Causes of hydrocephalus

Written by Gao Yi Shen
Neurosurgery
Updated on February 19, 2025
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There are many causes of hydrocephalus, and it is important to make specific judgments based on the circumstances. In some infants, congenital hydrocephalus can be caused by intracranial birth injuries, which occur during the birth process and lead to intracranial hemorrhaging. It can also be due to congenital developmental abnormalities, such as anencephaly or spina bifida. In adults, hydrocephalus can be caused by intracranial tumors, such as choroid plexus papillomas, which overproduce cerebrospinal fluid. Others might develop hydrocephalus due to blockages caused by blood clots, such as cerebral hemorrhage or subarachnoid hemorrhage. There are also cases where hydrocephalus can occur alongside chronic conditions like subdural hematoma or epidural hematoma, depending on the specific clinical presentations of the patients.

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Is hydrocephalus easy to treat?

Hydrocephalus is relatively easy to treat. Before treatment, it is advised to first perform a cranial CT scan or MRI on the patient to determine the type and severity of the hydrocephalus, and based on whether the patient currently shows significant clinical symptoms, decide if surgical treatment is necessary. Additionally, a cranial CT or MRI can help identify the cause of the hydrocephalus, such as whether there is an intracranial space-occupying lesion or if the cerebral fluid circulation pathway is obstructed for other reasons, leading to hydrocephalus. If treatment is deemed necessary, it is generally recommended to opt for ventriculo-peritoneal shunt surgery for the patient. Most patients can achieve good results after the surgical treatment.

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Can hydrocephalus be effectively treated?

For patients with hydrocephalus, if timely and effective treatment can be obtained, most patients can achieve very good treatment results. For patients with progressive obstructive hydrocephalus, it is especially important to seize the time to perform surgical treatment in the early stages. Clinically, it is generally recommended to choose ventriculoperitoneal shunt surgery, placing a drainage tube in the patient's lateral ventricle, entering the peritoneal cavity through a subcutaneous tunnel, and draining the cerebrospinal fluid from the ventricle to the peritoneal cavity, thereby achieving the purpose of relieving the excessive cerebrospinal fluid in the ventricular system. After undergoing surgery, the patient's dilated bilateral lateral ventricles can effectively shrink, and conditions such as pre-existing cognitive dysfunction, limb motor dysfunction, and incontinence will improve.

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How should hydrocephalus be treated?

Treatment of hydrocephalus must be specific to the patient's condition, as different cases of hydrocephalus require different treatment approaches. For some mild cases of hydrocephalus without obvious clinical symptoms, the focus is on observation or the use of internal medicine to improve cerebral circulation and neuroprotective medications. However, if symptoms emerge later and significantly affect daily life, shunt surgery from the cerebral ventricles to the abdominal cavity is performed for chronic hydrocephalus, aiming to alleviate the patient's suffering. In cases of acute hydrocephalus caused by cerebral hemorrhage or subarachnoid hemorrhage, treatment might involve the use of neuroendoscopy to create a ventriculostomy at the floor of the third ventricle or external ventricular drainage. Thus, treatment is determined based on the specific circumstances.

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Causes of Hydrocephalus

Under normal conditions, the secretion, circulation, and absorption of cerebrospinal fluid (CSF) maintain a dynamic balance. In some pathological states, this balance is disrupted, leading to an excessive accumulation of CSF within the ventricular system, a condition known as hydrocephalus. Hydrocephalus can be classified into obstructive hydrocephalus and communicating hydrocephalus. The causes of obstructive hydrocephalus mainly include obstructions in the ventricular system, such as congenital malformations or abnormal development of the cerebral aqueduct, which are the most common causes of hydrocephalus in infants. In adults, tumors, bleeding, blockages, or compression of the ventricular system are also common causes of hydrocephalus. Communicating hydrocephalus results primarily from acquired diseases, such as cranial infections or blockages of arachnoid granulations by subarachnoid hemorrhage, leading to impairments in CSF absorption.

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Manifestations of Hydrocephalus

For hydrocephalus, it often manifests as noticeable enlargement of the ventricular system. Additionally, patients experience symptoms of increased intracranial pressure such as headaches, dizziness, nausea, and dry heaves. Severe hydrocephalus can lead to significant increases in intracranial pressure, with patients suffering from severe headaches, dizziness, and even accompanied by papilledema, decreased vision, visual field defects, and optic atrophy. Furthermore, patients with hydrocephalus may exhibit significant cognitive dysfunction, characterized by reduced intelligence levels, diminished learning ability, computational skills, and memory loss. The physical motor functions of patients also gradually decline, presenting as unstable walking, a propensity to fall, and even possibly accompanied by urinary and fecal incontinence.