Surgical management of arrested hydrocephalus: Case report, literature review, and 18-month follow-up.
OBJECTIVE
Arrested hydrocephalus is stable ventriculomegaly without evidence of neurologic deterioration or symptoms. Management of arrested hydrocephalus in asymptomatic adults is controversial, with little clinical data. This case highlights the potential for decompensation in adults with arrested hydrocephalus and reviews the literature regarding pathophysiology and management of this clinical entity.


METHODS
A 39 year-old gentleman with arrested hydrocephalus incidentally found during work-up for new-onset seizure and managed conservatively for ten years presented with increasing headache, memory loss, gait instability and urinary and fecal incontinence. Stable massive triventriculomegaly was documented on serial brain imaging, and ophthalmologic exam revealed no papilledema.


RESULTS
The patient underwent endoscopic third ventriculostomy with immediate post-operative improvement of headache, resolution of incontinence, and cessation of seizures. At 15 months after surgery, neuropsychiatric testing demonstrated improvement in visuomotor skills, problem solving, verbal fluency and cognitive flexibility compared to his pre-operative baseline. At 18 months after surgery he remained seizure free with full continence and significant improvement in headaches.


CONCLUSIONS
Early recognition of arrested hydrocephalus and its potential for decompensation may prompt surgical treatment and prevent neurologic deterioration.
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Electronic address: Jennifer.Hong@Hitchcock.org.
Jennifer
J
Hong
Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. Electronic address: Benjamin.G.Barrena.mil@mail.mil.
Benjamin G
BG
Barrena
Division of Neurosurgery, University of Vermont Medical Center, Fletcher House 301, 111 Cholchester Ave., Burlington, VT 05401, USA. Electronic address: S.Scott.Lollis@Hitchcock.org.
S Scott
SS
Lollis
Pediatric Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Electronic address: David.F.Bauer@Hitchcock.org.
David F
DF
Bauer
D000328:Adult; D060825:Cognitive Dysfunction / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery*; D008297:Male; D020542:Third Ventricle / Q000601:surgery; D014696:Ventriculostomy
Arrested hydrocephalus; Compensated hydrocephalus; Endoscopic third ventriculostomy; Hydrocephalus; Late idiopathic aqueductal stenosis; Long-standing overt ventriculomegaly of adulthood