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"Occult" hydrocephalus in children.

C Di Rocco¹, M Caldarelli, A Ceddia

¹Istituto di Neurochirurgia, Policlinico A. Gemelli, Rome, Italy.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery

|April 1, 1989

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Late-onset hydrocephalus in children presents with nonspecific symptoms, not elevated intracranial pressure. CSF shunting effectively treated 30 of 32 pediatric patients, with subdural effusion as the main complication.

Area of Science:

Pediatric Neurology
Neurosurgery

Background:

Hydrocephalus can manifest clinically late in childhood.
Nonspecific symptoms may mask increased intracranial pressure in pediatric cases.

Purpose of the Study:

To describe the clinical presentation, etiology, and management of late-onset hydrocephalus in children.
To evaluate the efficacy and complications of cerebrospinal fluid (CSF) shunting in this population.

Main Methods:

Retrospective review of 32 children (2-15 years) with late-onset hydrocephalus.
Clinical assessment, neuroimaging (CT scan), and analysis of patient histories.
Evaluation of CSF shunting outcomes and complications.

Main Results:

Presenting signs included macrocrania, psychomotor retardation, gait disturbance, and epilepsy.

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Possible causes identified in one-third of cases: perinatal hemorrhage, leptomeningitis, neurofibromatosis, vein of Galen aneurysm.

CT scans showed triventricular dilation in most patients.

CSF shunting led to complete recovery in 30 of 32 children.

Post-operative subdural effusion occurred in 7 patients, requiring surgery in 2.

Conclusions:

Late-onset hydrocephalus in children presents with subtle, nonspecific signs.
CSF shunting is a highly effective treatment for this condition.
Subdural effusion is the most common complication following CSF shunting.