Corticostriatal Structural Connectivity and Integrity in Children with Hydrocephalus and Executive Dysfunction

Purpose: Infantile hydrocephalus causes diffuse neuronal injury and periventricular white matter damage and is a common neurosurgical indication to limit adverse neurodevelopmental outcomes. Higher-order executive functions which develop throughout childhood and adolescence are not currently well characterized in surgically managed patients. Methods This case-control diffusion-weighted imaging study measured corticostriatal structural connectivity and integrity in school-aged children with ventriculoperitoneal (VP) shunted infantile hydrocephalus and age-matched controls. Probabilistic tractography and diffusion tensor metrics (such as fractional anisotropy, and mean, radial and axial diffusivity) were used to assess microstructural alterations in the executive corticostriatal network. A bootstrapped correlational analysis was used to identify significant dissimilarity between patient structural networks and the mean control network. The Behaviour Rating Inventory for Executive Functions (BRIEF2), the gold standard for assessing clinically elevated and ecologically valid executive dysfunction in children, was used to obtain three domain measures and one global measure of executive function. Results Patients with hydrocephalus showed significant differences of white matter connectivity and integrity within the executive corticostriatal network when compared to the healthy controls. Patients with higher global executive dysfunction demonstrated lower similarity of fractional anisotropy within the executive corticostriatal network when compared to the control network, indicating decreased white matter integrity. Conclusion The current study demonstrates patient structural deviation from a control network and highlights atypical development of corticostriatal white matter and related executive dysfunction in children with VP shunted hydrocephalus.