Surgical management of arrested hydrocephalus: Case report, literature review, and 18-month follow-up

•Arrested hydrocephalus is stable ventriculomegaly without neurologic symptoms.•Headache, cognitive decline, and seizure can signal decompensation.•Endoscopic third ventriculostomy and ventriculo-peritoneal shunting are treatments.•Shunting carries a risk of subdural hematoma from over-drainage.•Early cerebral spinal fluid diversion may halt the progression of cognitive decline.

ObjectiveArrested hydrocephalus is stable ventriculomegaly without evidence of neurologic deterioration or symptoms. Management of arrested hydrocephalus in asymptomatic adults is controversial, with little clinical data. This case highlights the potential for decompensation in adults with arrested hydrocephalus and reviews the literature regarding pathophysiology and management of this clinical entity.Patients and methodsA 39 year-old gentleman with arrested hydrocephalus incidentally found during work-up for new-onset seizure and managed conservatively for ten years presented with increasing headache, memory loss, gait instability and urinary and fecal incontinence. Stable massive triventriculomegaly was documented on serial brain imaging, and ophthalmologic exam revealed no papilledema.ResultsThe patient underwent endoscopic third ventriculostomy with immediate post-operative improvement of headache, resolution of incontinence, and cessation of seizures. At 15 months after surgery, neuropsychiatric testing demonstrated improvement in visuomotor skills, problem solving, verbal fluency and cognitive flexibility compared to his pre-operative baseline. At 18 months after surgery he remained seizure free with full continence and significant improvement in headaches.ConclusionEarly recognition of arrested hydrocephalus and its potential for decompensation may prompt surgical treatment and prevent neurologic deterioration.