Results of ventriculoatrial shunt surgery for hydrocephalus using Indian shunt valve: evaluation of intellectual performance with particular reference to computerized axial tomography.

The clinical experience of treating 110 Indian Children for hydrocephalus by ventriculoatrial shunts using the Upadhyaya shunt valve has been presented. Most of the children had a poor socioeconomic background and were late referrals. Children operated during the period from March 1979 to February 1980 were evaluated pre and postoperatively for mental performance and by CAT scanning as a longitudinal study. Children operated earlier than March 1979 and who came to the clinic for follow-up were also included in the study for observing serial changes in CAT scans and mental performance. A new method of quantifying mental performance in infants and children has been described. Age at operation and nature of hydrocephalus do not seem to have any correlation with the mental performance in shunted children. Severity of hydrocephalus measured as ventricular/brain ratio on CAT scan appears to have a very significant correlation with the intellectual status, children with smaller ventricles having better performance. The longitudinal part of the follow-up study indicates that mental performance of shunted children improves progressively up to 5 years. Longitudinal study of mental performance and serial CAT scans after shunt surgery are recommended as essential refinements in the management of hydrocephalic children.