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Increased intraventricular pressure without ventriculomegaly in children with shunts: "normal volume" hydrocephalus

M Engel, P W Carmel, A M Chutorian

    Neurosurgery
    |November 1, 1979
    PubMed

    Insights

    Patients with shunt-dependent hydrocephalus can have normal ventricular size despite high pressure due to shunt malfunction. This "normal volume" hydrocephalus indicates high elastance and requires urgent surgical intervention.

    Area of Science:

    • Neurosurgery
    • Pediatric Neurology
    • Biomedical Engineering

    Background:

    • Hydrocephalus is a condition characterized by excessive cerebrospinal fluid (CSF) accumulation in the brain's ventricles.
    • Shunt systems are commonly used to treat hydrocephalus by draining excess CSF.
    • Shunt malfunction can lead to dangerously elevated intracranial pressure.

    Observation:

    • Five patients with shunt-dependent hydrocephalus presented with normal ventricular size despite significant increases in ventricular pressure after shunt malfunction.
    • Elastance, a measure of ventricular wall stiffness (dP/dV), was assessed in four patients by measuring pressure changes after CSF withdrawal.

    Findings:

    • Patients exhibiting normal ventricular volume with markedly increased ventricular pressure demonstrated high elastance.
    • This specific presentation, termed "normal volume" hydrocephalus, was associated with distal shunt occlusions.
    • Common factors included initial shunting in infancy, prolonged shunt dependency, and absence of recent shunt revisions.

    Implications:

    • Elevated intracranial pressure with normal ventricular volume represents a critical clinical scenario.
    • Prompt surgical intervention is necessary for patients with "normal volume" hydrocephalus to prevent neurological damage.
    • Understanding shunt mechanics and patient history is crucial for diagnosing and managing this condition.

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