What are the indications for referring a patient with suspected hydrocephalus to a neurosurgeon?

Indications for referring a patient with suspected hydrocephalus to a neurosurgeon include:

• Neurological deterioration caused by acute hydrocephalus, which may require drainage or diversion of cerebrospinal fluid.
• Persistent or progressive symptoms with a clinical diagnosis of chronic hydrocephalus, where drainage or permanent diversion of cerebrospinal fluid is considered.
• If there is uncertainty about the benefit of permanent diversion, a trial of temporary drainage may be used to assess the need for permanent diversion.
• In children under 4 years with suspected abnormal head shape or size, especially if head circumference measurements differ by 2 or more centile lines from previous measurements, referral for assessment and cranial imaging is indicated to exclude progressive hydrocephalus.
• Immediate referral to paediatric services is warranted if the child also has signs or symptoms of raised intracranial pressure such as tense fontanelle, sixth nerve palsy, failure of upward gaze ('sunsetting'), vomiting, unsteadiness (ataxia), or headache.

These criteria ensure timely specialist assessment and management to prevent neurological damage and optimize outcomes.

References: NICE NG127, NICE NG228