Motivation: Whether there exist association between glymphatic/white matter impairment and postoperative outcomes of paediatric hydrocephalus. Goal(s): We tried to investigate the glymphatic and white matter abnormalities in paediatric hydrocephalus using MRI metrics. Approach: Fifty-five children with hydrocephalus who underwent MRI and ventriculoperitoneal shunt surgery were prospectively enrolled. DTI metrics were analyzed. Results: Compared with controls, DTI-ALPS index decreased before surgery and recovered after surgery. The preoperative and postoperative DTI-ALPS index and FA in association fibres could predict the short-term motor and long-term cognition outcomes, respectively. Impact: The DTI-ALPS index and FA could be a sensitive biomarker of underlying neuroanatomical changes and developmental outcomes, which would benefit the decision-making of treatment plans.

Association of glymphatic and white matter impairment with outcomes of paediatric hydrocephalus after ventriculoperitoneal shunt