title: Postshunt lateral ventricular volume, white matter integrity, and intellectual outcomes in spina bifida and hydrocephalus.
abstract: OBJECTIVE
  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.
authors: Department of Psychology, University of Houston;
authors: Victoria J
authors: VJ
authors: Williams
authors: Jenifer
authors: J
authors: Juranek
authors: Karla K
authors: KK
authors: Stuebing
authors: Paul T
authors: PT
authors: Cirino
authors: Maureen
authors: M
authors: Dennis
authors: Robin M
authors: RM
authors: Bowman
authors: Susan
authors: S
authors: Blaser
authors: Larry A
authors: LA
authors: Kramer
authors: Jack M
authors: JM
authors: Fletcher
mesh_terms: D000293:Adolescent; D016880:Anisotropy; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000473:pathology* / Q000523:psychology / Q000601:surgery*; D007360:Intelligence; D007361:Intelligence Tests; D020547:Lateral Ventricles / Q000473:pathology*; D016014:Linear Models; D008297:Male; D009929:Organ Size; D016135:Spinal Dysraphism / Q000473:pathology* / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D066127:White Matter / Q000473:pathology*
keywords: AD = axial diffusivity; DTI = diffusion tensor imaging; FA = fractional anisotropy; ICP = intracranial pressure; RD = radial diffusivity; SBH = spina bifida and hydrocephalus; WM = white matter; congenital; diffusion tensor imaging; hydrocephalus; neural tube defect; spina bifida