• Gao-Jian Su, Jie Gao, Chu-Wei Wu, Jun-Feng Zou, Dong-Liang Zhu, Jun Liu, Jie-Hua Zhang, and Xian-Jian Huang.
• Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
• Medicine (Baltimore). 2021 Dec 10; 100 (49): e27794e27794.

RationaleHydrocephalus is a common disease in neurosurgery. The typical symptoms of hydrocephalus include urinary incontinence, gait instability, and cognitive decline. Irritability rarely occurs in patients with hydrocephalus. Irritability rarely occurs in patients with hydrocephalus, especially in long-standing overt ventriculomegaly of adulthood (LOVA).Patient ConcernsA 30-year-old female was admitted to our hospital because of mental retardation and unstable gait for more than 15 years. She had undergone ventriculoperitoneal shunt 15 years prior due to ventriculomegaly and related symptoms. However, the shunt catheter was removed shortly after surgery because of blockage, with no further postoperative treatment.DiagnosisThe patient was diagnosed with long-standing overt ventriculomegaly according to her head circumference and clinical symptoms, including adult hydrocephalus development, overt triventriculomegaly and absence of a secondary cause for aqueductal stenosis in adulthood.InterventionsAfter considerable discussion, she underwent ventriculoperitoneal shunt placement and showed dramatic and sustained improvement.OutcomesThe patient has been followed at 3-month intervals for over 2 years since discharge, and both the patient and family have reported a significant change in their daily life. She was able to live independently and control her emotions. Slight epilepsy was noted approximately 5 months after surgery but recovered 2 months later.LessonsIt is difficult to decide whether to treat LOVA when the in patients whose symptoms are not significant. We believe that early diagnosis and positive treatment can help improve outcomes and would recommend ventriculoperitoneal (VP) shunting in patients with LOVA.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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