Management of Developing Ventriculomegaly with Communicating Hydrocephalus
Immediate Assessment and Monitoring
- The American College of Neurological Surgeons recommends determining if a patient requires emergent intervention by evaluating for signs of elevated intracranial pressure, such as altered mental status, headache, nausea/vomiting, papilledema, or Cushing's triad, with a strength of evidence of Class III 2
- The Congress of Neurological Surgeons suggests evaluating for progressive macrocephaly in infants with open fontanelles, with a strength of evidence of Class III 3, 4
- The management of developing ventriculomegaly with communicating hydrocephalus requires urgent neurosurgical consultation for cerebrospinal fluid diversion, with treatment decisions based on the presence of symptoms, progressive ventricular enlargement, and signs of elevated intracranial pressure rather than ventricular size alone, with a strength of evidence of Class III 1, 2
Surgical Management Options
- The American Association of Neurological Surgeons recommends external ventricular drainage for acute obstructive hydrocephalus to prevent cerebral herniation, with a strength of evidence of Class III 1, 2
- The Congress of Neurological Surgeons suggests that ventriculoperitoneal shunting is the definitive treatment for symptomatic communicating hydrocephalus requiring permanent CSF diversion, with a strength of evidence of Class III 2
- Endoscopic third ventriculostomy with or without choroid plexus coagulation offers an alternative to shunt dependency and associated high shunt failure morbidity, with a strength of evidence of Class III 3, 4, 5
Conservative Management
- The American College of Neurological Surgeons recommends conservative management for asymptomatic ventriculomegaly, involving serial neuroimaging to monitor ventricular size, regular neurological examinations, and monitoring for development of symptoms requiring intervention, with a strength of evidence of Class III 2, 3, 4, 6