Airway Management in an Infant With Huge Hydrocephalus.

Huge hydrocephalus is defined as a head circumference larger than the length of the child. We discuss the perioperative anesthetic management of a case of huge hydrocephalus during ventriculoperitoneal shunt placement, focusing primarily on the airway management. The patient was a 4-month-old with a midline supratentorial lesion causing obstructive hydrocephalus due to compression of the sylvian aqueduct. For optimum positioning for direct laryngoscopy, a pillow was placed below the baby's torso, to achieve a slight extension at the atlantoaxial joint. This maneuver decreased the angle between the line of vision and the laryngeal axis (calculated from the images), which effectively improved alignment.