eMedicine Specialties > Neurosurgery > Trauma

Hydrocephalus: Follow-up

Author: Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Coauthor(s): Kamran Sahrakar, MD, Clinical Professor, Department of Neurosurgery, University of California-Davis; Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California
Contributor Information and Disclosures

Updated: Dec 19, 2007

Outcome and Prognosis

In general, outcome is good. A typical patient should return to baseline after shunting, unless prolonged elevated intracranial pressure or brain herniation has occurred. The neurologic function of children is optimized with shunting. Infection, especially if repeated, may affect cognitive status.

The best long-term results in the most carefully selected patients are no better than 60% in normal pressure hydrocephalus. Few complete recoveries occur. Often, gait and incontinence respond to shunting, but dementia responds less frequently.

Often, various other neurologic abnormalities associated with hydrocephalus are the limiting factor in patient recovery. Examples are migrational abnormalities and postinfectious hydrocephalus.

Future and Controversies

Hydrocephalus research and treatment have advanced tremendously in the last 20 years. Examples are the development of new shunt materials and, more recently, programmable valve technology. Current research categories include the following:

  • Transplantation of tissue, such as vascularized omentum, to reestablish normal cerebrospinal fluid (CSF) could be the best method to treat communicating hydrocephalus.
  • Third ventriculostomies and aqueductoplasty eliminate the need for shunting in noncommunicating cases of hydrocephalus. New optics and smaller scopes have expanded this field over the last 5 years.

 
Acknowledgments

The author would like to thank Dr. Yoon Hahn and Dr. David McLone for their guidance in treating patients with hydrocephalus.



More on Hydrocephalus

Overview: Hydrocephalus
Workup: Hydrocephalus
Treatment: Hydrocephalus
Follow-up: Hydrocephalus
References
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References

  1. Hahn YS, Engelhard H, McLone DG. Abdominal CSF pseudocyst. Clinical features and surgical management. Pediatr Neurosci. 1985-1986;12(2):75-9. [Medline].

  2. Aronyk KE. The history and classification of hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):599-609. [Medline].

  3. Black PMcL, Ojemann RG. Hydrocephalus in adults. In: Youman JR, ed. Neurological Surgery. 3rd ed. Philadelphia, Pa:. WB Saunders Co;1990:927-944.

  4. Gleason PL, Black PM, Matsumae M. The neurobiology of normal pressure hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):667-75. [Medline].

  5. McLone DG, Partington MD. Arrest and compensation of hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):621-4. [Medline].

  6. Milhorat T. Hydrocephalus: Pathophysiology and Clinical Features. Neurosurgery. 1996;3:3625-3632.

  7. Pang D, Altschuler E. Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. Oct 1994;35(4):643-55; discussion 655-6. [Medline].

  8. Sainte-Rose C. Hydrocephalus in childhood.In: Youmans JR, ed. Neurological Surgery. Philadelphia, Pa:. WB Saunders Co;1996:890-926.

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Further Reading

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Keywords

hydrocephalus, abnormal rise in cerebrospinal fluid volume, abnormal rise in cerebrospinal fluid pressure, CSF, imbalance of cerebrospinal fluid production and absorption, spinal bifida, congenital hydrocephalus, acquired hydrocephalus, aqueductal stenosis, intracranial tumor obstruction, intracranial trauma, intracranial hemorrhage, intracranial infection, disorders of cerebrospinal fluid production, disorders of cerebrospinal fluid circulation, disorders of cerebrospinal fluid absorption, cerebrospinal fluid diversion, third ventriculostomy, normal pressure hydrocephalus

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Contributor Information and Disclosures

Author

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Kamran Sahrakar, MD, Clinical Professor, Department of Neurosurgery, University of California-Davis
Kamran Sahrakar, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association
Disclosure: Nothing to disclose.

Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California
Dachling Pang, MD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Duc Hoang Duong, MD, Associate Professor, Director of Neuroscience Physician Assistant Program, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles R Drew University
Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Disclosure: Nothing to disclose.

CME Editor

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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