Huge hydrocephalus: definition, management, and complications.
OBJECTIVE
Lack of comprehensive knowledge and numerous socioeconomic problems may make the parents leave hydrocephalic children untreated, leading to progressive hydrocephalus and eventual unordinary big head. Management of huge hydrocephalus (HH) differs from common hydrocephalus. We present our experience in the management of these children.


METHODS
HH is defined as head circumference larger than the height of the infant. Nine infants with HH have been shunted in Children's Hospital Medical Center and followed up for 0.5 to 7 years.


RESULTS
The most common cause of hydrocephalus was aqueductal stenosis. The mean age of patients during shunting was 3 months. The head circumference ranged from 56 to 94 cm with the average of 67 cm. Cognitive statuses were appropriate based on their age in five patients. Motor development was normal only in one patient. Complications were found in most cases which included subdural effusion (six patients), shunt infection (four patients), skin injury (three patients), proximal catheter coming out of ventricle to the subdural space (two patients), and shunt exposure (one patient). Three patients died due to shunt infection and sepsis.


CONCLUSIONS
Numerous complications may occur in patients with HH after shunt operation such as subdural effusion, ventricular collapse, electrolyte disturbance, skull deformity, scalp injury, and shunt infection. Mental and motor disabilities are very common in patients with HH. Many of these complications can be related to overdrainage; therefore, drainage control using programmable shunts is advisable.
Faghih Jouibari
Morteza
M
Department of Neurosurgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
Baradaran
Nazanin
N
Shams Amiri
Rouzbeh
R
Nejat
Farideh
F
El Khashab
Mostafa
M
D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D017287:Ventriculoperitoneal Shunt