Neuro-ophthalmologic Complications of Hydrocephalus and Shunting Procedures

Ventricular enlargement due to obstructed cerebrospinal fluid (CSF) flow can produce a multitude of neuro-ophthalmic problems that range from disturbed ocular motility such as the dorsal midbrain syndrome to visual field defects of optic disc, chiasmal and retrogeniculate nature, and loss of visual acuity (1-4). The most frequently cited complications are reported in those patients who have aqueductal obstruction and enlargement of the third ventricle however neuro-ophthalmologic abnormalities are found in patients with communicating hydrocephalus. Some neuro-ophthalmic problems are due simply to the effects of increased intracranial pressure. Complications attributed to hydrocephalus must be separated from damage to visual pathways directly caused by tumors, infections, inflammation and other conditions causing hydrocephalus (5-7). It is not always possible to make clean divisions but it has been my aim in this review to try to identify problems resulting from ventricular and aqueductal dilation, as well as e effects of increased spinal fluid pressure.