ArticleBrain sciences2026
Beyond Ventricular Enlargement: Multimodal MRI Assessment Improves Surgical Decision-Making in Normal Pressure Hydrocephalus.
Article in Brain sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
objectivesThis study aimed to evaluate the utility of MRI-based morphometric and qualitative parameters in identifying patients with suspected normal pressure hydrocephalus (NPH) associated with shunt surgery selection following clinical and lumbar puncture evaluation.
methodsWe retrospectively analyzed 134 participants: 84 symptomatic patients evaluated for suspected NPH and 50 age-matched controls with normal brain MRI findings. Symptomatic patients were categorized according to subsequent clinical management following lumbar puncture evaluation into those who underwent shunt surgery (Shunt group) and those who received conservative management (Conservative group). The Evans index, fronto-occipital horn ratio (FOHR), bicaudate index, callosal angle, ventricular measurements, and disproportionately enlarged subarachnoid space hydrocephalus (DESH) components were analyzed. The discriminatory performance of MRI parameters for shunt surgery selection was assessed using ROC analysis; independent predictors of shunt surgery selection were determined using logistic regression.
resultsAlthough conventional ventricular indices and ventricular dimensions were significantly greater in symptomatic patients than in the control group (
conclusionsVentricular width-based indices alone appear insufficient for identifying patients selected for shunt surgery among individuals evaluated for suspected NPH. Both qualitative and quantitative MRI features, particularly high-convexity tightness and an Evans Index > 0.36, were independently associated with shunt surgery selection following routine clinical assessment. Integrating multimodal imaging parameters with clinical evaluation may provide a more reliable approach for identifying patients who are ultimately selected for shunt surgery following lumbar puncture assessment.
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