Care of hydrocephalus in adults pearls

1. Hydrocephalus may be decreasing.  Reasons may include higher threshold for surgery (artefact of practice) increased folate in pregnancy causing less myelomeningocoele.

2.  Unchanged CT scan does not exclude obstruction

3.  ETV or endoscopic third ventriculostomy is a more recent alternative to shunting in a highly select group of patients.  The procedure is more prone to immediate catastrophe, but less to long term infection, although obstruction can occur years later (as it can with any shunting procedure).  ETV may be best for older children with obstructive hydrocephalus or aqueductal stenosis.

4.  A top down approach to assessing meningocoele would sequentially assess hydrocephalus, Chiari malformation, syringobulbia.syringomyelia, tethered cord.