Abstract
Objective
Lack of comprehensive knowledge and numerous socioeconomic problems may make the parents leave hydrocephalic children untreated, leading to progressive hydrocephalus and eventual unordinary big head. Management of huge hydrocephalus (HH) differs from common hydrocephalus. We present our experience in the management of these children.
Methods
HH is defined as head circumference larger than the height of the infant. Nine infants with HH have been shunted in Children's Hospital Medical Center and followed up for 0.5 to 7 years.
Results
The most common cause of hydrocephalus was aqueductal stenosis. The mean age of patients during shunting was 3 months. The head circumference ranged from 56 to 94 cm with the average of 67 cm. Cognitive statuses were appropriate based on their age in five patients. Motor development was normal only in one patient. Complications were found in most cases which included subdural effusion (six patients), shunt infection (four patients), skin injury (three patients), proximal catheter coming out of ventricle to the subdural space (two patients), and shunt exposure (one patient). Three patients died due to shunt infection and sepsis.
Conclusion
Numerous complications may occur in patients with HH after shunt operation such as subdural effusion, ventricular collapse, electrolyte disturbance, skull deformity, scalp injury, and shunt infection. Mental and motor disabilities are very common in patients with HH. Many of these complications can be related to overdrainage; therefore, drainage control using programmable shunts is advisable.
Similar content being viewed by others
References
Blackburn BL, Fineman RM (1994) Epidemiology of congenital hydrocephalus in Utah, 1940–1979: report of an iatrogenically related “epidemic”. Am J Med Genet 52:123–129
Chumas P, Tyagi A, Livingston J (2001) Hydrocephalus—what's new? Arch Dis Child Fetal Neonatal Ed 85:F149–F154
Del Bigio MR (2001) Pathophysiologic consequences of hydrocephalus. Neurosurg Clin N Am 12:639–649, vii
Del Bigio MR (2004) Cellular damage and prevention in childhood hydrocephalus. Brain Pathol 14:317–324
Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, Haines S, Schiff SJ, Cochrane DD, Steinbok P, MacNeil N (1998) Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294–303, discussion 303–295
Fernell E, Hagberg G, Hagberg B (1994) Infantile hydrocephalus epidemiology: an indicator of enhanced survival. Arch Dis Child Fetal Neonatal Ed 70:F123–F128
Garne E, Loane M, Dolk H, De Vigan C, Scarano G, Tucker D, Stoll C, Gener B, Pierini A, Nelen V, Rosch C, Gillerot Y, Feijoo M, Tincheva R, Queisser-Luft A, Addor MC, Mosquera C, Gatt M, Barisic I (2005) Prenatal diagnosis of severe structural congenital malformations in Europe. Ultrasound Obstet Gynecol 25:6–11
Jeelani NU, Kulkarni AV, Desilva P, Thompson DN, Hayward RD (2009) Postoperative cerebrospinal fluid wound leakage as a predictor of shunt infection: a prospective analysis of 205 cases. Clinical article. J Neurosurg Pediatr 4:166–169
Joo JG, Toth Z, Beke A, Papp C, Toth-Pal E, Csaba A, Szigeti Z, Rab A, Papp Z (2008) Etiology, prenatal diagnostics and outcome of ventriculomegaly in 230 cases. Fetal Diagn Ther 24:254–263
Kestle JR, Drake JM, Cochrane DD, Milner R, Walker ML, Abbott R 3rd, Boop FA (2003) Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98:284–290
Kestle JR, Walker ML (2005) A multicenter prospective cohort study of the strata valve for the management of hydrocephalus in pediatric patients. J Neurosurg 102:141–145
Kontny U, Hofling B, Gutjahr P, Voth D, Schwarz M, Schmitt HJ (1993) CSF shunt infections in children. Infection 21:89–92
Kulkarni AV, Drake JM, Lamberti-Pasculli M (2001) Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg 94:195–201
Laurence KM, Coates S (1962) The natural history of hydrocephalus. Detailed analysis of 182 unoperated cases. Arch Dis Child 37:345–362
Lifshutz JI, Johnson WD (2001) History of hydrocephalus and its treatments. Neurosurg Focus 11:E1
Lorber J (1961) Systematic ventriculographic studies in infants born with meningomyelocele and encephalocele. The incidence and development of hydrocephalus. Arch Dis Child 36:381–389
Mccullough DC (1990) History of the treatment of hydrocephalus. In: Scott MR (ed) Hydrocephalus, vol 3. Williams & Wilkins, Baltimore, pp 1–10
Pollack IF, Albright AL, Adelson PD (1999) A randomized, controlled study of a programmable shunt valve versus a conventional valve for patients with hydrocephalus. Hakim-Medos Investigator Group. Neurosurgery 45:1399–1408, discussion 1408–1311
Rekate HL (2008) The definition and classification of hydrocephalus: a personal recommendation to stimulate debate. Cerebrospinal Fluid Res 5:2
Tromp CN, van den Burg W, Jansen A, de Vries SJ (1979) Nature and severity of hydrocephalus and its relation to later intellectual function. Z Kinderchir Grenzgeb 28:354–360
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Faghih Jouibari, M., Baradaran, N., Shams Amiri, R. et al. Huge hydrocephalus: definition, management, and complications. Childs Nerv Syst 27, 95–100 (2011). https://doi.org/10.1007/s00381-010-1177-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-010-1177-z