Hydrocephalus - Treating hydrocephalus

Hydrocephalus (fluid on the brain) is treated with surgery.

Congenital and acquired hydrocephalus

Babies who are born with hydrocephalus (congenital hydrocephalus) and adults or children who develop hydrocephalus (acquired hydrocephalus) usually require prompt treatment to reduce the pressure on their brain. If the hydrocephalus is not treated, the rise in pressure will damage the brain.

Both congenital and acquired hydrocephalus will be treated with either shunt surgery or neuroendoscopy (see below).

Normal pressure hydrocephalus

Hydrocephalus that usually develops in older people (normal pressure hydrocephalus or NPH) can also be treated with a shunt. However, experience has shown that not everyone with NPH will benefit from shunt surgery.

Due to the risks of complications occurring as a result of surgery, you will need tests to assess whether the potential benefits of surgery outweigh the risks. A lumbar drainage test or lumbar infusion test, or both, can be used to find out whether shunt surgery will benefit you. See diagnosing hydrocephalus for more information about these tests.

Shunt surgery will be recommended if testing reveals that it would be beneficial.

Shunt surgery

Shunt surgery involves implanting a thin tube, called a shunt, in the brain. The excess cerebrospinal fluid (CSF) in the brain runs through the shunt to another part of the body, usually the abdomen. From here the fluid is absorbed into your blood stream. The shunt has a valve inside to control the flow of CSF and to ensure it does not drain too quickly. You can feel the valve as a lump under the skin of your scalp.

The operation

Shunt surgery is carried out by a neurosurgeon (a specialist in surgery of the brain and nervous system). You will be given a general anaesthetic before the operation so that you will be asleep throughout the procedure, which usually takes one to two hours. 

After the operation, you may need to spend a few days in hospital to recover. If you have stitches in the wound in your head, they may dissolve on their own, or you may be advised about when these will be removed. Some surgeons use skin staples to close the wound. Like stitches, these will need to be removed after a few days.

Once the shunt has been installed, further treatment for hydrocephalus may be required if the shunt becomes blocked or infected. Shunt repair surgery will then be necessary. See complications of hydrocephalus for more information.

Endoscopic third ventriculostomy (ETV)

An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV).

ETV involves making a hole in the floor of the brain, allowing the trapped CSF to escape to the surface of the brain where it can be absorbed, instead of inserting a shunt.

An ETV is not suitable for everyone. However, it could be a possible treatment option if the build-up of CSF in your brain is the result of a blockage (obstructive hydrocephalus). The CSF will be able to drain through the hole, avoiding the blockage.

The operation

You will be given general anaesthetic before the operation. The neurosurgeon will then make a small hole in your skull and use an endoscope to look inside the chambers of your brain. An endoscope is a thin, long tube that has a light and a video camera at one end. A small hole will be made inside your brain with the help of the endoscope. After the endoscope has been removed, the wound will be closed using stitches. The procedure takes around one hour.

There is less risk of an infection developing after an ETV than with shunt surgery. However, as with all surgical procedures, there are some risks associated with ventriculostomy (see complications of hydrocephalus). 

The long-term results for treatment with ETV are very similar to those for a shunt operation. As with shunts, ETVs may block months or years after surgery, resulting in your symptoms reoccurring.