Is 1 cm Hydrocephalus Serious? When Is Surgery Necessary?

Is 1 centimeter of hydrocephalus serious? Is surgery necessary?

Hello Dr.
Chang,
My baby experienced an unexplained intracranial hemorrhage at 3 and a half months old (without any trauma or vigorous shaking).
A CT scan was performed on the day of the hemorrhage, and the hospital reported that the bleeding was minimal, located on the right side of the brain and extending to the posterior midline.
However, 8 hours later, due to a significant drop in hemoglobin, there was suspicion of ongoing bleeding, and 100cc of blood was transfused.
On the third day, an ultrasound was performed, and the hospital determined there was no further bleeding, but there was hydrocephalus measuring 0.5 cm, possibly due to a blood clot obstructing the absorption of cerebrospinal fluid.
At that time, medication was used to control intracranial pressure, and surgery was not recommended.
The baby was discharged after 14 days, and no further ultrasound examinations were conducted during this period.

On the 21st day, during a follow-up visit, an ultrasound showed that the hydrocephalus had increased to 1 cm.
The hospital believes it may have already reached 1 cm before discharge, but since no ultrasound was performed initially, this could not be confirmed.
They now recommend a follow-up examination in one month.
Currently, the baby is only taking anticonvulsant medication.

I would like to ask Dr.
Chang: Is a 1 cm hydrocephalus considered severe? How long does it typically take for a blood clot from a brain hemorrhage to be absorbed? Is it possible for the hydrocephalus to resolve? At what measurement would surgery be necessary? Thank you.

ken, 30~39 year old female. Ask Date: 2010/11/29

Dr. Zhang Yuanyi reply Neurosurgery

Dear Ken,
Hello, it is unclear whether the hydrocephalus you mentioned refers to communicating hydrocephalus or chronic subdural hematoma.
Generally, if there is a significant amount of blood clot, it typically takes more than a month to be absorbed.
The resolution of hydrocephalus cannot be predicted.
If it is a subdural hematoma, the decision to operate depends on the presence of associated neurological symptoms.
In adults, if the subdural hematoma exceeds 1 cm, the likelihood of spontaneous absorption is lower.
Therefore, if it exceeds 1 cm and is accompanied by neurological deficits, surgical intervention is generally recommended.
In any case, please discuss this matter in detail with your original physician.
Wishing you safety and health.
Sincerely,
Dr.
Zhang Yuan-yi
Attending Physician, Department of Neurosurgery
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2010/11/29

More Info

Hydrocephalus, or the accumulation of cerebrospinal fluid (CSF) in the brain, can be a serious condition, especially in infants. In your case, a measurement of 1 cm of hydrocephalus is concerning, but it is not necessarily critical. The severity of hydrocephalus is often assessed based on the rate of increase in ventricular size, the presence of symptoms, and the underlying cause.

In infants, hydrocephalus can develop due to various reasons, including bleeding in the brain, as you mentioned with your baby's case of intracranial hemorrhage. The blood can block the normal flow of CSF, leading to an accumulation of fluid. The fact that your baby had a small amount of bleeding and subsequently developed hydrocephalus indicates that the body is responding to the injury, but it also requires careful monitoring.

Typically, a ventricular size of 1 cm is considered mild to moderate hydrocephalus. However, the need for surgical intervention depends on several factors:
1. Symptoms: If your baby exhibits signs of increased intracranial pressure, such as irritability, vomiting, lethargy, or changes in consciousness, this may necessitate surgical intervention.
2. Rate of Increase: If the hydrocephalus is progressive, meaning the ventricular size is increasing rapidly over time, this is a stronger indication for surgery. Regular follow-up imaging, such as ultrasounds or MRIs, is crucial to monitor this.

3. Underlying Cause: If the hydrocephalus is secondary to a blockage caused by a blood clot, it may resolve as the clot is absorbed. The absorption of blood clots can vary; typically, it may take weeks to months for a clot to be reabsorbed completely, depending on the size and location.

4. Surgical Threshold: Generally, surgery is considered when the ventricular size exceeds 1.5 to 2 cm, especially if there are associated symptoms or if the hydrocephalus is worsening. The most common surgical treatment for hydrocephalus is the placement of a shunt, which helps drain excess CSF and relieve pressure on the brain.

In your situation, it is essential to follow the recommendations of your healthcare team and continue with the scheduled follow-up ultrasounds. The fact that your baby is currently on anticonvulsant medication suggests that the medical team is taking a cautious approach to manage any potential complications from the brain injury.

In summary, while 1 cm of hydrocephalus is not immediately alarming, it does require close monitoring. The key is to watch for any changes in symptoms and to have regular imaging to assess the condition of the ventricles. If there are any concerns about your baby's condition or if symptoms develop, do not hesitate to contact your healthcare provider for further evaluation.

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