Pediatric Hydrocephalus

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Pediatric hydrocephalus (HDC) is a common surgically correctable neurological problem in children  with estimated incidence of 1 in every 500 children. HDC can result from various congenital and  acquired causes including aqueductal stenosis, Chiari malformations, intraventricular hemorrhage,  trauma,  tumors,  and  infection.  There  are  effective  surgical  interventions  that  can  preserve  and  improve quality of life in patients with HDC.  

Clinical presentation 

  • Abnormal increase in head size
  • Delayed/regressed developmental milestones
  • Headache and impaired vision
  • Seizure

Investigations 

  • Cranial Ultrasound
  • Non contrast head CT scan
  • MRI brain scan

Pharmacological management  Management of associated seizures: 

A: phenobarbital (PO) 5mg/kg 12hourly for 4weeks 

OR 

C: sodium valproate (PO) 10-15mg/kg 12hourly for 4weeks 

Non pharmacological management 

  • Both CSF shunts and endoscopic third ventriculostomy (ETV) are options in the treatment of pediatric hydrocephalus. Refer for expert neurosurgical evaluation.
  • Consider Endoscopic third ventriculostomy with choroid plexus coagulation (ETV+CPC) as first line option in cases with clear obstruction to CSF flow.
  • Consider  insertion  of  ventriculoperitoneal  shunt  (VP  shunt)  where  ETV+CPC  is  not available,   has   failed   or   is   contraindicated.   Other   alternative   CSF   shunts   include ventriculoatrial (VA) or ventriculopleural shunts.
  • Prescribe preoperative antibiotics to prevent shunt infection in patients undergoing shunt surgery.

Pharmacological management 

D: ceftriaxone+sulbactam (FDC) (IV) 100mg/kg stat during anesthesia induction