Hydrocephalus in infancy and childhood: diagnosis and indication for operation.

Improvement of the prognosis for children suffering from hydrocephalus requires prompt diagnosis and reliable indication of surgical treatment. Today, intrauterine hydrocephalus is detectable within the first three months of pregnancy; in infancy, before the cranial sutures have fused, pathological growth of the head is the principal sign confirming together with anatomical examinations (ultrasound, CT scan) the indication of operative treatment. In later childhood, surgical treatment is only definitely indicated by symptoms and morphological examination of clearly active hypertensive hydrocephalus. Intermittently normotensive hydrocephalus (not "normal-pressure-hydrocephalus"!) showing symptoms adapted to childhood, however, often requires exact examination of intracranial pressure dynamics, including quantitative volume provocation test. "Step-by-step-procedure" is advisable (Table III).