Analysis of variation in radiological parameters in congenital hydrocephalus after ventriculoperitoneal shunt placement and its association with the functional outcome

Background: Cerebrospinal fluid (CSF) buildup in the brain's ventricular system is a hallmark of congenital hydrocephalus, which can result in elevated intracranial pressure and possible neurological damage. The major surgical procedure for removing extra CSF and releasing pressure is still ventriculoperitoneal (VP) shunting. It is still up for debate, nevertheless, whether functional results and radiological improvements following shunting are related. The objective of this research is to examine the relationship between neurological outcomes and changes in Evans' ratio, cortical mantle thickness (CMT), frontal horn to inter caudate distance (FH/ID) ratio, and temporal horn size after surgery. Methods: Fifty patients with congenital hydrocephalus who had VP shunting participated in this retrospective cross-sectional study, which was carried out at Jinnah Postgraduate Medical Centre in Karachi. Preoperative and postoperative radiological measurements were among the data gathered from medical records during a one-year follow-up. The chi-square test was used to determine the significance of the statistical analysis, which was carried out using SPSS 23.0. Results: Significant decreases in ventricular size were indicated by significant decreases in Evans' ratio (58% of patients, p = 0.00051). While 14% showed further thinning, 28% of patients showed a rise in CMT, indicating possible brain tissue recovery. Thirty percent of instances had an improvement in the FH/ID ratio, whereas 56 percent saw no change. Although there were differences in response, 34% of patients experienced a decrease in temporal horn size. Conclusion: Although VP shunting successfully shrinks the ventricle, there is still inconclusive evidence linking it to neurological improvement. The results indicate that ventricular size by itself is not a reliable prognostic indicator, underscoring the necessity of multimodal evaluations that consider cerebral perfusion and white matter integrity to improve patient care and make more accurate predictions.