Congenital hydrocephalus: surgical or medical approach?

While it is the treatment of choice for dogs with congenital hydrocephalus, ventriculoperitoneal shunt placement (VSP), can bring complications and the clinical parameters to take into account when deciding between surgery and medical management can be unclear.

When dealing with a hydrocephalic patient, the aim should be either to decrease cerebrospinal fluid (CSF) or increase its absorption. Corticosteroids may be effective as some studies show evidence of improvement and long-term stabilization using this therapy.

The authors of a retrospective study compared 40 cases of MRI-confirmed hydrocephaly in dogs to determine whether different clinical signs and outcomes were seen between animals treated with oral prednisolone and those treated with VSP.

The cases were grouped into those which received medical treatment (12) and those which had surgical intervention (28).

Half of the dogs in both groups experienced good long-term results with no significant dissimilarities in clinical signs, seizure history or ventricle-to-brain height ratio (VBHR) measurement on magnetic resonance imaging. This suggests that corticotherapy may be an alternative to VSP, reducing the risk of complications such as infection, pain, ventricular collapse and subdural hematoma.

The research highlights the need to further investigate the natural progression of congenital hydrocephalus and the need for similar studies with larger samples.

It’s important to note that CSF was not performed in the medically treated animals so the possibility of an underlying inflammatory CNS disease in some of the cases studied cannot be ruled out.

Gillespie, S.; Gilbert, Z.; Decker S. Results of oral prednisolone administration or ventriculoperitoneal shunt placement in dogs with congenital hydrocephalus: 40 cases (2005–2016). JAVMA – APR 1, 2019. VOL 254, NO. 7