This document discusses hydrocephalus, defined as an increase in cerebrospinal fluid volume within the ventricles of the brain. It can be caused by increased CSF production, decreased reabsorption, or obstruction of CSF outflow. The main types are communicating and obstructive. Clinical features include an enlarged head circumference, bulging fontanelles, and signs of increased intracranial pressure. Investigations include CT and MRI imaging and lumbar puncture. Treatment involves addressing the underlying cause, temporary external drainage, and longer term shunt procedures to drain CSF, though these carry risks of complications like over or underdrainage.

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??