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External hydrocephalus in infants involves fluid buildup without ventricle enlargement. Treatment with shunts is not recommended, as the condition typically resolves naturally, normalizing head growth.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Radiology
Background:
- External hydrocephalus is characterized by increased pressure and fluid accumulation in the subarachnoid space.
- It presents with abnormal head growth and transillumination in infants, but without ventricular dilation.
Purpose of the Study:
- To investigate the clinical course and optimal management of infants diagnosed with external hydrocephalus.
- To evaluate the necessity of surgical intervention, such as shunting, for this condition.
Main Methods:
- Nine infants with pathologically increasing head circumference and abnormal transillumination were studied.
- Diagnostic imaging included pneumoencephalography (PEG) and/or computed tomography (CT) to assess sulcal and ventricular dimensions.
- Surgical exploration (craniotomy) was performed in 7 patients; 2 patients received shunts.
Main Results:
- CT scans revealed widened sulci frontally, parietally, and interhemispherically, but no ventricular widening.
- Exploratory craniotomy identified a deep subarachnoid space in most patients.
- Follow-up CT examinations demonstrated normalization of the subarachnoid space and head growth in all patients.
Conclusions:
- Infants presenting with clinical signs of hydrocephalus and a CT pattern of external hydrocephalus should not undergo shunting.
- The widened subarachnoid space and accelerated head growth associated with external hydrocephalus are expected to resolve spontaneously.
- Conservative management is suggested, as the condition typically normalizes without intervention.
Abstract:
External hydrocephalus means abnormal fluid accumulation in the subarachnoid space under increased pressure with no or slight widening of the ventricles. 9 children were investigated because of pathologically increasing head circumference and abnormal transillumination. PEG and/or CT showed widened sulci frontally, parietally and interhemispherically but no widening of the ventricles. 7 patients were subjected to exploratory craniotomy which disclosed a deep arachnoid space. 2 patients were shunted. All follow-up CT examinations showed normal conditions. We suggest that infants with clinical signs of hydrocephalus and CT picture of external hydrocephalus should not be treated with shunt. The widening of the subarachnoidal space will normalize. The rate of headgrowth will also normalize.