Pediatric Hydrocephalus: Current State of Diagnosis and Treatment

Zachary Wright; Thomas W. Larrew; Ramin Eskandari

doi:10.1542/pir.2015-0134

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Zachary Wright, MD*
Thomas W. Larrew, MD*
Ramin Eskandari, MD, MS*

^*Department of Neurosurgery, Medical University of South Carolina, Charleston, SC

AUTHOR DISCLOSURE
Drs Wright, Larrew, and Eskandari have disclosed no financial relationships relevant to this article. This commentary does not contain discussion of an unapproved/investigative use of a commercial product/device.

Practice Gap

Hydrocephalus is a neurologic condition that requires lifelong vigilance by various health care professionals. Nonsurgical clinicians treating children with hydrocephalus, with or without shunts, often have questions about disease recognition, shunt infection, and shunt malfunction. Imaging modalities such as nonsedated magnetic resonance imaging and nonshunt endoscopic surgery have changed the landscape of the primary pediatric clinician’s interaction with this patient population. This article addresses the practice gap between pediatric outpatient and neurosurgical management of children with hydrocephalus in both the acute and chronic care settings.

Objectives

After completing this article, readers should be able to:

Understand basic pathophysiology related to hydrocephalus and available treatments.
Recognize presenting signs and symptoms of hydrocephalus.
Recognize when neurosurgical consultation is appropriate and manage hydrocephalus until a neurosurgeon is available.

Etiology, Diagnosis, and Presentation

Hydrocephalus in the pediatric population is characterized by an initial increase in intraventricular pressure, resulting in pathologic dilation of the cerebral ventricles with an accumulation of cerebrospinal fluid (CSF). Although the pressure may be slight or severe, the balance between CSF production, flow, and absorption is lost in hydrocephalus. This condition is a significant cause of morbidity and mortality within the pediatric population, with a prevalence of approximately 6 in 10,000 live births and a neonatal mortality rate before initial hospital discharge of 13%. (1) The impact of this complex neurologic pathology on society is extremely large. According to nationally representative data sets, every year pediatric hydrocephalus accounts for 38,200 to 39,900 hospital admissions, 391,000 to 433,000 hospital days, and $1.4 to $2.0 billion in total hospital charges in the United States. (2)

In the healthy child, CSF is primarily produced in the choroid plexus, …