Values of Head Circumference after Shunting

In a group of patients with congenital hydrocephalus (head circumference at birth above the 97th percentile) the majority of patients have - on follow-up after early shunting - head circumference values within the normal limits (blue part of the column at the bottom). The patients with persistent macrocrania (white part of the column) had either extremely high values of head circumference prior to surgery, or were shunted too late, or had had a shunt insufficiency for a long time. The latter group with long-standing shunt insufficiency belongs to the pathologies which have to be considered in the differential diagnosis of a native hydrocephalus, or of macrocrania in general. Therefore, in every case of macrocrania, mainly in cases with an unknown history (handicapped children in nursery homes) one should look for postoperative scars and palpable parts of a shunt.