Neurosurgery for Hydrocephalus Workup

  • Author: Herbert H Engelhard III, MD, PhD, FACS; Chief Editor: Allen R Wyler, MD   more...
 
Updated: Nov 4, 2011
 

Imaging Studies

  • 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.
Next

Diagnostic Procedures

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 eMedicine article Meningitis).

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Herbert H Engelhard III, MD, PhD, FACS  Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago College of Medicine

Herbert H Engelhard III, MD, PhD, FACS 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, 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, FACS  Clinical Professor, Department of Neurosurgery, University of California at San Francisco

Kamran Sahrakar, MD, FACS 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  Professor 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.

Specialty Editor Board

Duc Hoang Duong, MD  Professor, Chief Physician, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles Drew University of Medicine and Science

Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association, Congress of Neurological Surgeons, and North American Skull Base Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ryszard M Pluta, MD, PhD  Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Clinical Staff Scientist, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH); Fishbein Fellow, JAMA, Chicago ,IL

Ryszard M Pluta, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons and Polish Society of Neurosurgeons

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD  Former 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.

Additional Contributors

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

References

  1. Tanaka N, Yamaguchi S, Ishikawa H, Ishii H, Meguro K. Prevalence of possible idiopathic normal-pressure hydrocephalus in Japan: the Osaki-Tajiri project. Neuroepidemiology. 2009;32(3):171-5. [Medline].

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

  3. Williams TA, Leslie GD, Dobb GJ, Roberts B, van Heerden PV. Decrease in proven ventriculitis by reducing the frequency of cerebrospinal fluid sampling from extraventricular drains. J Neurosurg. Nov 2011;115(5):1040-6. [Medline].

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

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

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

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

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

  9. 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].

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

 
Previous
Next
 
Noncommunicating obstructive hydrocephalus caused by obstruction of the foramina of Luschka and Magendie. This MRI sagittal image demonstrates dilatation of lateral ventricles with stretching of corpus callosum and dilatation of the fourth ventricle.
Communicating hydrocephalus with surrounding "atrophy" and increased periventricular and deep white matter signal on fluid-attenuated inversion recovery (FLAIR) sequences. Note that apical cuts (lower row) do not show enlargement of the sulci, as is expected in generalized atrophy. Pathological evaluation of this brain demonstrated hydrocephalus with no microvascular pathology corresponding with the signal abnormality (which likely reflects transependymal exudate) and normal brain weight (indicating that the sulci enlargement was due to increased subarachnoid cerebrospinal fluid [CSF] conveying a pseudoatrophic brain pattern).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.