Fig. 1

Flowchart of infantile hydrocephalus management

Definition of nonprogressive hydrocephalus: (1) the measurement indices are stable or decreased upon the latest continuous cranial ultrasonography (cUS) and (2) clinical manifestations include a large head, bulging anterior fontanel, suture separation, irritability, sunset phenomena of the eyes, and hypotonia, without neurological deterioration. Temporizing neurosurgical procedures (TNPs) were performed upon the surgeon’s discretion if the head circumference and cUS measurement indices increased. The surgical intervention time was according to the reference ventricular index (VI) value for the corrected age at hydrocephalus onset less than or equal to 40 weeks [30]. The VI greater than 18.5 mm (P97th + 4 mm at 40 week) or persistent progressive cUS indices with neurological deterioration were the surgical intervention time for the patients at onset corrected age greater than 40 weeks. TNPs include ventricular access devices or Ommaya reservoir, external ventricular drainage, and ventriculosubgaleal shunts. The appropriate technique was selected based on the surgeon’s discretion. The TNPs aimed at reducing ventricular dilation by draining or aspirating 10–20 ml/kg of cerebrospinal fluid daily as per continuous cUS monitoring and clinical assessment. Moreover, it is crucial to evaluate intraoperative and postoperative complications.

Abbreviation: cUS, cranial ultrasonography; VP, ventriculoperitoneal; VI, ventricular index; CA, corrected age