title: Long term neuropsychological outcome and management of 'decompensated' longstanding overt ventriculomegaly in adults.
abstract: OBJECTIVE
  We aimed to study a group of patients presenting with symptomatic longstanding overt ventriculomegaly in adults (LOVA) requiring treatment (endoscopic third ventriculostomy), and to study their long term neuropsychological status and functionality.
  
  
  METHODS
  Twenty patients were treated with endoscopic third ventriculostomy on presentation and were studied with neuropsychological assessments including the repeatable battery for the assessment of neuropsychological status and the hospital anxiety and depression scores. Pre- and post-operative MRI studies were used to assess the patency of the endoscopic third ventriculostomy (ETV) along with clinical outcome scores.
  
  
  RESULTS
  A variety of presenting symptoms were experienced including headache (90%), worsening imbalance, attacks of loss of consciousness and cognitive decline. Mean age of patients was 52 years (range, 17-78) with mean head circumference of 60.9 cm. ETV was successful in controlling symptoms in 89% of patients with three patients requiring shunts (gravitational valves). There were no subdurals after surgery. All patients did universally badly in all aspects of the neuropsychological studies without showing any undue anxiety or depression.
  
  
  CONCLUSIONS
  LOVA patients can decompensate at any time in their adult life with acute symptoms, which are generally well controlled with ETV and with few complications. Sadly, the long-term effects of carrying 'asymptomatic' or compensated hydrocephalus since childhood are of a significant cognitive cost to these patients.
authors.affiliation: Department of Neurosurgery, The Walton Centre, Lower Lane, Liverpool, UK. mjumaily@univ-montp2.fr
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Jumaily
authors.forename: Bethan
authors.initials: B
authors.lastname: Jones
authors.forename: Caroline
authors.initials: C
authors.lastname: Hayhurst
authors.forename: Michael D
authors.initials: MD
authors.lastname: Jenkinson
authors.forename: Peter
authors.initials: P
authors.lastname: Murphy
authors.forename: Neil
authors.initials: N
authors.lastname: Buxton
authors.forename: Conor
authors.initials: C
authors.lastname: Mallucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000523:psychology / Q000601:surgery*; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D044583:Neuroendoscopy / Q000379:methods* / Q000523:psychology; D009483:Neuropsychological Tests; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods* / Q000523:psychology; D055815:Young Adult