How should hydrocephalus be treated?

Written by Gao Yi Shen
Neurosurgery
Updated on January 10, 2025
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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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Hydrocephalus Clinical Manifestations

In adults, hydrocephalus can be of the normal pressure type, mainly characterized by unsteady gait, slow responses, urinary and fecal incontinence, among others. There is also high-pressure hydrocephalus, which mainly presents as increased intracranial pressure, with the most common symptoms being headache, vomiting, papilledema, and ataxia. In children and infants, hydrocephalus has its own characteristics. In addition to some of the adult symptoms, there are also anomalies such as an abnormally increased head size, bulging fontanelles, "sunset" eye sign, intellectual and cognitive impairments, decreased vision, visual field defects, decreased hearing, epilepsy seizures, and more.

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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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Causes of hydrocephalus in infants

The occurrence of hydrocephalus in infants involves congenital factors, including poor brain development caused by exposure to medications, radiation, rays, and viral or bacterial infections during the embryonic stage, leading to hydrocephalus. Infant hydrocephalus also includes some acquired factors, such as birth injuries occurring during delivery, and post-birth conditions like inflammation in the brain, tumors, or arachnoid cysts. These conditions can lead to excessive production of cerebrospinal fluid, impaired circulation, or insufficient absorption, resulting in hydrocephalus.

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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.

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How to deal with hydrocephalus?

The treatment of hydrocephalus must clearly identify the severity of the condition. Hydrocephalus can be categorized into acute and chronic types. In cases of acute hydrocephalus, emergency ventricular puncture drainage surgery is required, otherwise, it may cause brain herniation leading to death. For chronic hydrocephalus, it is crucial to distinguish whether it is communicating hydrocephalus or obstructive hydrocephalus. For obstructive hydrocephalus, treatment options include creating a patency in the cerebral aqueduct and third ventriculostomy. For other types of hydrocephalus, ventriculoperitoneal shunt surgery can be performed. Therefore, it is essential to clearly determine the type of hydrocephalus to fundamentally select the appropriate surgical methods and instruments.