Ventriculo-skull Distance: Its Reliability as an Estimate of "Cerebral Mantle" in the Normocephalic Child

THE "CEREBRAL mantle" (pallium or cortex) has been described as an objective and quantitative reciprocal index of ventricular dilatation.^1-8 Dramatic change in "cerebral mantle" thickness following adequate surgical decompression of acute hydrocephalus has been recorded.^3-5

Attempts to use the cerebral mantle thickness as a preoperative index of future potential has led one author to state "The present study has failed to yield any reliable correlation between preoperative cortical thickness and subsequent intellectual development."⁶ Such a conclusion is strengthened when one reads various reports suggesting 0.5 cm,⁴ 1 cm,⁶ less than 1 to 3 cm,⁷ 1.2 cm,³ and 0.5 to 3.5 cm⁸ as minimum preoperative cerebral mantle thickness that limits normal future development.

More detailed developmental and subjective pneumoencephalographic studies further suggest an inability to prognosticate future intellectual function from air contrast study changes.^9,10

Despite the disagreement that exists, most investigators indicate