Cerebrospinal fluid (CSF) diversionary surgery is a common therapy for patients with congenital hydrocephalus. Magnetic resonance imaging is used to confirm that a ventriculoperitoneal shunt or endoscopic third ventriculostomy is working properly. But it is challenging to identify underlying neuroanatomical changes and postsurgical developmental outcome in these patients. Researchers at Cincinnati Children’s Hospital Medical Center decided to explore whether diffusion tensor imaging (DTI) before surgery and during the course of recovery could be a useful tool.

This prospective study included 54 pediatric patients with congenital hydrocephalus who underwent CSF diversionary surgery, and a control group of 64 pediatric subjects. DTI and neurodevelopmental outcome data were collected once in the control group and three times (preoperatively and at three and 12 months postoperatively) in the patients with hydrocephalus. The study was led by Francesco Mangano, DO, pediatric neurosurgery chief at Cincinnati Children’s, and Weihong Yuan, PhD, radiology, who have published extensively about hydrocephalus and DTI.

“We looked at white matter tracks to get an objective idea of what is happening in the brain, and the data showed significant correlation between DTI and neuropsychological measures,” Mangano says. “These findings help establish the technique as a non-invasive, sensitive biomarker for underlying neuroanatomical changes and postsurgical developmental outcome, and even as a predictor of future outcomes for patients with congenital hydrocephalus.”

Mangano says the next step is to develop software that would allow physicians to use DTI in the post-surgical phase of care for patients with congenital hydrocephalus. The study was published in the Journal of Neurosurgery: Pediatrics (September 2016).