Developmental considerations in hydrocephalus after traumatic brain injury in children: a narrative review

INTRODUCTION: Posttraumatic hydrocephalus (PTH) is an uncommon but serious complication of traumatic brain injury (TBI). Although extensively studied in adults, important developmental differences in the pediatric central nervous system contribute to differing PTH pathophysiology, with important differences in diagnosis, clinical course, and treatment. OBJECTIVE: This review synthesizes current evidence regarding pediatric PTH, with specific attention to the influence of pediatric developmental pathophysiology on disease susceptibility, diagnosis, and outcomes. KEY TAKEAWAYS: Pediatric-specific data on PTH remain limited; however, recent studies suggest that younger age - particularly under five years at injury - as well as injury severity are the two strongest predictors of PTH development. Clinically, PTH may present acutely with neurological deterioration or chronically with delayed recovery and neurodevelopmental regression. Early recognition is critical, as untreated PTH can lead to lifelong neurological dysfunction and even death, yet diagnosis is often delayed by symptom overlap with other posttraumatic conditions and difficulties in distinguishing true hydrocephalus from ventriculomegaly. Management is primarily surgical and centers on cerebrospinal fluid (CSF) diversion, most commonly with external ventricular drainage (EVD) in the acute phase and permanent shunting or ventriculostomy in select cases. Despite timely intervention, long-term morbidity remains substantial, underscoring the importance of prevention, early detection, and multidisciplinary follow-up.