adult hydrocephalus

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LOVA stands for long-standing ventriculomegaly of the adults. Shizuo Oi in 1996 described LOVA as a distinct entity of adult hydrocephalus.

Definition of LOVA is controversial. The two common criteria for diagnosing LOVA are the Oi and the Vad criteria.


Diagnostic criteria

Oi criteria for diagnosis of LOVA

The first criteria for LOVa was published by Oi et. al [2]

  • Macrocephaly
    • > 2 standard deviation
      • males: 58 cm
      • females: 57 cm
  • Sella turcica
    • significant expand or,
    • destruction

Ved criteria for diagnosis of LOVA

Ved and colleagues from Cardiff published their criteria for LOVA in 2017 [3].

  • Clinical symptoms of hydrocephalus in adults
    • headaches
    • cognitive decline
    • imbalance
    • gait disturbance
    • psychological disturbance
    • visual deterioration/diplopia
  • Macrocephaly
    • > 98th
      • male: > 53.8 cm
      • females: > 52.9 cm
  • MRI/CT
    • tri-ventriculomegaly +
    • sulcal effacement +/-
    • destruction of sella
  • No evidence of secondary cause of aqueduct stenosis in adults
    • previosu meningitis
    • subarcahnoid haemorrhage


Patients with LOVA could be divided into those with obstruction to flow at the aqueduct of sylvius or not.

Figure 1. Types of LOVA


Oi S et. al (1996) reported that half of their patient with LOVA had mental retardation or dementia (check the original reference). LOVA may or may not be associated with aqueduct stenosis. Al-Jumaily et. al (2012) undertook pre-op neuropsychological studies in their patients with LOVA associated with aqueduct stenosis.

Al-Jumaily et. al found that mean score on Repeatable battery for the assessment of neuropsychological status (RBANS) the mean score for each of the parameters (immediate memory, visuospatial/constructional, language,  attention, delayed memory) were lower than for the average population; the total mean score was 71. This is lower than that of general population which is around100.

Post-operatively 6 of the 9 patients reported subjective improvement in memory. It would appear 11 of the 20 patients (i.e.55% of the patients) did not undergo post-op neuropsychological assessment.  There was no report of the results of post-op formal neuropsychological assessment (RBANS). The authors found  the there was no statistically significant difference in the Hospital Anxiety and Depression Scale (HADS) score between the patients they had studied and the general population.


Al-Jumaily M, Jones B, Hayhurst C, Jenkinson MD, Murphy P, Buxton N, Mallucci C. Long term neuropsychological outcome and management of ‘decompensated’ longstanding overt ventriculomegaly in adults. Br J Neurosurg. 2012 Oct; 26(5): 717-21. doi: 10.3109/02688697.2012.673647. Epub 2012 Apr 3. PMID: 22468979.

Oi S, Sato O, Matsumoto S: Neurological and medico-social problems of spina bifida patients in adolescence and adulthood. Childs Nerv Syst 12:181–187, 1996

Oi S, Shimoda M, Shibata M, Honda Y, Togo K, Shinoda M, Tsugane R, Sato O. Pathophysiology of long-standing overt ventriculomegaly in adults. J Neurosurg. 2000; 92(6): 933-40. doi: 10.3171/jns.2000.92.6.0933. PMID: 10839252.

Ved R, Leach P, Patel C. Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA) Acta Neurochir (Wien) 2017; 159(1): 71–79. doi: 10.1007/s00701-016-2998-7

Last updated byGanealingam Narenthiran on November 15, 2022

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