Objective:

To determine the relationship between changes in ventricular volume and early clinical improvement in patients with hemorrhage-associated normal pressure hydrocephalus (HANPH) after ventriculoperitoneal shunting (VPS).

Approach:

• Study Design: Retrospective pre-post within-subject study involving 180 adult HANPH patients who underwent VPS.
• Data Collection: CT scans were obtained preoperatively and 2 weeks post-VPS, measuring lateral ventricular subregions using 3D Slicer.
• Clinical Assessment: Gait ability, modified Rankin Scale (mRS), and Barthel Index (BI) were assessed to evaluate clinical improvement.

Key Findings:

• Significant reductions in absolute volumes of lateral ventricular subregions were observed post-VPS.
• Postoperative relative volume of the lateral body of the lateral ventricle increased, while other subregions decreased.
• Reductions in the absolute volumes of the frontal horn, temporal horn, and atrium negatively correlated with early clinical improvement.
• Logistic regression revealed that for every 5‰ reduction in volume of these subregions, the likelihood of clinical improvement significantly increased by 180.3%, 340.9%, and 504.2%, respectively.

Interpretation:

The reduction in atrial volume of the lateral ventricle is crucial for early clinical improvement in HANPH post-VPS.

Limitations:

• Retrospective nature of the study may introduce bias.
• Lack of randomization in group assignment.

Conclusion:

Catheter placement in the occipital horn may optimize outcomes by effectively reducing atrial volume and minimizing risks.