Communicating Hydrocephalus
Communicating hydrocephalus is the accumulation of cerebrospinal fluid (CSF) caused by impaired absorption even though the flow pathway through the ventricular system remains open. It commonly follows damage to the absorptive surfaces after subarachnoid hemorrhage or meningitis.
Përditësimi i fundit: 2026-06-07
Definition
Communicating hydrocephalus is the accumulation of CSF resulting from an imbalance between production and absorption in the subarachnoid space, even though CSF circulation within the ventricular system is unobstructed. CSF passes freely from the ventricles into the subarachnoid space, but absorption at the level of the arachnoid villi is inadequate; as a result the entire ventricular system enlarges diffusely and intracranial pressure rises.
Causes
The most common cause is reduced CSF absorption due to fibrosis of the arachnoid villi after subarachnoid hemorrhage or meningitis. Less often, excess CSF production from a choroid plexus tumor plays a role. Trauma and prior infections can also impair the absorptive surfaces and cause communicating hydrocephalus. Hemorrhage and infection are prominent causes in adults, and perinatal hemorrhage and infection in children.
Symptoms
Symptoms reflect raised intracranial pressure: headache, nausea and vomiting, blurred and double vision, balance and gait disturbance, difficulty with attention and memory, and a tendency to drowsiness. The presentation may be acute or develop slowly over weeks to months. In infants with open fontanelles, rapid head growth, a tense fontanelle and downward deviation of the eyes may be seen.
Diagnosis
Brain CT shows diffuse ventricular enlargement and periventricular edema; the absence of a flow-path obstruction suggests the communicating type. Brain MRI provides detailed anatomical assessment and helps exclude obstructive causes. Lumbar puncture may be performed when communicating hydrocephalus is suspected, evaluating CSF pressure and composition. The differential diagnosis should exclude ventricular enlargement secondary to age-related brain atrophy (ex-vacuo).
Treatment
In acute symptomatic cases, a temporary external ventricular drain can control pressure. Definitive treatment most often uses a ventriculoperitoneal (VP) shunt, a valve system carrying CSF from the ventricle to the abdominal cavity while regulating pressure. Ventriculoatrial or lumboperitoneal shunts may be alternatives in selected cases. Endoscopic third ventriculostomy is generally not suitable in communicating hydrocephalus, because the problem lies in absorption rather than the flow pathway.
Prognosis
Untreated hydrocephalus can lead to progressive neurological decline and brain injury. With appropriate shunt treatment, most patients can lead a functional life. Shunts may over time become blocked or infected or cause over- or under-drainage, so regular follow-up and shunt revision when needed are important. Outcomes vary by patient and cannot be guaranteed.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:426-451.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:495-514.
- Rekate HL. A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics. Childs Nerv Syst. 2011;27(10):1535-1541.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.