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Hydrocephalus


Risk

  • Found in newborns and children with anatomic CNS abnormalities (including myelomeningocele)

  • Head trauma and intracranial hemorrhage (prematurity, SAH, other causes)

  • CNS tumors

  • Meningitis

  • Recurrent VP shunt malfunction

Perioperative Risks

  • Cerebral ischemia and neurologic sequelae

  • Impaired airway reflexes,LOC, gastric emptying

  • Cardiorespiratory arrest

Worry About

  • Intracranial Htn

  • Persistent N/V

  • Bradycardia

  • Decreased LOC

Overview

  • Excess accumulation of CSF due to obstruction in normal CSF flow pattern from ventricular system to cortical surface (obstructive hydrocephalus), or from impaired reabsorption of CSF at arachnoid villi (communicating hydrocephalus).

  • Slow progressive hydrocephalus can be well tolerated for weeks, with slowly worsening symptoms (headache, nausea, papilledema).

  • Acute hydrocephalus results in acute symptoms and may be life-threatening, owing to herniation of brain with catastrophic ischemic injury (bradycardia, Htn, depressed LOC, depressed airway reflexes and resp drive, and gastric atony).

Etiology

  • Congenital: Anatomic abnormalities, including aqueductal stenosis, Arnold-Chiari malformation, Dandy-Walker syndrome

  • Posthemorrhagic/posttraumatic: Intraventricular hemorrhage (newborns or adults) with blood clot in ventricular system

  • Neoplastic: Brain tumor obstructing normal CSF flow

  • Postinflammatory: Meningitis, abscess, meningoencephalitis, intracranial hemorrhage

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