Research Horizons


Creating a Predictive Tool for CSF Diversion Surgery

Neurosurgery | Top Scientific Achievement
2023 Research Discoveries
A New Tool for Managing Hydrocephalus

A new cerebrospinal fluid (CSF) diversion surgery index (CDSI) may soon give surgeons a robust decision-making tool when it comes to managing hydrocephalus in pediatric patients. A recent study led by first author Francesco Mangano, DO, and corresponding author Weihong Yuan, PhD, has identified a new model to better predict which pediatric patients are likely to require CSF diversion surgery.  

Individual surgeons evaluate a wide variety of factors when deciding whether to pursue CSF diversion for pediatric patients. Through this retrospective study, the research team built a composite index that incorporates clinical measures and neuroimaging biomarkers to better predict the need for CSF diversion surgery in pediatric patients. 

The team’s objective was to create a composite, evidence-based index incorporating clinical, demographic and neuroimaging measures that could be used as a predictive model to improve identification of hydrocephalus in patients following prenatal myelomeningocele repair. The resulting model, which had an overall accuracy of 84.8%, is better than the performance of any of these factors on their own.  

In a retrospective analysis of 33 patients with prenatal myelomeningocele repair, the researchers found variables—including the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum—were significant predictors of a patient having CSF diversion surgery. Fractional anisotropy in the posterior limb of the internal capsule and sex also had marginal impacts on the model. Future avenues for this research may include additional variables, including biometric measures, for evaluation. The next steps also may include the design of a CDSI clinical trial to improve the standard of care for these patients. 

The CSF diversion surgery index model outperformed all other predictors of CSF diversion surgery,” Yuan says. This model offers clinicians a robust tool for identifying which patients will require surgery and assist them in hydrocephalus management.” 

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Publication Information
Original title: The Construction of a Predictive Composite Index for Decision-Making of CSF Diversion Surgery in Pediatric Patients following Prenatal Myelomeningocele Repair
Published in: American Journal of Neuroradiology
Publish date: July 28, 2022
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Research By

Francesco Mangano, DO, FACS, FAAP, FACOS
Francesco Mangano, DO, FACS, FAAP, FACOS
Division Chief, Division of Pediatric Neurosurgery