A case of massive hydrocephalus; perioperative challenges and literature review

Abstract

Hydrocephalus is a disorder of abnormal accumulation of cerebrospinal fluid (CSF) in the ventricular system. Accumulation of CSF occurs due to an imbalance between CSF production and absorption. In the newborn and infants, hydrocephalus almost entirely presents as an enlarged head resulting from the separation of cranial bone plates, so any newborn or infant with an enlarged head should undergo evaluation. Late reporting of cases makes it obvious that hydrocephalus may have become enlarged massively. We report a case of giant hydrocephalus in a 1 year old infant (head circumference of 86 cm) posted for ventriculoperitoneal shunt surgery with anesthetic consideration of difficult intubation because of such a large head size, positioning , age related pathophysiology and temperature regulation. The case was managed successfully with an uneventful hospital stay and a significant decrease in head size was noted from pre-operative 86 cm to 70 cm on fifteenth post-operative follow up day.

Key words: Hydrocephalus; Positioning; Craniotomy; Hydrocephalus / surgery; Ventriculoperitoneal Shunt 
Citation: Sharma J, Purohit S, Sharma M, Kumar M. A case of massive hydrocephalus; perioperative challenges and literature review. Anaesth Pain & Intensive Care 2016;20(3):353-357

Received: 19 August 2016; Reviewed: 12 September 2016; Accepted: 15 September 2016