Treatment for Hydrocephalus

Hydrocephalus usually need prompt treatment to reduce the pressure on brain. In most of the cases, surgery is the best option to treat hydrocephalus and can be performed by following ways:  

• Shunt Surgery: It is procedure of surgical insertion of a drainage system, called shunt in the brain. Shunt basically consists of a long, flexible tube whose one end is placed in one of the ventricles of brain and other end is tunnelled under skin to another part of the body where the excessive CSF can be absorbed easily like abdomen. The shunt also has a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. Shunt needs to be regularly monitored for the rest of life of the patient to check for any blockage or infection. Shunts are of following types and have individual advantages that should be considered before choosing a type of shunt for a patient:  
  • A ventriculoperitoneal (VP) shunt
  • A ventriculoatrial (VA) shunt or "vascular shunt"
  • A lumboperitoneal shunt
  • A Torkildsen shunt
  • A ventriculopleural shunt
• Endoscopic third ventriculostomy (ETV): It is an alternative procedure to Shunt surgery that can be performed on patients with obstructive hydrocephalus. The procedure is performed using a small video camera to directly view the inside of brain. A small hole is made in the bottom of one of the ventricles or between the ventricles to allow the trapped cerebrospinal fluid to flow out of the brain. As with shunts, ETVs also need regular follow up to check for any kind of blockage or infection.
• Repeat lumbar punctures can be performed only in cases of communicating hydrocephalus
• Endoscopic fenestration of the floor of the third ventricle can be performed to provide an alternative route for CSF toward the subarachnoid space.
• Cerebral aqueductoplasty is an effective treatment for membranous and short-segment stenoses of the sylvian aqueduct.

Choroid plexectomy or choroid plexus coagulation may be effective in some cases.

Emergency treatment of Rapid-onset hydrocephalus with increased intracranial pressure (ICP)

It is an emergency condition that should be treated promptly with the following, depending on each specific case:

• Ventricular tap in infants
• Open ventricular drainage in children and adults
• LP in posthemorrhagic and postmeningitic hydrocephalus

Authored by Dr. Shyam Sundar K