Related Experiment Video
Updated: Apr 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Postshunt lateral ventricular volume, white matter integrity, and intellectual outcomes in spina bifida and
Victoria J Williams1, Jenifer Juranek, Karla K Stuebing
1Department of Psychology, University of Houston;
Insights
In children with spina bifida and hydrocephalus, enlarged ventricles correlate with white matter changes, but not intellectual ability. Diffusion tensor imaging (DTI) reveals these white matter alterations, offering insights into hydrocephalus management.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Biomedical Engineering
Background:
- Spina bifida and hydrocephalus (SBH) often require shunting, leading to potential white matter (WM) integrity issues.
- Previous research has not comprehensively linked WM integrity, shunt revisions, ventricular volume, and cognition in medically stable SBH patients.
Purpose of the Study:
- To investigate the relationship between WM integrity, ventricular volume, shunt history, and cognitive function in children with SBH.
- To determine if DTI metrics can serve as indicators of chronic, mild hydrocephalus.
Main Methods:
- Eighty children with SBH underwent MRI for diffusion tensor imaging (DTI) and IQ testing.
- DTI metrics (FA, RD) were analyzed along frontal and parietal tectocortical pathways.
- Correlations were assessed between DTI metrics, ventricular volume, and shunt revision history.
Main Results:
- Enlarged lateral ventricle volume and more shunt revisions were associated with higher fractional anisotropy (FA) and lower radial diffusivity (RD).
- Children without shunt revisions had larger ventricles but better WM integrity (higher FA, lower RD).
- Parietal DTI metrics predicted IQ scores, but cognitive function was not directly correlated with ventricular size or shunt history.
Conclusions:
- Increased ventricular volume in medically stable SBH patients is associated with DTI changes suggestive of axonal compression from elevated intracranial pressure.
- DTI metrics may indicate chronic, mild hydrocephalus even without overt symptoms.
- Despite WM changes, enlarged ventricles and multiple shunt revisions did not negatively impact intellectual ability in this cohort.
Object:
No previous reports exist that have evaluated the relationships of white matter (WM) integrity with the number of shunt revisions, ventricular volume after shunting, and cognition in medically stable children who have spina bifida and hydrocephalus (SBH). The authors hypothesized that enlarged ventricles and a greater number of shunt revisions decrease WM integrity in children.
Methods:
In total, 80 children (mean age 13.7 years) who had SBH underwent MRI and IQ testing. Probabilistic diffusion tractography was performed to determine mean diffusion tensor imaging (DTI) metrics along the frontal and parietal tectocortical pathways. The DTI metrics were evaluated for significant correlation with a composite IQ measure and with the total number of shunt revisions and the total lateral ventricular volume obtained through semiautomated parcellation of T1-weighted MRI scans.
Results:
An enlargement in total lateral ventricle volume and an increase in the number of shunt revisions were both associated with higher fractional anisotropy (FA) and with lower radial diffusivity (RD) along both frontal and parietal tectocortical pathways. Children who had not undergone a shunt revision had on average a greater lateral ventricle volume and higher FA and lower RD along frontal and parietal pathways than those who had undergone multiple shunt revisions. The mean DTI metrics along parietal pathways predicted IQ scores, but intellectual ability was not significantly correlated with ventricular volume or with the number of lifetime shunt revisions.
Conclusions:
Significant changes in DTI metrics were observed as a function of ventricular volume. An increased lateral ventricle volume was associated with elevated FA and decreased RD. Given that the participants were medically stable at the time of the MRI examination, the results suggested that those who have enlarged ventricles show a DTI pattern consistent with axonal compression due to increased intracranial pressure (ICP) in attenuated hydrocephalus. Although limited by a cross-sectional design, the study's findings suggest that DTI metrics may serve as sensitive indicators for chronic, mild hydrocephalus in the absence of overt clinical symptoms due to increased ICP. Having enlarged ventricles and undergoing multiple shunt revisions did not affect intellectual ability in children with SBH.
Related Concept Videos
01:22Cerebral Edema ll: Pathophysiology
01:18Anatomy of the Brain: Ventricles
01:29Increased Intracranial Pressure ll: Pathophysiology