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Updated: May 13, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Changes of head circumference and ventricular width in infant hydrocephalus managed with adjustable shunt valves and
Isabel Fernandes Arroteia1, Hans Christoph Bock2, Andreas Schaumann3
1Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. Isabel.fernandes@charite.de.
Insights
Adjustable shunt valve settings significantly impact head circumference and ventricular width in infants with hydrocephalus. Initial valve selection influences cerebrospinal fluid (CSF) diversion and anatomical outcomes, highlighting the importance of valve resistance.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Cerebrospinal Fluid Dynamics
Background:
- Ventriculoperitoneal shunting is the primary treatment for infantile hydrocephalus.
- Infancy is a critical period for head growth, sensitive to intracranial pressure.
- Adjustable shunt valves offer customizable cerebrospinal fluid (CSF) drainage.
Purpose of the Study:
- To analyze changes in head circumference and ventricular width in infants undergoing shunt surgery.
- To evaluate the interdependence of head growth and ventricular size post-shunting.
- To compare outcomes between two adjustable valve regimens: differential pressure (DP) with gravitational unit (aDPG) and gravitational assistance (GA) with DP unit (aGDP).
Main Methods:
- Retrospective analysis of 155 infants (<2 years at implantation) from two pediatric neurosurgical centers.
- Comparison of head circumference z-scores and ventricular width (fronto-occipital horn ratio - FOHR) over 3 years.
- Collection and statistical comparison of patient demographics, valve opening pressures, and FOHR.
Main Results:
- No significant difference in head circumference z-score changes between the aDPG and aGDP groups.
- The aGDP group showed more enlarged ventricles (higher FOHR) at implantation but a more pronounced reduction in ventricular size by follow-up.
- A significant association was found between changes in FOHR and head circumference at follow-up (R²=0.22, p<0.0001), influenced by initial valve settings.
Conclusions:
- A strong relationship exists between ventricular width changes (FOHR) and head circumference in shunted hydrocephalic infants.
- Initial shunt valve settings directly influence ventricular width and head circumference changes, underscoring the role of valve resistance in CSF diversion.
- Further research is necessary to determine the long-term neurodevelopmental and functional impact of these parameters.
Objective:
Cerebrospinal fluid (CSF) drainage via a ventriculoperitoneal shunt remains to be the most common treatment for infantile hydrocephalus. Since head growth is particularly dynamic and susceptible to intracranial pressure changes during the first months of life, shunting can have a considerable impact. This study aimed to examine changes in head circumference and ventricular width and evaluate their interdependence in children who underwent shunting during infancy with either of two different adjustable valve regimens.
Methods:
We conducted a retrospective analysis on synchronized patient databases at two tertiary pediatric neurosurgical centers. One center implanted a differential pressure (DP) adjustable valve with a fixed gravitational unit (aDPG group). The other center used an adjustable gravitational assistance (GA) valve combined with a fixed DP unit (aGDP group). We included infants less than 2 years of age at shunt implantation with a follow-up time of 3 years, respectively. Patient demographics, head circumferences (z-scores), ventricular width and opening pressure settings of the shunt valves were collected and compared using statistical tests as appropriate.
Results:
A total of 155 infants (n = 78 in aDPG group and n = 77 in the aGDP group) could be included in this study. Changes in head circumference z-scores across follow-up time were similar in both groups (p = 0.99). In the aGDP group, patients had more pronounced pathologically enlarged ventricles measured by fronto-occipital horn ratio (FOHR) at implantation compared to the aDPG group (p = 0.037). At the end of follow-up, in both groups, the proportion of patients showing a normal FOHR (0.37 ± 0.026) increased significantly, while reduction in ventricular size over time was more pronounced in the aGDP group (p < 0.01). The valve setting in the aGDP group was significantly lower in standing and in lying position compared to the aDPG group. Regression analysis revealed a significant association between the change in median FOHR and head circumference at the end of follow-up (slope (95%CI) = 3.46 (2.42-4.49), R2 = 0.22, p < 0.0001). Median change in FOHR, as well as head circumference at the end of follow-up, did correlate to valve settings at shunt implantation (p<0.01).
Conclusions:
The present study demonstrates a strong relation between changes in median FOHR and head circumference at the end of follow-up in shunted hydrocephalic infants. In addition, we identified a direct influence of initial valve setting on changes of ventricular width and head circumference at follow-up, underlining the importance of valve resistance for regulating CSF diversion and its anatomical consequences. Further investigations are needed to assess the influence of these parameters on long-term neurodevelopment and functional outcome.
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