A Report on Two Cases of Spontaneous Cutaneous Rupture Secondary to Severe Congenital Hydrocephalus

Introduction: Congenital hydrocephalus is one of the most common causes of neurosurgical consults globally. Management delays may cause unique complications such as spontaneous cutaneous rupture and cerebrospinal fluid leakage. This may occur frequently in low-to-middle income countries, where prenatal and neurosurgical healthcare services are less accessible; however, no such cases have been recorded in the Philippines. Case Presentation: We present two cases of severe hydrocephalus with spontaneous cutaneous rupture. The first is a 7 - month-old female with leaking CSF from a 1-centimeter spontaneous cutaneous rupture at the right anterior aspect of her anterior fontanelle. On admission, her head circumference was 85 cm. Her imaging showed markedly dilated lateral ventricles with pneumoventricle, and a widened anterior fontanelle. Her defect was sutured, and she was treated with appropriate antibiotics. She was discharged once infection resolved, but eventually expired at home. Discussion: The second is a 3-year-old male who presented with leaking CSF from a cutaneous rupture at the anterior border of the posterior fontanelle. His head circumference was 92cm, with a 4-centimeter scalp defect exposing the underlying ventricle. The defect was sutured at the emergency room. His family refused further diagnostics and treatment, and opted to bring him home, and was lost to follow-up. Results: Only a few case reports on spontaneous cutaneous rupture are available to guide its treatment, with none coming from the Philippines. Our cases establish the local incidence of this underreported complication and demonstrate that simple suturing and antibiotic treatment do not lead to desirable outcomes.