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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How is hydrocephalus treated?

If hydrocephalus is suspected, it is advised to first visit a local hospital for an emergency cranial CT scan to determine the type and severity of the hydrocephalus. This helps identify the main causes of the condition and whether it is communicating or non-communicating hydrocephalus. Treatment plans should then be based on the patient's symptoms and physical signs. For those with obvious clinical symptoms of obstructive hydrocephalus, surgery is often recommended. Clinically, a ventriculoperitoneal shunt surgery is generally chosen. Through surgical intervention, original symptoms can gradually alleviate or even disappear, and the morphology of the ventricular system can progressively return to normal.

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Is hydrocephalus serious?

Hydrocephalus is a relatively severe neurological disorder, generally caused by disturbances in cerebrospinal fluid (CSF) circulation, leading to obstructive hydrocephalus due to blocked circulation pathways. Other causes include overproduction of CSF or reduced absorption, which can also lead to hydrocephalus. If the volume of hydrocephalus is not large, the clinical symptoms are generally not obvious, and the patient may only experience dizziness, slow response, cognitive impairment, and unstable walking. If the hydrocephalus is significant, it often causes severe compression of brain tissue, which can lead to consciousness disturbances, progressive dementia, epileptic seizures, and incontinence. Timely surgical intervention is necessary to relieve the pressure caused by the edema.

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Causes of hydrocephalus

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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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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What is hydrocephalus shunt?

Patients with hydrocephalus usually require shunt surgery, among which the most common is the ventriculoperitoneal shunt. The shunt tube used in this surgery typically features a reservoir, often referred to by patients as a "water basket". Patients are frequently required to press this reservoir to promote the excess cerebral spinal fluid to flow through the shunt tube into the abdominal cavity, where it is absorbed by the omentum. If the reservoir is not pressed, the shunt tube may become blocked, potentially requiring the surgery to be performed again.