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"Occult" hydrocephalus in children
C Di Rocco1, M Caldarelli, A Ceddia
1Istituto di Neurochirurgia, Policlinico A. Gemelli, Rome, Italy.
Insights
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.
- 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.
Abstract:
The authors describe 32 children between 2 and 15 years of age who had hydrocephalus that was only clinically manifest late in life. The clinical picture of these children did not suggest an obvious increase in intracranial pressure; instead, the presenting signs were rather nonspecific and included macrocrania, mild psychomotor retardation, unsteady gait, increased muscle tone and deep tendon reflexes in the lower limbs, impaired ocular movement, epilepsy, and endocrine dysfunction. Their histories suggest the possible causes of the ventricular dilation in about one third of the cases were: perinatal hemorrhage, leptomeningitis, neurofibromatosis, and untreated aneurysm of the great vein of Galen. In 20 patients, however, no positive anamnestic findings were reported. CT scan revealed triventricular dilation in more than half of the cases; tetraventricular dilation was present in 6 patients, and biventricular dilation in the remaining subjects. All children underwent CSF shunting, which resulted in complete recovery in all but 2 cases. The most frequently recorded surgical complication was post-operative subdural effusion (7 subjects), which required surgical treatment in only 2 cases.