The factors often associated with the dysfunction of the endoscopic ventriculocisternostomy found in this study are essentially: age, bulging fontanelle, ectasia of the scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the bottom of the third ventricle. In the absence of a statistically significant relationship, it would be useful to analyse these parameters closely on a much larger sample. Neurosurgery Obstructive Hydrocephalus Child ventriculocisternostomy Conakry 1. Introduction For a long time, cerebrospinal fluid (CSF) bypass valves were the only treatment for hydrocephalus. The development of neuro-endoscopy has brought other possibilities in the treatment of this pathology. Endoscopic ventriculocisternostomy (VCS) of the third ventricle (3rd V) is now considered the standard treatment for non-communicating hydrocephalus, whether congenital or secondary to an obstructive lesion [ 1 , 2 , 3 ]. This pathology, which is frequent in the pediatric environment, recognizes a multitude of etiologies, most often malformative and haemorrhagic in the neonatal period, post-meningitis in infants and tumours in older children [ 4 , 5 , 6 ]. Macrocrania is the main clinical manifestation in children. [ 7 ]. Since its advent, VCS has been a reliable alternative to the ventriculoperitoneal shunt (DVP). It considerably reduces the number of re-interventions [ 8 ]. The objective of this study is to identify factors predictive of VCS dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center (CHU) in Conakry. 2. Materials And Methods This study was previously submitted to the ethics committee for approval and confidentiality was maintained throughout the study period. Informed consent of patients and/or responsible persons was obtained for all patients. Thumbprints were used instead of signatures for parents with low or no literacy skills. This was a mixed study of an analytical type involving 32 records of children aged 0–15 years who had received VCS in the Neurosurgery Department of Conakry University Hospital during the period from July 2015 to May 2020. The sample size was obtained from the number of cases recorded during the survey. The parameters studied included epidemiological; clinical; paraclinical (tri ventricular dilatation, tetra ventricular dilatation); etiological (congenital, infectious, tumor) ; endoscopic findings (hemosiderin deposits, choroid plexus reshaping, pulsation of the 3rd V fundus, arachnoid adhesions, hypothalamic adhesions, closure of the Sylvius aqueduct, narrow retroclival space, venous bleeding ); post-operative complications (simple, CSF leakage, death) and post-operative evaluation (favorable; unfavorable). We used a KARL STORZ® flexible endoscope. The evaluation of the results was done according to the clinical criteria of Drake and the Canadian Pediatric Neurosurgery Group [ 9 ] which considered as successful (favorable), all patients who showed lasting clinical improvement after CSF without the need for valving. Epi Data 3.1 software was used for data entry and R software for statistical analyses. Proportions were calculated for the qualitative variables. Quantitative variables were expressed as mean ± standard deviation. The Chi2 test or exact Fisher test was used to compare proportions. The Wilcoxon test was used to compare means. The significance threshold was set at risk alfa = 0.05. 3. Results During the study period 32 cases of VCS were completed, mostly children. The mean age with standard deviation at diagnosis was 13.84 ± 23.03 with extremes from 28 days to 180 months. The age range from 0 to 30 months was the most affected (87.5%) with a male predominance (sex ratio of 1.13). Progressive macrocraniality (93.8%), bulging fontanelles (84.4%), ectasia of scalp veins (68.8%) were the main clinical signs (Table 1), Neuroimaging characteristic of obstructive hydrocephalus, represented by the tri ventricular and tetra ventricular dilatations. In 62.5% of cases (20 patients) congenital etiology was the most common, followed by infectious etiology in 25% (8 patients) and tumor in 12.5% (4 patients). The endoscopic finding revealed a choroid plexus reshaping in 29 patients, or 90.6%, and the thinning of the 3rd V fundus was found in 18 patients, or 56.3%. Haemosiderin deposition and pulsation of the bottom of the 3rd V were recorded in equal proportions, i.e. in 15 patients (46.9%). Closure of the mesencephalic aqueduct, arachnoid adhesions and narrow retroclival space were observed in 13 patients (40.6%), 12 patients (37.5%), and 11 patients (34.4%), respectively. Furthermore, hypothalamic adhesions and venous bleeding were found separately in equal proportions in 4 patients (12.5%). Post-operatively, there were 26 patients (81.3%) without complications, while 6 other patients (18.8%) had complications of the order: leakage of CSF and death, distributed respectively in the following proportions: 5 patients (15.6%); 1 patient (3.1%) Table 2. We had performed an analysis of the impact of clinical parameters and endoscopic findings on the outcome of VCS and this allowed us to note the dysfunction of VCS in the children who clinically presented the bulging of the fontanelles and the ectasia of the scalp veins distributed respectively in the following proportions: 13 (92.86%); 11 (78.57%). In addition, dysfunction of VCS was noted in a proportion of children with choroid plexus reshaping, hemosiderin deposits and arachnoid adhesions, represented respectively in the following proportions: 13 (92.86%), 6 (42.86%), 8 (57.14%); (Table 3). Based on age, VCS was successful in 16 infants (55.2%) and dysfunction in 13 (44.8%), while 2 children (66.7%) were successful in VCS versus 1 (33.3%) in dysfunction (Table 4). Based on clinical criteria from Drake and the Canadian Pediatric Neurosurgery Group, we considered the success rate for VCS to be 56% and 43.7% unfavourable. 4. Discussion We conducted a mixed study of 32 cases of hydrocephalus in which an endoscopic ventriculocisternostomy (VCS) was performed. As the dilated aspect of the 3rd V was, among other things, the main indication for this surgical technique, we were able to observe in practice the often unexpected dysfunction of this internal shunt after it was actually placed in some of the patients. The objective of this study was to identify the predictive factors that could influence the outcome of CNS, based on objective criteria, both anthropometric and endoscopic. The criteria that we focused our attention on following the results of the R-analysis using the confidence interval are: - Clinical criteria: age, sex, cranial perimeter (CP), existence or not of certain clinical signs such as: sunset gaze, bulging of the fontanelles, ectasia of the scalp veins, disjunction of the skull sutures; - Neuroimaging criteria: tri-ventricular dilatation, tetra-ventricular dilatation; - Criteria of endoscopic findings: choroid plexus reshaping, hemosiderin deposits, pulsation of the 3rd V fundus arachnoid adhesions, hypothalamic adhesions, closure of the Sylvius aqueduct; We found a male predominance of 53.1% with a sex ratio (M/F) of 1.13. Several studies have shown a predominance of the male sex, this predominance would be linked in part to the fact that congenital hydrocephalus can be transmitted in a sex-linked recessive mode [9 ; 10]. The age of the children ranged from 28 days to 180 months (15 years) with a mean of 13.84 ± 23.03 months. The 0–30 month age group was the most represented with a proportion of 85%.The delay in medical consultations with modern medicine is due to ignorance and lack of knowledge of the disease, a consequence of the dominant traditional beliefs of the parents. With regard to age, the proportion of VCS dysfunction is higher in infants than in children, but this difference is not statistically significant. In the literature, there is debate about the influence of age, the causes of hydrocephalus or both (2) on the success of VCS. Drake and colleagues conclude in agreement with other authors that the success of VCS depends essentially on the age of the patients [ 11 ]. Salvador S.F. et al. found in 2012 at the São João Hospital Center (CHSJ) in Porto, Portugal, that age is a predictive factor of endoscopic ventriculocisternostomy dysfunction [ 12 ]. Although the statistical test does not show a significant difference between success and failure; however, the confidence intervals do not overlap, this difference can be considered significant. Clinical signs were dominated by progressive macrocraniality followed by bulging fontanelles and ectasia of scalp veins with proportions of 93.8%; 84.4% and 68.8% respectively. These signs reflect a compression of the cerebral parenchyma and also the consequences of the delay in specialist consultation. Cerebral computed tomography (CT) scan without injection of the contrast agent was performed on all patients; it revealed the obstructive etiology. Thus, in our series we found tri-ventricular dilatation in 24 cases, i.e. 75%, and tetra-ventricular dilatation in 8 cases, i.e. 25%. The same signs were found but in variable proportions in a series carried out in Morocco in 2012, where it was reported: tri-ventricular dilatation in 98 cases, i.e. 80.4%, and tetra-ventricular dilatation in 24 cases, i.e. 19.6% [ 9 ]. The etiological diagnosis of hydrocephalus was based on clinical findings, patient history, and brain scan data without injection of the contrast agent. Congenital hydrocephalus was the most represented with 62.5% of cases, followed by infectious and tumor hydrocephalus with 25% and 12.5% of cases respectively. Intraoperatively, choroid plexus reshaping was the most common endoscopic finding with 90.6%. The expansive effect of the CSF in the ventricles due to the increased pressure in the skull could explain this result. In our series, the postoperative outcome was simple in 26 cases (81.3%). Leakage of CSF through the operative scar was reported in 5 cases or 15.6% and we noted one case of death. This leakage of CSF through the operative scar is the most frequent post-operative complication found in the literature; according to Bouras T. in his meta-analysis, the incidence of this complication varies between 0-5.2% with an average of 1.7% [ 13 ]. We believe that the thinner skin and immaturity of the subarachnoid spaces in children could be related to this result in our observation. Patients without a bottom V pulsation showed a higher proportion of ventriculocisternostomy dysfunction compared to those with a bottom 3rd V pulsation, but this difference is not statistically significant. In the post-operative clinical evaluation of the outcome of the operation (VCS) 56.3% of cases were favorable while 43.7% of cases were unfavorable. The regular and rigorous post-operative follow-up of children after initial management could be related to this result. Opinions differ as to the definition of success of endoscopic ventriculocisternostomy (VCS). The success rate of endoscopic ventriculocisternostomy (VCS) in our series was 56%. VCS dysfunction in our series was found in 44% of patients. Statistical analysis using R software with the following factors: age, sex, bulging fontanelles, sunset gaze, ectasia of scalp veins, skull suture disjunction, hemosiderin deposits, choroid plexus reshaping, 3rd V bottom pulsation, arachnoid adhesions, hypothalamic adhesions and Sylvius aqueduct closure did not show a statistically significant difference in VCS dysfunction. However, among all the factors analyzed, the impact of a few seemed to be preponderant: age, sex, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the 3rd V bottom. The existence of arachnoid adhesions in patients shows a higher proportion of VCS dysfunction compared to the absence of this abnormality but this difference is not statistically significant. This finding may be related to the presence of fibrinous deposits in the subarachnoid spaces responsible for blocking and clogging the flow and resorption pathways of cerebrospinal fluid (CSF), resulting in ventricular dilatation by accumulation of upstream CSF. The limitation of this study is related to the smaller sample size, which would necessitate the continuation of similar studies in order to analyze these factors on a much larger sample. Conclusion Taking into account the results of this work and data from the current literature, we can conclude that endoscopic ventriculocisternostomy remains an effective surgical technique in the treatment of obstructive hydrocephalus. However, its performance has not been established in infants, with 44.8% of VCS dysfunction in subjects of this age in this series. In addition, our observations reveal that factors such as age, bulging fontanelle, ectasia of scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the 3rd V bottom and haemosiderin deposits are often associated with VCS dysfunction. Abbreviations 3 rd V: the third ventricle; CHU: University Hospital Center; CP: cranial perimeter; CNS: central nervous system; CSF: cerebrospinal fluid; CT: Cerebral computed tomography; DVP: ventriculoperitoneal shunt; VCS: Endoscopic ventriculocisternostomy Declarations Acknowledgement The authors would like to thank the patients and their parents and the ethics committee for consenting to this study. Authors' contributions: All authors contributed to this work. Availability of data and materials All data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request. Funding The authors did not receive any funded support for research, writing and publication of this article. Declaration of interest The authors declare that they have no conflicts of interest. Consent for publication: This work was done after receiving informed consent and signatures from patients and/or parents. Ethical Approval and Consent to Participate The collection of samples and the analysis of data were approved by the ethics committee of the CHU of Conakry: The National Ethics Committee for Health Research (CNERS). Contact Miss Aissatou Sanoussy BAH at the phone number +224 669. 930 951 References Salem-memou S, Badara TA, Kpelao E, Mbaye M, Ba MC, Badiane SB. Traitement de l’hydrocéphalie de l’enfant par ventriculocisternostomie endoscopique au Sénégal. Neurochirurgie. 2014;60:254–7. Baldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy for occlusive hydrocephalus caused by cerebellar infarction. Neurosurgery. 2006;59:539–44. Fritsch MJ, Doerner L, Kienke S, Mehdorn HM. Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy. J Neurosurg. 2005;103(suppl.):40–2. Souare IS, Souare IS jr, Haidara A, Boubane DT, Bah AB, Diawara S, Béavogui K, Diallo LL. Hydrocéphalie chez l’enfant: résultats préliminaires d’une prise en charge multidisciplinaire en Guinée. Journal de Neurologie-Neurochirurgie-Psychiatrie (www.jnnp.fr) Vol. 002, N16, 2017; Pp: 47–53. Tabarki B, et al. Hydrocéphalies de l’enfant, aspects étiologiques et évolutifs à propos de 86 observations. Rev Maghreb Pédiatrie Mars – Avril. 2001;XI-II:65–70. Tortora G. Principe d’anatomie et de physiologie, l’encéphale et les nerfs crâniens; 2ème édition française, 1994, p.420. Tapsoba TL, Sanon H, Soubeiga KJ, Ouattara TF, Kabre A, Cisse R. Aspects épidémiologiques, cliniques et tomodensitométriques des hydrocéphalies chez les enfants de zéro à 15 ans (à propos de 53 patients colligés au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou: CHU YO). Médecine nucléaire. 2010;34S:e3–7. Hellwig D, Grotenhuis JA, Tirakotai W, et al. Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev. 2005;28:1–34. Ould Benazzouz Y. Prise en charge de l’hydrocéphalie malformative chez les enfants de moins de 15 ans à propos de 122 cas. Thèse de doctorat en Médecine Université de Marrakech; 2014: 2–86. Weller S, Gartner J. Genetic and clinical aspect of X-linked hydrocephalus (L1 Disease): Mutations in the L1CAM Gene. Hum Mutat. 2001;18:1–12. Drake JM. Endoscopic third ventriculostomy in pedriatric patients: the Canadian experience; Canadian pedriatric neurosurgery study group. Neurosurgery. 2007;60:881–6. Salvador SF, Oliveira J, Pereira J, Barros H, Vaz R. Endoscopic third ventriculostomy in the management of hydrocephalus: outcome analysis of 168 consecutive procedures; Clinical Neurology and Neurosurgery; 126 (2014) 130–136. Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy in children. A meta-analysis. JNeurosurg Pediatr. 2011;7:643–9. Tables Table 1: Distribution of patients according to clinical signs, paraclinical signs and etiologies. Features Staff N=32 Percentage (%) Clinical Signs Evolutionary macrocrania Bulging of the fontanelles Ectasia of scalp veins Sunset gaze Vomiting, Refusing to suckle Seizures Psychomotor deceleration Disconnection of the skull sutures Visual disturbance Signs of Brain CT Triple ventricular dilatation Tetra ventricular dilatation 30 27 22 11 10 5 5 3 2 24 8 93,8 84,4 68,8 34,4 31,3 15,6 15,6 9,4 6,3 75 25 Table 2: Breakdown of patients according to post-operative outcomes, post-operative complications and post-operative evaluation N=32 Features Effectif Pourcentage (%) Surgical suites Simple Complicated Post-operative complications CSF leakage Death Post-operative evolution Favorable Unfavourable 26 6 5 1 18 14 81,3 18,8 15,6 3,1 56,3 43,7 Table 3: Analysis of the impact of clinical parameters and endoscopic findings on VCS outcome and progression. FEATURES VENTRICULO-CISTERNOSTOMY P-value Dysfunction Seccess CLINICAL SIGNS Bulging of the fontanelles 0.50 Yes 13 (92.86) 14 (77.78) No 1 (7.14) 4 (22.22) Ectasia of scalp veins 0.50 Yes 11 (78.57) 11 (61.11) No 3 (21.43) 7 (38.89) Sunset gaze 0.81 Yes 4 (28.57) 7 (38.89) No 10 (71.43) 11 (61.11) Wider separation of skull sutures 0.81 Yes 2 (14.29) 1 (5.56) No 12 (85.71) 17 (94.44) ENDOSCOPIC DISCOVERIES Hemosiderin deposits 0.96 Yes 6 (42.86) 9 (50,00) No 8 (57.14) 9 (50.00) Choroid plexus reshaping 1.00 Yes 13 (92.86) 16 (88.89) No 1 (7.14) 2 (11.11) 3rd V Bottom Pulse 0.44 Yes 5 (35.71) 10 (55.56) No 9 (64.29) 8 (44.44) Arachnoid Adhesions 0.09 Yes 8 (57.14) 4 (22.22) No 6 (42.86) 14 (77.78) Hypothalamic adhesions 1.00 Yes 2 (14.29) 2 (11.11) No 12 (85.71) 16 (88.89) Closure of the Sylvius Aqueduct 0.38 Yes 4 (28.57) 9 (50.00) No 10 (71.43) 9 (50.00) Table 4: Analysis of VCS Outcome by Child's Age VCS Success Dysfunction Age P-value Infant Child 16 (55,2%) 2 (66,7%) 1,00 13 (44,8%) 1 (33,3%) Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-277563","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":17364300,"identity":"87b596d5-1849-4d6f-961b-62fc01443b72","order_by":0,"name":"Ibrahima Sory Souare","email":"","orcid":"","institution":"University Hospital Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ibrahima","middleName":"Sory","lastName":"Souare","suffix":""},{"id":17364301,"identity":"9ebf2afe-85bc-41e7-b9e1-af87cd1a630d","order_by":1,"name":"Mohamed Lamine Sylla","email":"","orcid":"","institution":"University Hospital Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Lamine","lastName":"Sylla","suffix":""},{"id":17364302,"identity":"40b0e903-5359-4022-8577-8c28971eb140","order_by":2,"name":"Ibrahima Sory Jnr Souaré","email":"","orcid":"","institution":"University Hospital Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ibrahima","middleName":"Sory Jnr","lastName":"Souaré","suffix":""},{"id":17364303,"identity":"ffd87822-409d-4db9-8bae-76783565c489","order_by":3,"name":"Hugues Ghislain Atakla","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-7134-6688","institution":"Magadh University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Hugues","middleName":"Ghislain","lastName":"Atakla","suffix":""},{"id":17364304,"identity":"1fb6cf66-2453-47e3-8af9-00350cd30e21","order_by":4,"name":"Mohamed Cherif","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYDACCSBOsAEzGR8wMByA0gS1pIGZzAYQLSCakBYGiBY2CaK08M9uPvbhQcIdOYPbh49V89TckeNnYGb7gNeSO8eSZyQkPDM2OJeWdpvn2DNjyQZm5hn4tBhI5BgzJP44nLjhDI/ZbR42IOMA/2G8DjOQyP/MkJBwuB6kpZjnH0gLMzMBLTnMIC0JBkAtzLxtRGiRuJFmDNJiOPMMW7Lk3L7DxpLNBLTwz0h+zPgj4bA83xnmgx/efDssx8/ejF8LCmDiAZEkaACmlB+kqB4Fo2AUjIIRAwBMokjZUZI+WQAAAABJRU5ErkJggg==","orcid":"","institution":"University Hospital Center","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Cherif","suffix":""},{"id":17364305,"identity":"2b8c0370-3ab5-411b-8f0f-b7eeba0372d4","order_by":5,"name":"Seylan Diawara","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIie3SIQ+CQBTA8ecMGp5a2VD4Co+xWWDjq5CgEEiOaIKiXZOfwVmMsAuW+wA4inZMJufcPEbCckTD/ct7F367CwegUv1ngxxgiDBaw7A5iimvJZi3RMx+BEDzexIz21D+Ojvz2b62nnHiAuoSQ5xTseUhalVk6zseAE59CdEiyicpQ6gi0sUCHsoedqip+AhiXrn9bgjKCJRIrLmFSlzqvQjxIGaLNESLBysHeYBSYmbseH+kjmdc2KnCxDXkD4MxdRY5EB/k9ruoVCqVqtsX9v4/ylcQjXUAAAAASUVORK5CYII=","orcid":"","institution":"University Hospital Center","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Seylan","middleName":"","lastName":"Diawara","suffix":""},{"id":17364306,"identity":"c23f4b68-bf3e-4ba4-8fd0-1aa7b60807c8","order_by":6,"name":"Beavogui Luc Kezely","email":"","orcid":"","institution":"University Hospital Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Beavogui","middleName":"Luc","lastName":"Kezely","suffix":""}],"badges":[],"createdAt":"2021-02-26 03:53:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-277563/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-277563/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13681698,"identity":"68761cb7-4184-4648-8fc5-2ce67dd41ddd","added_by":"auto","created_at":"2021-09-17 11:52:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":413024,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-277563/v1/27d3b89c-cba7-444b-8b2b-193150765f71.pdf"}],"financialInterests":"","formattedTitle":"Obstructive Hydrocephalus in Children: Predictive factors of ventriculocisternostomy dysfunction at the CHU of Conakry.","fulltext":[{"header":"1. Introduction","content":" \u003cp\u003eFor a long time, cerebrospinal fluid (CSF) bypass valves were the only treatment for hydrocephalus. The development of neuro-endoscopy has brought other possibilities in the treatment of this pathology. Endoscopic ventriculocisternostomy (VCS) of the third ventricle (3rd V) is now considered the standard treatment for non-communicating hydrocephalus, whether congenital or secondary to an obstructive lesion [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This pathology, which is frequent in the pediatric environment, recognizes a multitude of etiologies, most often malformative and haemorrhagic in the neonatal period, post-meningitis in infants and tumours in older children [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Macrocrania is the main clinical manifestation in children. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Since its advent, VCS has been a reliable alternative to the ventriculoperitoneal shunt (DVP). It considerably reduces the number of re-interventions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The objective of this study is to identify factors predictive of VCS dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center (CHU) in Conakry.\u003c/p\u003e "},{"header":"2. Materials And Methods","content":"\u003cp\u003e\u003cdiv class=\"Ethics-ToolTip\"\u003eThis study was previously submitted to the ethics committee for approval and confidentiality was maintained throughout the study period.\u003c/div\u003e Informed consent of patients and/or responsible persons was obtained for all patients. Thumbprints were used instead of signatures for parents with low or no literacy skills.\u003c/p\u003e\u003cp\u003eThis was a mixed study of an analytical type involving 32 records of children aged 0\u0026ndash;15 years who had received VCS in the Neurosurgery Department of Conakry University Hospital during the period from July 2015 to May 2020.\u003c/p\u003e\u003cp\u003eThe sample size was obtained from the number of cases recorded during the survey. The parameters studied included epidemiological; clinical; paraclinical (tri ventricular dilatation, tetra ventricular dilatation); etiological (congenital, infectious, tumor) ; endoscopic findings (hemosiderin deposits, choroid plexus reshaping, pulsation of the 3rd V fundus, arachnoid adhesions, hypothalamic adhesions, closure of the Sylvius aqueduct, narrow retroclival space, venous bleeding ); post-operative complications (simple, CSF leakage, death) and post-operative evaluation (favorable; unfavorable). We used a KARL STORZ\u0026reg; flexible endoscope. The evaluation of the results was done according to the clinical criteria of Drake and the Canadian Pediatric Neurosurgery Group [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] which considered as successful (favorable), all patients who showed lasting clinical improvement after CSF without the need for valving.\u003c/p\u003e\u003cp\u003eEpi Data 3.1 software was used for data entry and R software for statistical analyses. Proportions were calculated for the qualitative variables. Quantitative variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The Chi2 test or exact Fisher test was used to compare proportions. The Wilcoxon test was used to compare means. The significance threshold was set at risk alfa\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eDuring the study period 32 cases of VCS were completed, mostly children. The mean age with standard deviation at diagnosis was 13.84 \u0026plusmn; 23.03 with extremes from 28 days to 180 months. The age range from 0 to 30 months was the most affected (87.5%) with a male predominance (sex ratio of 1.13). Progressive macrocraniality (93.8%), bulging fontanelles (84.4%), ectasia of scalp veins (68.8%) were the main clinical signs (Table 1),\u003c/p\u003e\n\u003cp\u003eNeuroimaging characteristic of obstructive hydrocephalus, represented by the tri ventricular and tetra ventricular dilatations. In 62.5% of cases (20 patients) congenital etiology was the most common, followed by infectious etiology in 25% (8 patients) and tumor in 12.5% (4 patients).\u003c/p\u003e\n\u003cp\u003eThe endoscopic finding revealed a choroid plexus reshaping in 29 patients, or 90.6%, and the thinning of the 3rd V fundus was found in 18 patients, or 56.3%. Haemosiderin deposition and pulsation of the bottom of the 3rd V were recorded in equal proportions, i.e. in 15 patients (46.9%). Closure of the mesencephalic aqueduct, arachnoid adhesions and narrow retroclival space were observed in 13 patients (40.6%), 12 patients (37.5%), and 11 patients (34.4%), respectively. Furthermore, hypothalamic adhesions and venous bleeding were found separately in equal proportions in 4 patients (12.5%).\u003c/p\u003e\n\u003cp\u003ePost-operatively, there were 26 patients (81.3%) without complications, while 6 other patients (18.8%) had complications of the order: leakage of CSF and death, distributed respectively in the following proportions: 5 patients (15.6%); 1 patient (3.1%) Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe had performed an analysis of the impact of clinical parameters and endoscopic findings on the outcome of VCS and this allowed us to note the dysfunction of VCS in the children who clinically presented the bulging of the fontanelles and the ectasia of the scalp veins distributed respectively in the following proportions: 13 (92.86%); 11 (78.57%). In addition, dysfunction of VCS was noted in a proportion of children with choroid plexus reshaping, hemosiderin deposits and arachnoid adhesions, represented respectively in the following proportions: 13 (92.86%), 6 (42.86%), 8 (57.14%); (Table 3).\u003c/p\u003e\n\u003cp\u003eBased on age, VCS was successful in 16 infants (55.2%) and dysfunction in 13 (44.8%), while 2 children (66.7%) were successful in VCS versus 1 (33.3%) in dysfunction (Table 4). Based on clinical criteria from Drake and the Canadian Pediatric Neurosurgery Group, we considered the success rate for VCS to be 56% and 43.7% unfavourable.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWe conducted a mixed study of 32 cases of hydrocephalus in which an endoscopic ventriculocisternostomy (VCS) was performed. As the dilated aspect of the 3rd V was, among other things, the main indication for this surgical technique, we were able to observe in practice the often unexpected dysfunction of this internal shunt after it was actually placed in some of the patients. The objective of this study was to identify the predictive factors that could influence the outcome of CNS, based on objective criteria, both anthropometric and endoscopic.\u003c/p\u003e\n\u003cp\u003eThe criteria that we focused our attention on following the results of the R-analysis using the confidence interval are:\u003c/p\u003e\n\u003cp\u003e- Clinical criteria: age, sex, cranial perimeter (CP), existence or not of certain clinical signs such as: sunset gaze, bulging of the fontanelles, ectasia of the scalp veins, disjunction of the skull sutures;\u003c/p\u003e\n\u003cp\u003e- Neuroimaging criteria: tri-ventricular dilatation, tetra-ventricular dilatation;\u003c/p\u003e\n\u003cp\u003e- Criteria of endoscopic findings: choroid plexus reshaping, hemosiderin deposits, pulsation of the 3rd V fundus arachnoid adhesions, hypothalamic adhesions, closure of the Sylvius aqueduct;\u003c/p\u003e\n\u003cp\u003eWe found a male predominance of 53.1% with a sex ratio (M/F) of 1.13. Several studies have shown a predominance of the male sex, this predominance would be linked in part to the fact that congenital hydrocephalus can be transmitted in a sex-linked recessive mode [9 ; 10]. The age of the children ranged from 28 days to 180 months (15 years) with a mean of 13.84\u0026thinsp;\u0026plusmn;\u0026thinsp;23.03 months.\u003c/p\u003e\n\u003cdiv class=\"Ethics-ToolTip\"\u003eThe 0\u0026ndash;30 month age group was the most represented with a proportion of 85%.The delay in medical consultations with modern medicine is due to ignorance and lack of knowledge of the disease, a consequence of the dominant traditional beliefs of the parents.\u003c/div\u003e\n\u003cp\u003eWith regard to age, the proportion of VCS dysfunction is higher in infants than in children, but this difference is not statistically significant. In the literature, there is debate about the influence of age, the causes of hydrocephalus or both (2) on the success of VCS. Drake and colleagues conclude in agreement with other authors that the success of VCS depends essentially on the age of the patients [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. Salvador S.F. et al. found in 2012 at the S\u0026atilde;o Jo\u0026atilde;o Hospital Center (CHSJ) in Porto, Portugal, that age is a predictive factor of endoscopic ventriculocisternostomy dysfunction [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although the statistical test does not show a significant difference between success and failure; however, the confidence intervals do not overlap, this difference can be considered significant.\u003c/p\u003e\n\u003cp\u003eClinical signs were dominated by progressive macrocraniality followed by bulging fontanelles and ectasia of scalp veins with proportions of 93.8%; 84.4% and 68.8% respectively. These signs reflect a compression of the cerebral parenchyma and also the consequences of the delay in specialist consultation.\u003c/p\u003e\n\u003cp\u003eCerebral computed tomography (CT) scan without injection of the contrast agent was performed on all patients; it revealed the obstructive etiology. Thus, in our series we found tri-ventricular dilatation in 24 cases, i.e. 75%, and tetra-ventricular dilatation in 8 cases, i.e. 25%. The same signs were found but in variable proportions in a series carried out in Morocco in 2012, where it was reported: tri-ventricular dilatation in 98 cases, i.e. 80.4%, and tetra-ventricular dilatation in 24 cases, i.e. 19.6% [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThe etiological diagnosis of hydrocephalus was based on clinical findings, patient history, and brain scan data without injection of the contrast agent. Congenital hydrocephalus was the most represented with 62.5% of cases, followed by infectious and tumor hydrocephalus with 25% and 12.5% of cases respectively.\u003c/p\u003e\n\u003cp\u003eIntraoperatively, choroid plexus reshaping was the most common endoscopic finding with 90.6%. The expansive effect of the CSF in the ventricles due to the increased pressure in the skull could explain this result. In our series, the postoperative outcome was simple in 26 cases (81.3%). Leakage of CSF through the operative scar was reported in 5 cases or 15.6% and we noted one case of death. This leakage of CSF through the operative scar is the most frequent post-operative complication found in the literature; according to Bouras T. in his meta-analysis, the incidence of this complication varies between 0-5.2% with an average of 1.7% [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. We believe that the thinner skin and immaturity of the subarachnoid spaces in children could be related to this result in our observation. Patients without a bottom V pulsation showed a higher proportion of ventriculocisternostomy dysfunction compared to those with a bottom 3rd V pulsation, but this difference is not statistically significant.\u003c/p\u003e\n\u003cp\u003eIn the post-operative clinical evaluation of the outcome of the operation (VCS) 56.3% of cases were favorable while 43.7% of cases were unfavorable. The regular and rigorous post-operative follow-up of children after initial management could be related to this result. Opinions differ as to the definition of success of endoscopic ventriculocisternostomy (VCS). The success rate of endoscopic ventriculocisternostomy (VCS) in our series was 56%. VCS dysfunction in our series was found in 44% of patients.\u003c/p\u003e\n\u003cp\u003eStatistical analysis using R software with the following factors: age, sex, bulging fontanelles, sunset gaze, ectasia of scalp veins, skull suture disjunction, hemosiderin deposits, choroid plexus reshaping, 3rd V bottom pulsation, arachnoid adhesions, hypothalamic adhesions and Sylvius aqueduct closure did not show a statistically significant difference in VCS dysfunction. However, among all the factors analyzed, the impact of a few seemed to be preponderant: age, sex, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the 3rd V bottom.\u003c/p\u003e\n\u003cp\u003eThe existence of arachnoid adhesions in patients shows a higher proportion of VCS dysfunction compared to the absence of this abnormality but this difference is not statistically significant. This finding may be related to the presence of fibrinous deposits in the subarachnoid spaces responsible for blocking and clogging the flow and resorption pathways of cerebrospinal fluid (CSF), resulting in ventricular dilatation by accumulation of upstream CSF.\u003c/p\u003e\n\u003cp\u003eThe limitation of this study is related to the smaller sample size, which would necessitate the continuation of similar studies in order to analyze these factors on a much larger sample.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTaking into account the results of this work and data from the current literature, we can conclude that endoscopic ventriculocisternostomy remains an effective surgical technique in the treatment of obstructive hydrocephalus. However, its performance has not been established in infants, with 44.8% of VCS dysfunction in subjects of this age in this series. In addition, our observations reveal that factors such as age, bulging fontanelle, ectasia of scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the 3rd V bottom and haemosiderin deposits are often associated with VCS dysfunction.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e V: the third ventricle; CHU: University Hospital Center; CP: cranial perimeter; CNS: central nervous system; CSF: cerebrospinal fluid; CT: Cerebral computed tomography; DVP: ventriculoperitoneal shunt; VCS: Endoscopic ventriculocisternostomy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the patients and their parents and the ethics committee for consenting to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data sets used and/or analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any funded support for research, writing and publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was done after receiving informed consent and signatures from patients and/or parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe collection of samples and the analysis of data were approved by the ethics committee of the CHU of Conakry: The National Ethics Committee for Health Research (CNERS). Contact Miss Aissatou Sanoussy BAH at the phone number +224 669. 930 951\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSalem-memou S, Badara TA, Kpelao E, Mbaye M, Ba MC, Badiane SB. Traitement de l\u0026rsquo;hydroc\u0026eacute;phalie de l\u0026rsquo;enfant par ventriculocisternostomie endoscopique au S\u0026eacute;n\u0026eacute;gal. Neurochirurgie. 2014;60:254\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy for occlusive hydrocephalus caused by cerebellar infarction. Neurosurgery. 2006;59:539\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFritsch MJ, Doerner L, Kienke S, Mehdorn HM. Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy. J Neurosurg. 2005;103(suppl.):40\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouare IS, Souare IS jr, Haidara A, Boubane DT, Bah AB, Diawara S, B\u0026eacute;avogui K, Diallo LL. Hydroc\u0026eacute;phalie chez l\u0026rsquo;enfant: r\u0026eacute;sultats pr\u0026eacute;liminaires d\u0026rsquo;une prise en charge multidisciplinaire en Guin\u0026eacute;e. Journal de Neurologie-Neurochirurgie-Psychiatrie (www.jnnp.fr) Vol.\u0026nbsp;002, N16, 2017; Pp: 47\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabarki B, et al. Hydroc\u0026eacute;phalies de l\u0026rsquo;enfant, aspects \u0026eacute;tiologiques et \u0026eacute;volutifs \u0026agrave; propos de 86 observations. Rev Maghreb P\u0026eacute;diatrie Mars \u0026ndash; Avril. 2001;XI-II:65\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTortora G. Principe d\u0026rsquo;anatomie et de physiologie, l\u0026rsquo;enc\u0026eacute;phale et les nerfs cr\u0026acirc;niens; 2\u0026egrave;me \u0026eacute;dition fran\u0026ccedil;aise, 1994, p.420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTapsoba TL, Sanon H, Soubeiga KJ, Ouattara TF, Kabre A, Cisse R. Aspects \u0026eacute;pid\u0026eacute;miologiques, cliniques et tomodensitom\u0026eacute;triques des hydroc\u0026eacute;phalies chez les enfants de z\u0026eacute;ro \u0026agrave; 15 ans (\u0026agrave; propos de 53 patients collig\u0026eacute;s au centre hospitalier universitaire Yalgado Ou\u0026eacute;draogo de Ouagadougou: CHU YO). M\u0026eacute;decine nucl\u0026eacute;aire. 2010;34S:e3\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHellwig D, Grotenhuis JA, Tirakotai W, et al. Endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurg Rev. 2005;28:1\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuld Benazzouz Y. Prise en charge de l\u0026rsquo;hydroc\u0026eacute;phalie malformative chez les enfants de moins de 15 ans \u0026agrave; propos de 122 cas. Th\u0026egrave;se de doctorat en M\u0026eacute;decine Universit\u0026eacute; de Marrakech; 2014: 2\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeller S, Gartner J. Genetic and clinical aspect of X-linked hydrocephalus (L1 Disease): Mutations in the L1CAM Gene. Hum Mutat. 2001;18:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrake JM. Endoscopic third ventriculostomy in pedriatric patients: the Canadian experience; Canadian pedriatric neurosurgery study group. Neurosurgery. 2007;60:881\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalvador SF, Oliveira J, Pereira J, Barros H, Vaz R. Endoscopic third ventriculostomy in the management of hydrocephalus: outcome analysis of 168 consecutive procedures; Clinical Neurology and Neurosurgery; 126 (2014) 130\u0026ndash;136.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouras T, Sgouros S. Complications of endoscopic third ventriculostomy in children. A meta-analysis. JNeurosurg Pediatr. 2011;7:643\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 1:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDistribution of patients according to clinical signs, paraclinical signs and etiologies.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width:6.3in;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219.75pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eFeatures\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eStaff \u0026nbsp;N=32\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003ePercentage (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 219.75pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 211.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:white;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eClinical Signs\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:yellow;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eEvolutionary macrocrania\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eBulging of the fontanelles\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eEctasia of scalp veins\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eSunset gaze\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eVomiting, Refusing to suckle\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eSeizures\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003ePsychomotor deceleration\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDisconnection of the skull sutures\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eVisual disturbance\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:white;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eSigns of Brain CT\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:#00B0F0;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eTriple ventricular dilatation\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTetra ventricular dilatation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 211.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:yellow;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:#00B0F0;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 211.15pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:yellow;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e93,8\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e84,4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e68,8\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e34,4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e31,3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e15,6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e15,6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e9,4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e6,3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:#00B0F0;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e75\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 2:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eBreakdown of patients according to post-operative outcomes, post-operative complications and post-operative evaluation N=32\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width:474.25pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eFeatures\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eEffectif\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003ePourcentage (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 183.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eSurgical suites\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eSimple\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eComplicated\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003ePost-operative complications\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eCSF leakage\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDeath\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003ePost-operative evolution\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eFavorable\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUnfavourable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 183.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:#00B0F0;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:yellow;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 183.1pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:#00B0F0;'\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003e81,3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e18,8\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;background:yellow;'\u003e\u003cspan style='font-size:16px;line-height: 150%;font-family:\"Times New Roman\",serif;color:black;'\u003e15,6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e3,1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e56,3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e43,7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 3:\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eAnalysis of the impact of clinical parameters and endoscopic findings on VCS outcome and progression.\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.9e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 212.65pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eFEATURES\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 212.9pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 21.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eVENTRICULO-CISTERNOSTOMY\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 134.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 27.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eDysfunction\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 27.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003eSeccess\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 27.95pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;height: 20.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eCLINICAL SIGNS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 20.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;height: 20.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;height: 20.9pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eBulging of the fontanelles\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e13 (92.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e14 (77.78)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e1 (7.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e4 (22.22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eEctasia of scalp veins\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e11 (78.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e11 (61.11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e3 (21.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e7 (38.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: yellow;padding: 0in 5.4pt;height: 21.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eSunset gaze\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e4 (28.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e7 (38.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e10 (71.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e11 (61.11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: white;padding: 0in 5.4pt;height: 20.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eWider separation of skull sutures\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e2 (14.29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e1 (5.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e12 (85.71)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e17 (94.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eENDOSCOPIC DISCOVERIES\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHemosiderin deposits\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.96\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e6 (42.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e9 (50,00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e8 (57.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e9 (50.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(251, 228, 213);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eChoroid plexus reshaping\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e13 (92.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e16 (88.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e1 (7.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e2 (11.11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: rgb(0, 176, 240);padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003e3rd V Bottom Pulse\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e5 (35.71)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e10 (55.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e9 (64.29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e8 (44.44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: white;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eArachnoid Adhesions\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.09\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e8 (57.14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e4 (22.22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e6 (42.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;color:black;'\u003e14 (77.78)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;background: yellow;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eHypothalamic adhesions\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e1.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e2 (14.29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e2 (11.11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e12 (85.71)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e16 (88.89)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eClosure of the Sylvius Aqueduct\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e0.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eYes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e4 (28.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e9 (50.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 212.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;font-family:\"Times New Roman\",serif;'\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134.65pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e10 (71.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e9 (50.00)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height: 115%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:0in;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003eTable 4:\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;Analysis of VCS Outcome by Child\u0026apos;s Age\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 113.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eVCS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eSuccess\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDysfunction\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-right: none;border-bottom: none;border-left: none;border-image: initial;border-top: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eInfant\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003eChild\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e16 (55,2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e2 (66,7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border: none;padding: 0in 5.4pt;height: 20.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;1,00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;background: yellow;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;color:black;'\u003e13 (44,8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e1 (33,3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height: 150%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;text-align:justify;'\u003e\u003cspan style='font-size:16px;line-height:115%;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obstructive Hydrocephalus, Child, ventriculocisternostomy, Conakry","lastPublishedDoi":"10.21203/rs.3.rs-277563/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-277563/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eContext and Objective: \u003c/strong\u003eThe treatment of hydrocephalus is surgical and uses two (2) main methods to date: ventriculoperitoneal shunt and endoscopic ventriculocisternostomy. The latter offers the advantage of avoiding the implantation of a foreign body (valve) in the body. However, there are sometimes dysfunctions that can lead to the evolutionary continuation of hydrocephalus. The objective of this study is to identify factors predictive of endoscopic ventriculocisternostomy dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center in Conakry.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods and Materials: \u003c/strong\u003eThis is a mixed analytical study of 32 cases of children aged 0-15 years who received endoscopic ventriculocisternostomy during the study period. Outcomes were evaluated according to Drake and Canadian Pediatric Neurosurgery Group clinical criteria. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe hospital frequency was 17% and a sex ratio (M/F) of 1.13. Clinical signs were dominated by progressive macrocraniality (93.8%), bulging fontanel (84.4%), ectasia of scalp veins (68.8%). cerebrospinal fluid leakage (9.4%) was the most frequent post-operative complication. According to age, VCS was successful in 16 infants (55.2%) and dysfunction in 13 (44.8%) while 2 children (66.7%) were successful with VCS versus 1 (33.3%) with dysfunction. We recorded one case of death.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The factors often associated with the dysfunction of the endoscopic ventriculocisternostomy found in this study are essentially: age, bulging fontanelle, ectasia of the scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the bottom of the third ventricle. In the absence of a statistically significant relationship, it would be useful to analyse these parameters closely on a much larger sample.\u003c/p\u003e","manuscriptTitle":"Obstructive Hydrocephalus in Children: Predictive factors of ventriculocisternostomy dysfunction at the CHU of Conakry.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-03-19 20:54:53","doi":"10.21203/rs.3.rs-277563/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd9747d2-5962-4019-a0a2-dec2380c85c2","owner":[],"postedDate":"March 19th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3092330,"name":"Neurosurgery"}],"tags":[],"updatedAt":"2021-03-19T20:54:55+00:00","versionOfRecord":[],"versionCreatedAt":"2021-03-19 20:54:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-277563","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-277563","identity":"rs-277563","version":["v1"]},"buildId":"qQ7_6M8ijIrYJ9CiyUnPg","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}