Arrested Hydrocephalus in Children: Report of Five Consecutive Cases and Comprehensive Review of the Literature
Aims: Hydrocephalus can be progressive or spontaneously arrested. In arrested hydrocephalus (AH), the balance between production and absorption of the cerebrospinal fluid is restored, ventricular dilatation is no longer progressive, and the intracranial pressure returns to normal values. Patients are mostly asymptomatic, and no surgical treatment is necessary. We report the case of five patients diagnosed with AH.
Methods: Data of five children referred to our two institutions were prospectively collected over 2 years. They included sex, age, clinical features, brain magnetic resonance imaging, and follow-up.
Results: The mean age of five patients at the first control was 2.6 years (range, 0.3–4.8 years), and mean follow-up time was 1.2 years.
The main complaint at the presentation was a macrocephaly. Mild motor disorders were present in four of five cases. Typical symptoms and signs associated with raised ICP were absent in all the five patients. MRI studies showed different combination of ventricular and extra-axial subarachnoid space enlargement. No definitive cause for hydrocephalus was found in any of our patients.
In each case, we proposed an initial conservative approach. During the follow-up, we observed complete resolution of the motor disturbances in two patients and improvement in another. One patient remained asymptomatic throughout the follow-up. All subsequent MRIs showed unchanged radiologic features. In one child, we observed an aggravation of the motor disorders, and shift to a surgical approach was needed.
Conclusion: Until now, no specific clinical or paraclinical features permitting the certain diagnosis of AH have been described. Making a distinction between arrested and progressive hydrocephalus is fundamental because of the opposed appropriate management. If AH is assumed as a benign self-limited condition, progressive hydrocephalus is a potentially fatal state, which requires a prompt intervention. With this work, we offer a review of the current literature available to date, and we propose our recommendations for the management of this particular condition.
Keywords: arrested hydrocephalus, treatment.