Hydrocephalus: Types and Treatment Options

of life.

What Is Hydrocephalus?

Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) within the brain's ventricles, causing them to enlarge and increasing pressure inside the skull. This fluid surrounds the brain and spinal cord, providing protection and nourishment. Hydrocephalus develops when the balance between CSF production and drainage is disrupted.

Symptoms of Hydrocephalus

The symptoms of hydrocephalus vary depending on the patient's age, the underlying cause, and the severity of the condition.

In infants, symptoms may include an abnormally enlarged head, noticeable bulging of the fontanelle (the soft spot on top of the baby's head), recurrent vomiting, excessive sleepiness or lethargy, and feeding difficulties.

In older children, symptoms may include headaches, vomiting, unusual drowsiness or lethargy, visual disturbances, difficulty maintaining balance or walking, and a noticeable decline in concentration or academic performance.

In adults, symptoms may include headaches, particularly in the morning, nausea or vomiting, blurred vision, and problems with balance or walking.

Normal pressure hydrocephalus, which typically affects older adults, is often associated with walking difficulties, memory impairment, and problems with bladder control.

The severity and onset of symptoms vary from one patient to another. Medical consultation is recommended if any of these symptoms occur so that the condition can be assessed and its underlying cause identified.

Types of Hydrocephalus

Hydrocephalus is classified into several main types according to its underlying mechanism and cause.

Communicating Hydrocephalus

Communicating hydrocephalus occurs when cerebrospinal fluid flows normally out of the ventricles but its subsequent absorption is impaired. It is frequently associated with conditions such as meningitis or subarachnoid hemorrhage.

Non-communicating or Obstructive Hydrocephalus

Non-communicating hydrocephalus, also known as obstructive hydrocephalus, results from a blockage in the flow of cerebrospinal fluid within the ventricular system. This may occur in conditions such as aqueductal stenosis, where narrowing of the cerebral aqueduct prevents fluid from reaching the areas where it is normally absorbed.

Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus typically affects older adults. It is characterized by enlarged ventricles despite cerebrospinal fluid pressure remaining within the normal range. It is commonly associated with walking difficulties, memory impairment, and problems with bladder control.

Hydrocephalus Ex Vacuo

Hydrocephalus ex vacuo develops when brain tissue shrinks or is lost, causing the ventricles to enlarge as a compensatory response rather than as a result of a direct disturbance in cerebrospinal fluid drainage.

Hydrocephalus by Time of Onset

Hydrocephalus may be congenital, meaning it is present at birth due to abnormalities of the nervous system or neural tube defects.

It may also be acquired, developing after birth as a result of head injuries, bleeding, meningitis, or brain tumors.

Treatment Options for Hydrocephalus

The primary treatment for hydrocephalus involves surgical intervention aimed at draining excess cerebrospinal fluid or improving its flow.

Ventricular Shunt Surgery

Ventricular shunt placement is one of the most widely used surgical treatments for hydrocephalus. The procedure involves implanting a flexible tube equipped with a specialized valve that redirects cerebrospinal fluid from a brain ventricle to another part of the body, such as the abdominal cavity.

This approach requires long-term follow-up because of the potential for shunt blockage, infection, or valve malfunction.

Endoscopic Third Ventriculostomy (ETV)

Endoscopic third ventriculostomy is used in selected cases. During this procedure, the surgeon creates a small opening in the floor of the third ventricle, allowing cerebrospinal fluid to flow into the spaces surrounding the brain while bypassing the obstruction.

In some cases, particularly in children, the procedure may be combined with choroid plexus cauterization (CPC) to reduce cerebrospinal fluid production.

Other Surgical Approaches

In certain cases, surgeons may use a combination of treatments or newer technologies, such as magnetically adjustable shunts, which allow more precise pressure adjustment. Other techniques remain under clinical investigation.

Complications and Follow-up Care

Although surgical treatment is effective, complications may occur, including shunt blockage or malfunction, infection, bleeding, seizures, or postoperative fluid accumulation beneath the skin.

Signs of Shunt Malfunction or Blockage

Patients with a ventricular shunt may develop warning signs of malfunction or blockage that require urgent medical assessment.

These signs may include severe or worsening headaches, recurrent vomiting, excessive sleepiness or difficulty waking up, sudden changes in consciousness, visual disturbances, swelling or redness along the shunt pathway beneath the skin, or the return of symptoms experienced before shunt placement.

If any of these warning signs appear, patients should seek medical attention or visit the nearest emergency department without delay.

Regular medical follow-up is essential. This includes periodic imaging to assess the function of the shunt or drainage opening, shunt adjustments as the child grows, and rehabilitative support when needed, such as physical therapy, speech therapy, and cognitive or educational support.

Long-term Outlook

Treatment outcomes depend on the type and underlying cause of hydrocephalus, as well as how quickly the condition is diagnosed.

Children who are diagnosed and treated early often achieve good growth and normal motor and cognitive development.

Patients with normal pressure hydrocephalus may require long-term follow-up to improve walking ability and cognitive function.

Hydrocephalus Care at Neuron Clinics

At Neuron Clinics, our neurosurgery consultants and specialists provide comprehensive care for children and adults with hydrocephalus. Care begins with a thorough assessment to determine the type and underlying cause of the condition, followed by selecting the most appropriate surgical intervention, including ventricular shunt placement or endoscopic third ventriculostomy when suitable.

Care extends beyond surgery to include long-term follow-up, ongoing assessment of the patient's condition, and monitoring of treatment effectiveness, with the aim of preserving brain function and improving quality of life.