A case of massive hydrocephalus; perioperative challenges an
A one year old male child presented to neurosurgery department of SMS Medical College, with history of gradually progressive head size since birth. But patient was asymptomatic & able to take feed properly until a month ago when his mother noticed occasional vomiting. Patient was delivered via an uncomplicated cesarean section. Uneventful birth history was given by mother and the cry was normal at birth. Except for the large head size at time of birth; no further detail of exact cause of cesarean section; previous details of antenatal, natal and postnatal checkups could collected from the mother because of her rural background. On examination there was profoundly large head size, fontanelle was lax, positive sunset sign in bilateral eyes, enlarged and engorged scalp vein (Figure 1). CT of the brain showed bilateral massive enlargement of lateral ventricle, splaying of sutures & cortical thinning, barely any cortex was visible (Figure 2). The patient was scheduled to undergo placement of ventriculoperitoneal shunt. A thorough pre anesthetic examination was performed. Routine laboratory investigations including hemoglobin, total and differential leucocyte count, urinalysis, and urine microscopy, and x-ray chest, were within normal limits. A difficult airway was anticipated because of massively enlarged head size. Child was kept nil by mouth and clear liquids were allowed 4 h before surgery....