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

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.