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Hydrocephalus
Blaise V. Jones, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Intraventricular obstructive hydrocephalus (IVOH)
              • Acute IVOH (aIVOH)
              • Chronic "compensated" IVOH (cIVOH)
            • Extraventricular obstructive hydrocephalus (EVOH)
            • Frontal occipital horn ratio (FOHR)
              • (Transverse diameter of frontal horns + transverse diameter of occipital horns) ÷ 2x transverse diameter of cranium
          • Definitions

            • Ventriculomegaly caused by
              • Obstruction of CSF egress from ventricles: IVOH
              • Decreased CSF resorption from subarachnoid space: EVOH
              • Increased CSF production
            • Ventriculomegaly secondary to loss of parenchyma, a.k.a. ex vacuo dilation, is not hydrocephalus

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Other Modality Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Ha SK et al: Magnetic resonance imaging and histopathological visualization of human dural lymphatic vessels. Bio Protoc. 8(8), 2018
                                      2. Patel SK et al: Advanced neuroimaging techniques in pediatric hydrocephalus. Pediatr Neurosurg. 52(6):436-45, 2017
                                      3. Algin O et al: Assessment of third ventriculostomy patency with the 3D-SPACE technique: a preliminary multicenter research study. J Neurosurg. 122(6):1347-55, 2015
                                      4. Jessen NA et al: The glymphatic system: A beginner's guide. Neurochem Res. 40(12):2583-99, 2015
                                      5. Russo N et al: Endoscopic Approaches to Intraventricular Lesions. J Neurol Surg A Cent Eur Neurosurg. ePub, 2015
                                      6. Flannery AM et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. J Neurosurg Pediatr. 14 Suppl 1:3-7, 2014
                                      7. Mazzola CA et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr. 14 Suppl 1:8-23, 2014
                                      8. Nikas DC et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr. 14 Suppl 1:77-81, 2014
                                      9. Dinçer A et al: Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst. 27(10):1543-62, 2011
                                      10. Mirone G et al: Hydrocephalus and spinal cord tumors: a review. Childs Nerv Syst. 27(10):1741-9, 2011
                                      11. Oi S: Classification of hydrocephalus: critical analysis of classification categories and advantages of "Multi-categorical Hydrocephalus Classification" (Mc HC). Childs Nerv Syst. 27(10):1523-33, 2011
                                      12. Dinçer A et al: Is all "communicating" hydrocephalus really communicating? Prospective study on the value of 3D-constructive interference in steady state sequence at 3T. AJNR Am J Neuroradiol. 30(10):1898-906, 2009
                                      13. Feng F et al: Evaluation of radionuclide cerebrospinal fluid scintigraphy as a guide in the management of patients with hydrocephalus. Clin Imaging. 33(2):85-9, 2009
                                      14. Linninger AA et al: Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement. Ann Biomed Eng. 37(7):1434-47, 2009
                                      15. Oertel JM et al: Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. J Neurosurg. 110(1):14-8, 2009
                                      16. Stoquart-El Sankari S et al: Phase-contrast MR imaging support for the diagnosis of aqueductal stenosis. AJNR Am J Neuroradiol. 30(1):209-14, 2009
                                      17. Sekula RF Jr et al: A case of an elderly adult presenting with obstructive hydrocephalus secondary to a rare hemorrhagic suprasellar pilocytic astrocytoma. Clin Neuropathol. 27(6):396-9, 2008
                                      18. Yamada S et al: Visualization of cerebrospinal fluid movement with spin labeling at MR imaging: preliminary results in normal and pathophysiologic conditions. Radiology. 249(2):644-52, 2008
                                      19. Erdogan AR et al: Sex and handedness differences in size of cerebral ventricles of normal subjects. Int J Neurosci. 114(1):67-73, 2004
                                      20. Gaser C et al: Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex. Am J Psychiatry. 161(1):154-6, 2004
                                      21. Wyldes M et al: Isolated mild fetal ventriculomegaly. Arch Dis Child Fetal Neonatal Ed. 89(1):F9-13, 2004
                                      22. Akhondi H et al: Hydrocephalus as a presenting manifestation of neurosarcoidosis. South Med J. 96(4):403-6, 2003
                                      23. Bhattacharyya KB et al: Bobble-head doll syndrome: some atypical features with a new lesion and review of the literature. Acta Neurol Scand. 108(3):216-20, 2003
                                      24. Brown KP et al: 1H MRS in human hydrocephalus. J MRI. 14:291-9, 2003
                                      25. Grunert P et al: The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg. 46(1):16-21, 2003
                                      26. Joseph VB et al: MR ventriculography for the study of CSF flow. AJNR Am J Neuroradiol. 24(3):373-81, 2003
                                      27. Sener RN: Callosal changes in obstructive hydrocephalus: observations with FLAIR imaging, and diffusion MRI. Comput Med Imaging Graph. 26(5):333-7, 2002
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Intraventricular obstructive hydrocephalus (IVOH)
                                                  • Acute IVOH (aIVOH)
                                                  • Chronic "compensated" IVOH (cIVOH)
                                                • Extraventricular obstructive hydrocephalus (EVOH)
                                                • Frontal occipital horn ratio (FOHR)
                                                  • (Transverse diameter of frontal horns + transverse diameter of occipital horns) ÷ 2x transverse diameter of cranium
                                              • Definitions

                                                • Ventriculomegaly caused by
                                                  • Obstruction of CSF egress from ventricles: IVOH
                                                  • Decreased CSF resorption from subarachnoid space: EVOH
                                                  • Increased CSF production
                                                • Ventriculomegaly secondary to loss of parenchyma, a.k.a. ex vacuo dilation, is not hydrocephalus

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Other Modality Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Ha SK et al: Magnetic resonance imaging and histopathological visualization of human dural lymphatic vessels. Bio Protoc. 8(8), 2018
                                                                          2. Patel SK et al: Advanced neuroimaging techniques in pediatric hydrocephalus. Pediatr Neurosurg. 52(6):436-45, 2017
                                                                          3. Algin O et al: Assessment of third ventriculostomy patency with the 3D-SPACE technique: a preliminary multicenter research study. J Neurosurg. 122(6):1347-55, 2015
                                                                          4. Jessen NA et al: The glymphatic system: A beginner's guide. Neurochem Res. 40(12):2583-99, 2015
                                                                          5. Russo N et al: Endoscopic Approaches to Intraventricular Lesions. J Neurol Surg A Cent Eur Neurosurg. ePub, 2015
                                                                          6. Flannery AM et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology. J Neurosurg Pediatr. 14 Suppl 1:3-7, 2014
                                                                          7. Mazzola CA et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: Management of posthemorrhagic hydrocephalus in premature infants. J Neurosurg Pediatr. 14 Suppl 1:8-23, 2014
                                                                          8. Nikas DC et al: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus. J Neurosurg Pediatr. 14 Suppl 1:77-81, 2014
                                                                          9. Dinçer A et al: Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst. 27(10):1543-62, 2011
                                                                          10. Mirone G et al: Hydrocephalus and spinal cord tumors: a review. Childs Nerv Syst. 27(10):1741-9, 2011
                                                                          11. Oi S: Classification of hydrocephalus: critical analysis of classification categories and advantages of "Multi-categorical Hydrocephalus Classification" (Mc HC). Childs Nerv Syst. 27(10):1523-33, 2011
                                                                          12. Dinçer A et al: Is all "communicating" hydrocephalus really communicating? Prospective study on the value of 3D-constructive interference in steady state sequence at 3T. AJNR Am J Neuroradiol. 30(10):1898-906, 2009
                                                                          13. Feng F et al: Evaluation of radionuclide cerebrospinal fluid scintigraphy as a guide in the management of patients with hydrocephalus. Clin Imaging. 33(2):85-9, 2009
                                                                          14. Linninger AA et al: Normal and hydrocephalic brain dynamics: the role of reduced cerebrospinal fluid reabsorption in ventricular enlargement. Ann Biomed Eng. 37(7):1434-47, 2009
                                                                          15. Oertel JM et al: Endoscopic third ventriculostomy in obstructive hydrocephalus due to giant basilar artery aneurysm. J Neurosurg. 110(1):14-8, 2009
                                                                          16. Stoquart-El Sankari S et al: Phase-contrast MR imaging support for the diagnosis of aqueductal stenosis. AJNR Am J Neuroradiol. 30(1):209-14, 2009
                                                                          17. Sekula RF Jr et al: A case of an elderly adult presenting with obstructive hydrocephalus secondary to a rare hemorrhagic suprasellar pilocytic astrocytoma. Clin Neuropathol. 27(6):396-9, 2008
                                                                          18. Yamada S et al: Visualization of cerebrospinal fluid movement with spin labeling at MR imaging: preliminary results in normal and pathophysiologic conditions. Radiology. 249(2):644-52, 2008
                                                                          19. Erdogan AR et al: Sex and handedness differences in size of cerebral ventricles of normal subjects. Int J Neurosci. 114(1):67-73, 2004
                                                                          20. Gaser C et al: Ventricular enlargement in schizophrenia related to volume reduction of the thalamus, striatum, and superior temporal cortex. Am J Psychiatry. 161(1):154-6, 2004
                                                                          21. Wyldes M et al: Isolated mild fetal ventriculomegaly. Arch Dis Child Fetal Neonatal Ed. 89(1):F9-13, 2004
                                                                          22. Akhondi H et al: Hydrocephalus as a presenting manifestation of neurosarcoidosis. South Med J. 96(4):403-6, 2003
                                                                          23. Bhattacharyya KB et al: Bobble-head doll syndrome: some atypical features with a new lesion and review of the literature. Acta Neurol Scand. 108(3):216-20, 2003
                                                                          24. Brown KP et al: 1H MRS in human hydrocephalus. J MRI. 14:291-9, 2003
                                                                          25. Grunert P et al: The role of third ventriculostomy in the management of obstructive hydrocephalus. Minim Invasive Neurosurg. 46(1):16-21, 2003
                                                                          26. Joseph VB et al: MR ventriculography for the study of CSF flow. AJNR Am J Neuroradiol. 24(3):373-81, 2003
                                                                          27. Sener RN: Callosal changes in obstructive hydrocephalus: observations with FLAIR imaging, and diffusion MRI. Comput Med Imaging Graph. 26(5):333-7, 2002