Clinical Review

Contemporary management and recent advances in paediatric hydrocephalus

BMJ 2011; 343 doi: (Published 13 July 2011) Cite this as: BMJ 2011;343:d4191
  1. Jothy Kandasamy, senior neurosurgical registrar12,
  2. Michael D Jenkinson, consultant neurosurgeon12,
  3. Conor L Mallucci, consultant neurosurgeon12
  1. 1Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ
  2. 2Department of Neurosurgery, Royal Liverpool Alder Hey Children’s Hospital, Liverpool L12 2AP
  1. Correspondence to: Jothy Kandasamy jegajothy{at}
  • Accepted 22 June 2011

Summary points

  • Hydrocephalus may develop in association with a congenital brain malformation or, more commonly, after a neurological insult such as infection or haemorrhage

  • Treatment involves draining cerebrospinal fluid from the lateral ventricles of the brain to another body cavity, usually the peritoneum

  • Shunts are mechanical devices that are prone to obstruction, infection, and failure. Delayed recognition of shunt malfunction still causes death

  • Endoscopic third ventriculostomy is an effective alternative to shunts in a select group of patients, but the stoma may eventually close and follow-up is needed to avoid fatalities

  • Image guided placement of ventricular catheters may reduce the rate of poor shunt placement (further studies are required to evaluate this)

  • Catheters impregnated with antibiotics or silver may reduce shunt infection (a large multicentre trial plans to evaluate them)

  • Many children and adults can lead normal lives with shunts in situ, including participation in sports. Future prognosis and good health will be largely determined by avoiding complications and detecting shunt malfunction early

The term hydrocephalus relates to an imbalance between the production and absorption of cerebrospinal fluid that may cause an increase in intracranial pressure. Rather than being a single pathological disease, hydrocephalus may be congenital or may arise secondary to intracranial haemorrhage, infection, or tumours.

Although some reports suggest the incidence of paediatric hydrocephalus has declined in many developed countries, others indicate increased rates because of improved survival of premature infants.1 2 3 4 High rates of neonatal infection and neural tube defects in developing countries are linked to higher rates of hydrocephalus than in the developed world. One prospective observational study of hydrocephalus in east Africa estimated more than 6000 new cases a year, and it continues to be a major source of morbidity and mortality.5

The management of hydrocephalus was revolutionised in the 1950s with the …

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