Hydro (peds)

Last modified by Hussein Abdallah on 2025/05/26 00:17

FACTS

Punchline

Can be classified as one of the following:

1. Communicating hydro (non-obstructive)

- NOTE: hydro ex vacuo is to be distinguished from communicating hydro by lack of 3rd V enlargement, effacement of sulci, and periventricular edema on T2/FLAIR) sequences.

2. Non-communicating hydro (obstructive)

CONSULT

HPI

Chart review:

- apneic spells, bradycardia, irregular respirations

- OFC increasing at >2cm // week or crossing 97th percentile

FOCUSED EXAM

Infants: fontanelle, sutures

upgaze paresis

IMG

Communicating (non-obstructive): should see dilation of entire ventricular system, patency of foramina of Monroe/aqeuduct, fourth ventricle outlets

Non-communicating (obstructive): dilation only proximal to obstruction

on MRI:

- should see transependymal flow in periventricular WM), cortical sulci. effacement

-evaluate for bowing of third ventricule (FIESTA sagittal)

-evaluate for aqueductal stenosis

A/P

[ ] MRI Brain with / without (not a FAST) to fully evaluate ventricular anatomy and rule out pressence of mass lesion.

To evaluate cisternal anatomy in detail (which influences treatment options), put one of the following sequences in special requests.

FIESTA (fast imaging employing steady-state acquisition)
bFFE (balanced fast field echo)
CISS (constructive interference in steady state)

[ ] Optho c/s ot evaluate for visual compromise

- Communicating hydro: need VPS

- Non-communicating (obstructive) hydro: need VPS vs. ETV +/- CPC (choroid plexus cauterization)

a favorable anatomy for ETV: prepontine/interpeduncular cisterns (on MRI bFFE/FIESTA/CISS sequences) need to be evaluated to localize basilar apex in relation to third ventricle and see if there are arachnoid adhesions that can obstruct subarachnoid cisternal space (increases risk fof failure of ETV)

- Counsel: up to 1/3 children will fail shunt in first 3 months, 6% will get infections.

risk factors for infection: young age (<6 months), G-tube, prior neurosurgery

Notes

Aqueductal stenosis

Figure 1: Sea