Analysis of Variation in Radiological Parameters in Congenital Hydrocephalus After Ventriculoperitoneal Shunt Placement and Its Association with the Functional Outcome

Shafin Bin Amin^1* and Tehniat Khaliq²

¹Department of Neurology, Shaheed Mohtarma Benazir Bhutto Medical College, Rangiwara, Karachi, Pakistan

²Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan

^*Corresponding author: Shafin Bin Amin, Department of Neurology, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara, Karachi, 75010, Pakistan, E-mail: [email protected]

Received: March 10, 2025, Accepted: March 25, 2025, Published: March 27, 2025

Citation: Shafin Bin Amin. Analysis of Variation in Radiological Parameters in Congenital Hydrocephalus After Ventriculoperitoneal Shunt Placement and Its Association with the Functional Outcome. Global J Neur Neurolog Dis. 2025;1(1): 1-8.

Copyright: ©2025 Shafin Bin Amin. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,

provided the original author and source are credited.

Abstract

A disease known as hydrocephalus is defined by an abnormal buildup of Cerebrospinal Fluid (CSF) in the brain's ventricles, which can be caused by either excessive CSF production or poor absorption. It may develop later in life (acquired) or be present from birth (congenital). Congenital hydrocephalus is further divided into two categories: non-communicative hydrocephalus, which happens when CSF drainage channels are blocked and communicating hydrocephalus, in which the ventricular system is unharmed. Congenital hydrocephalus is brought on by several risk factors, such as infections, genetic disorders, preterm birth and structural abnormalities such as Chiari malformations, Dandy-Walker malformations, neural tube defects, cerebral aqueduct stenosis and corpus callosum agenesis.

Keywords: Congenital hydrocephalus, Cerebrospinal fluid, Ventriculoperitoneal

Abbreviations: CMT: Cortical Mantle Thickness; Fd/ihd: Frontal Horn to Interhemispheric Distance; Vp: Ventriculoperitoneal Shunt; Icp: Intracranial Pressure; Csf: Cerebrospinal Fluid

1. Introduction

A disease known as hydrocephalus is defined by an abnormal buildup of Cerebrospinal Fluid (CSF) in the brain's ventricles, which can be caused by either excessive CSF production or poor absorption. It may develop later in life (acquired) or be present from birth (congenital)¹. Congenital hydrocephalus is further divided into two categories: non-communicative hydrocephalus, which happens when CSF drainage channels are blocked and communicating hydrocephalus, in which the ventricular system is unharmed. Congenital hydrocephalus is brought on by several risk factors, such as infections, genetic disorders, preterm birth and structural abnormalities such as Chiari malformations, Dandy-Walker malformations, neural tube defects, cerebral aqueduct stenosis and corpus callosum agenesis^2,3. Pharmacological methods such as acetazolamide and surgical procedures like endoscopic third ventriculostomy and Ventriculoperitoneal (VP) shunt implantation are used to treat hydrocephalus. The most popular and successful treatment among these is still VP shunt insertion⁴. To assist CSF drainage, a catheter is inserted into the brain's ventricular system, with its distal end placed in the peritoneal cavity. VP shunting improves neurological function and decreases ventricular size; these improvements are frequently assessed using radiological markers. These postoperative radiological findings, however, vary widely, which has sparked continuous discussion on their relationship to long-term functional outcomes⁵. Evans' index, the frontal horn to inter caudate distance (FH/IHD) ratio, temporal horn size and Cortical Mantle Thickness (CMT) are some of the important radiological characteristics that are used to evaluate hydrocephalus and forecast prognosis. The degree of parenchymal thinning brought on by prolonged ventricular enlargement is reflected in CMT; higher thinning is linked to worse neurological outcomes⁶. A common indicator of ventricular enlargement is Evans' index, which is determined by dividing the greatest width of the frontal horns by the maximum biparietal diameter. Higher values of this index signify more severe hydrocephalus and a poorer prognosis⁷. Another measure of ventricular volume is the FH/IHD ratio; larger values indicate more ventricular dilatation and the detrimental consequences it has on deep brain structures and neurodevelopment⁸. A common early indicator of hydrocephalus is temporal horn enlargement, which usually occurs before other ventricular areas dilate. After shunt surgery, persistent temporal horn dilatation could indicate poor shunt function or insufficient CSF diversion⁹. Although these radiological markers offer important information on the course of hydrocephalus and the effectiveness of treatment, there is ongoing discussion regarding their prognostic utility. A more thorough approach to patient evaluation is required, as some research indicates that gains in neurological function do not necessarily follow ventricular size reduction following shunting^10,11. To improve understanding of prognosis in the management of hydrocephalus, this study intends to examine changes in these radiological markers and their relationship to functional results.

Table 1: Summary of observed changes in outcomes.

Figure 1: Bar graph of Evans ratio.