adult hydrocephalus


Table of Contents


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 S et. al in 2000 published their criteria for LOVA. This was based on clinico-radiological findings.

Oi criterion
  • Overt ventriculomegaly (lateral and third ventricles) + obliteration of cortical sulci on brain imaging
  • Macrocephaly
    • > 2 standard deviation
      • males: 58 cm
      • females: 57 cm
    • +/- following symptoms:
      • subnormal IQ
      • headaches
      • dementia
      • gait disturbance
      • urinary incontinence
      • vegetative state
      • akinetic mutism
      • apathetic consciousness
      • Parkinsonism
    • Sella turcica
      • significant expand or, destruction

Clinical features

The main clinical features of LOVA are difficulty in mobilization, impaired cognition and bladder control.

The difficulty in walking could be due to gait and balance problems. The cognitive impairment includes dementia, apathy, low IQ. The main bladder problem is urinary incontinence.

Walking difficulty

COgnitive difficulty

Poor bladder control





Table 3: The incidence of major symptoms in patients with LOVA

Clinical features
  • macrocephaly
  • gait disturbance
  • urinary incontinence
  • dementia
  • low IQ
  • apathy
  • akinetic mutism
  • vegetative state
  • headaches
  • Parkinsonism
  • neuropsychiatric conditions
    • schizophrenia
    • depression
    • bi-polar disease
    • disinhibition

Table 4: Clinical features related to LOVA (Montemurro N et. al)


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

Figure 1: Classifying LOVA based on MRI findings relating to the aqueduct of Sylvius and floor of the third ventrlcle


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 around 100.

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.


Conservative management

Surgical management

Ventriculoperitoneal shunt

Endoscopic third ventriculostomy (ETV)


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.

Montemurro N, Indaimo A, Di Carlo DT, Benedetto N, Perrini P. Surgical Treatment of Long-Standing Overt Ventriculomegaly in Adults (LOVA): A Comparative Case Series between Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV). Int J Environ Res Public Health. 2022 Feb 9;19(4):1926. doi: 10.3390/ijerph19041926. PMID: 35206112; PMCID: PMC8872207.

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 December 11, 2022

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