What are the treatment options for hydrocephalus?

The treatment for hydrocephalus aims to reduce pressure on the brain caused by the accumulation of excess cerebrospinal fluid (CSF). The most common treatment for hydrocephalus is surgery, and there are two primary surgical options: shunt placement or endoscopic third ventriculostomy (ETV) [1].

A shunt is a thin tube that is surgically inserted into the brain. The shunt is connected to another tube under the skin to drain excess fluid into the chest cavity or abdomen, where the body can absorb it [1]. Endoscopic third ventriculostomy (ETV) is a procedure in which a small hole is made in the floor of the third ventricle in the brain, allowing cerebrospinal fluid to flow out to relieve pressure [1].

Shunt Surgery

Shunts generally work well, but they require regular medical monitoring and check-ups [1]. Shunts may stop working or become infected, leading to the accumulation of cerebrospinal fluid in the brain again [1]. In these cases, a doctor must replace the blocked shunt system to reduce the buildup of cerebrospinal fluid [1]. A person may require several surgeries to repair or replace the shunt over their lifetime [1]. Regular care and follow-up by a doctor are important to identify subtle changes that might indicate problems with the shunt [1].

Endoscopic Third Ventriculostomy

Endoscopic third ventriculostomy (ETV) can sometimes be used as an alternative to shunt surgery [4]. During this procedure, a small hole is made in the floor of the third ventricle to allow trapped fluid to escape to the surface where it can be absorbed [4]. Sometimes, a doctor may perform this procedure in conjunction with cauterizing the choroid plexus in the lateral ventricles to reduce the production of cerebrospinal fluid [1].

Surgical Risks and Complications

Brain surgery involves general risks such as reactions to medications, breathing problems, bleeding, blood clots, and infection [3]. Potential risks of brain surgery may include problems with speech, memory, muscle weakness, balance, vision, and coordination, which may persist for a short time or may be permanent [3]. Before undergoing surgery, the surgeon should discuss potential complications with you [4].

Recovery and Post-Surgical Care

After surgery, you will be closely monitored by a healthcare team to ensure that your brain is functioning properly [3]. You may need oxygen for a few days, and the head of your bed will be kept elevated to help reduce swelling of your face or head [3]. You will be given medications to relieve pain [3]. You will typically stay in the hospital for 3 to 7 days [3]. You may require physical therapy (rehabilitation) [3]. People should seek medical help immediately if symptoms appear that suggest the shunt system is not working correctly, such as headaches, double vision, nausea or vomiting, neck or shoulder muscle pain, seizures, redness or tenderness along the shunt track, low-grade fever, drowsiness or fatigue, or the return of hydrocephalus symptoms [1]. More information about hydrocephalus, its diagnosis, and living with it can be found in the article Hydrocephalus: Diagnosis, Treatment, and Coexistence (Arabic).

Long-term Outcomes

The success of shunt treatment varies from person to person, but some individuals recover almost completely after treatment and enjoy a good quality of life [1]. Many people diagnosed with hydrocephalus benefit from rehabilitative therapies and educational interventions in addition to surgery [1]. Treatment by a multidisciplinary team of medical specialists, rehabilitation therapists, and educational experts is crucial for achieving a positive outcome [1].

Medical references

• Hydrocephalus
• Hydrocephalus - NHS
• Brain surgery