Neurosurgery notes/CSF/Hydrocephalus (HCP)/Arrested hydrocephalus

Arrested hydrocephalus

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Hydrocephalus (HCP)

General information

  • The exact definition of this term is not generally agreed upon, and some use the term “compensated hydrocephalus” interchangeably.
  • Most clinicians use these terms to refer to a situation where there is no progression or deleterious sequelae due to hydrocephalus that would require the presence of a CSF shunt.
  • Patients and families should be advised to seek medical attention if they develop symptoms of intracranial hypertension (decompensation), which may include: headaches, vomiting, ataxia or visual symptoms.

Arrested hydrocephalus satisfies the following criteria in the absence of a CSF shunt

  • Near normal ventricular size
  • Normal head growth curve
  • Continued psychomotor development
  • Shunt independence
    • Shunt independence is controversial
      • Some feel that shunt independence occurs more commonly when the HCP is due to a block at the level of the arachnoid granulations (communicating hydrocephalus), but others have shown that it can occur regardless of the etiology.
      • These patients must be followed closely, as there are reports of death as late as 5 years after apparent shunt independence, sometimes without warning.

When to remove a disconnected or non-functioning shunt?

  • A disconnected shunt may continue to function by CSF flow through an endothelialized subcutaneous tract. → never remove a shunt UNLESS it is infected
  • Recommendations on whether or not to repair vs. remove a disconnected or nonfunctioning shunt
    • When in doubt, shunt
    • Indications for shunt repair (vs. removal)
      • Marginally functioning shunts
      • The presence of any signs or symptoms of increased ICP (vomiting, upgaze palsy, sometimes H/A alone…)
      • Changes in cognitive function, ↓ attention span, or emotional changes
      • Patients with aqueductal stenosis or spina bifida: most are shunt-dependent
    • Because of risks associated with shunt removal, surgery for this purpose alone should be performed only in the situation of a shunt infection (and then, and EVD is usually placed)
    • Patients with a nonfunctioning shunt should be followed closely with serial CTs, and possibly with serial neuropsychological evaluations