hydrocephalous- definition, aetiology, classification, clinical features, treatment

1. Hydrocephalous
UG Batch-2018
Date- 15/9/21
Dr. Ankita Singh
Assistant Professor
Department of Surgery

2. Definition
Increase in CSF (cerebrospinal fluid) volume
with ventricular enlargement,
often presenting symptoms of raised ICP
(intracranial pressure)

3. Pathway of CSF flow

4. Aetiology
1. Increased CSF production (rare)
 Choroid plexus papilloma/ carcinoma
2. Decreased reabsorption
 Post haemorrhage
 CSF infection
 Raised CSF proteins
3. Obstruction to outflow
 SOL – ventricle, ventricular wall, external
compression

5. Classification
I. Congenital vs. Acquired
Associated with spina-bifida and
myelomeningocele.
May be unilateral or bilateral
(midline obstruction)
• Failure of formation of CSF
pathways
• Chronic meningitis
• Arnold-Chiari malformation • Trauma
• Congenital stenosis of
aqueduct of Sylvius
• Subarachnoid haemorrhage
• Presents with widening of
sutures, tense fontanelles and
decreased cortical thickness
• Brain tumours-
(pineal/cerebellar/
craniopharyngiomas)
• Enlargement of head occurs,
either prenatal (can cause
obstructed labour) or postnatal
• Colloid cyst of 3rd ventricle
• Arachnoid cysts

6. Classification..
Communicating type:
Defective reabsorption of CSF
Due to- any inflammation, subarachnoid
hemorrhage or trauma
Obstructive/ non communicating type:
Obstruction within ventricle/ exit
Due to- tumours, any inflammatory process

7. Clinical features..
Raised head circumference more than 2
cm/month
Craniofacial disproportion & cephalopelvic
disproportion , leading to obstructed labour
Bulging & tense anterior fontanelle , more
prominent on crying
Engorged scalp veins, scalp is thin and shiny,
suture line separation

8. Clinical features..
Decreased upward gaze (sunsetting sign)
• Perinaud’s syndrome- dorsal midbrain compression
On percussion cracked pot sound due to dilated
ventricle (Macewen's sign)
Impared consciousness, vision
Delayed milestones, mental retardation and
difficulty in retaining feeds
Cerebral herniation- cardiovascular, neurological
deficit & death

10. Clinical features
Features on raised ICP in adult
• Lethargy, irritability
• ‘high pressure headache’
worsening on cough, bending forwards
Associated nausea & vomiting
• Ataxia
• Blurred & double vision
• Abducens palsy
Eye movement abnormality
• Papllioedema, blindness due to ophthalmoplegia
• Cardio Respiratory failure & death

11. Investigation
NCCT brain
MRI brain
Lumbar puncture-
• Diagnostic: deriving opening pressure
measurement & CSF analysis
• Therapeutic: goal of halfing the opening pressure
by drainage
• Caution: risk of herniation & death (obstructive)

15. Treatment
Acute obstructive hydrocephalous
• Emergency
• Treat underlying cause- tumour excision
• Temporary ventricular drainage
Communicating or obstructive
• Treat underlying cause
• Drainage procedures

16. Treatment..
 Drainage procedures:
• EXTERNAL VENTRICULAR DRAINAGE
• VENTRICULO-LUMBAR DRAINAGE
• VENTRICULO-PERITONEAL SHUNTING
• VENTRICULO-ATRIAL & VENTRICULO-PLEURAL SHUNTING

17. Complication of shunts
Overdrainage- low pressure headaches
Sudden collapse of venticles- fluid/ blood in
subdural space
Underdrainage- high pressure headaches, non
resolution of symptoms
Disconnection, infection & blockage of shunts

18. Thank you
Any queries??