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Individualized treatment strategies and long-term prognosis of congenital hydrocephalus: an integrated analysis based
Panyi Yang1, Hao Lin2, Min Li3
1Department of Pediatric Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, Sichuan, 610041, People's Republic of China.
Insights
Ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) efficacy for pediatric hydrocephalus depends on patient age and hydrocephalus subtype. Tailoring treatment improves outcomes in congenital hydrocephalus.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Imaging
Background:
- Hydrocephalus is a significant pediatric neurological disorder.
- It can lead to severe developmental and physical impairments, including intellectual disability and visual impairment.
- Abnormal head enlargement is a key characteristic.
Purpose of the Study:
- To compare ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) efficacy in pediatric congenital hydrocephalus subtypes.
- To develop a machine learning model predicting ETV success using preoperative imaging.
- To analyze the impact of postoperative management on long-term prognosis for individualized treatment.
Main Methods:
- Multicenter retrospective study of pediatric patients (<18 years) with congenital hydrocephalus.
- 1:1 matching ratio for VPS and ETV groups.
- Collected clinical data including imaging parameters (Evans index, basal cistern patency), CSF dynamics, surgical details, and outcomes.
Main Results:
- ETV showed higher success in children >3 years with obstructive hydrocephalus without Chiari malformation; VPS was better for infants <1 year and communicating hydrocephalus.
- VPS reintervention linked to shunt obstruction/infection; ETV failure associated with basal cistern hypoplasia.
- Higher cognitive improvement with ETV in patients with normal CSF dynamics.
Conclusions:
- Treatment efficacy for congenital hydrocephalus differs significantly between VPS and ETV based on patient subgroups.
- Findings support precision neurosurgical approaches for congenital hydrocephalus.
Introduction:
Hydrocephalus is a common pediatric neurological disorder characterized by abnormal head enlargement, intellectual disability, visual impairment, and death.
Objective:
To compare the short- and long-term efficacy of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) in children with different subtypes of congenital hydrocephalus, construct a machine learning (ML)-based predictive model for ETV success rate using preoperative imaging parameters, and explore the impact of postoperative management strategies on long-term prognosis, thereby establishing an individualized treatment pathway.
Methods:
This multicenter retrospective study involves pediatric patients, < 18 years old with congenital hydrocephalus who underwent VPS or ETV in a 1:1 group matching ratio. The study was divided into three modules and clinical data included imaging parameters such as Evans index, basal cistern patency, cerebrospinal fluid dynamics, surgical details, and follow-up outcomes were collected.
Results:
A total of 800 pediatric patients with congenital hydrocephalus who underwent VPS or ETV were retrieved from patients' records. The surgical success rate of ETV was significantly higher in children > 3 years old with obstructive hydrocephalus without Chiari malformation (p < 0.001), while VPS showed better outcomes in infants < 1 year old and patients with communicating hydrocephalus (p < 0.05). The 2-year reintervention rate of VPS was mainly affected by shunt obstruction and infection, whereas ETV failure was closely related to basal cistern hypoplasia (p < 0.01). Cognitive improvement rate was higher in the ETV group among patients with normal cerebrospinal fluid dynamics (p < 0.05).
Conclusion:
The efficacy of VPS and ETV in congenital hydrocephalus varies significantly across different patient subgroups. Our findings provide a scientific basis for precision neurosurgical treatment of congenital hydrocephalus.
