Neurosurgery for Hydrocephalus Workup
- Author: Herbert H Engelhard, III, MD, PhD, FACS; Chief Editor: Brian H Kopell, MD more...
CT scan of the head delineates the degree of ventriculomegaly and, in many cases, the etiology. When performed with contrast, it can show infection and tumors that cause obstruction. It also helps with operative planning. Ventricles are usually dilated proximal to the point of obstruction. In pseudotumor cerebri, the CT scan findings are usually normal.
Perform MRI scan of head in most, if not all, congenital cases of hydrocephalus. This delineates the extent of associated brain anomalies such as corpus callosum agenesis, Chiari malformations, disorders of neuronal migration, and vascular malformations. Some tumors, for example the midbrain tectal gliomas, only can be detected with this study. T2-weighted images can show transependymal flow of cerebrospinal fluid (CSF).
Fetal and neonatal cranial ultrasound is a good study for monitoring ventricular size and intraventricular hemorrhage in the neonatal ICU setting. Certainly, prior to treatment, perform other imaging studies.
Lumbar puncture can be used to measure intracranial pressure, but it should only be performed after imaging studies rule out an obstruction. A diagnostic high-volume lumbar puncture in normal pressure hydrocephalus can assist in making decisions regarding shunting. Spinal fluid can show the type and severity of infection (see the Medscape Reference article Meningitis).
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