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Introduction <p>Hydrocephalus is a common pediatric neurological disorder characterized by abnormal head enlargement, intellectual disability, visual impairment, and death.</p> Objective <p>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.</p> Methods <p>This multicenter retrospective study involves pediatric patients, &lt; 18&#xa0;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.</p> Results <p>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 &gt; 3&#xa0;years old with obstructive hydrocephalus without Chiari malformation (<i>p</i> &lt; 0.001), while VPS showed better outcomes in infants &lt; 1&#xa0;year old and patients with communicating hydrocephalus (<i>p</i> &lt; 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 (<i>p</i> &lt; 0.01). Cognitive improvement rate was higher in the ETV group among patients with normal cerebrospinal fluid dynamics (<i>p</i> &lt; 0.05).</p> Conclusion <p>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.</p>

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Individualized treatment strategies and long-term prognosis of congenital hydrocephalus: an integrated analysis based on multicenter retrospective data and machine learning

  • 期刊论文

  • 发表日期：

    2026年4月2日

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  • Panyi Yang,
  • Hao Lin,
  • Min Li,
  • Jun Lei,
  • Seidu A. Richard,
  • Zhigang Lan

摘要

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.