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Updated: Aug 19, 2026

Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Communicating hydrocephalus: a reversible complication of the Mustard operation with serial hemodynamics and
Insights
Severe superior vena cava obstruction after the Mustard operation can increase intracranial pressure in infants. Surgical relief of this obstruction led to reduced head growth and ventricular size, suggesting a favorable outcome is possible with prompt treatment.
Area of Science:
- Pediatric Cardiology
- Neurosurgery
- Medical Physiology
Background:
- The Mustard operation, a palliative procedure for complex congenital heart disease, can lead to superior vena cava (SVC) obstruction.
- SVC obstruction can cause increased intracranial pressure (ICP), leading to significant neurological complications in infants.
- Understanding the pathophysiology of ICP elevation secondary to SVC obstruction is crucial for timely intervention.
Abstract:
Severe superior vena caval (SVC) obstruction following the Mustard operation resulted in substantially increased intracranial pressure in 3 patients. A pathophysiological mechanism is postulated to explain the cerebral edema in 1 and the communicating hydrocephalus in 2. Following surgical relief of the obstruction in the latter 2, there was a decrease in both the rate of head growth and the ventricular size. It is of note that despite the angiographic appearance of azygous decompression, the pressure elevation from the SVC obstruction was transmitted to the brain. The long-term follow-up at three and four years of the 2 infants with communicating hydrocephalus suggests that aggressive treatment is compatible with a favorable outcome.
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Increased Intracranial Pressure ll: Pathophysiology
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