The treatment of hydrocephalus focuses on lowering the extra cerebrospinal fluid (CSF) in the brain’s ventricles. This helps ease pressure on the brain and stops further damage. Since hydrocephalus can affect people of all ages and result from different causes, treatment depends on the patient’s age, type of hydrocephalus, and other health issues.
Surgery is the main treatment, but medicine and supportive care also play roles. Early diagnosis and fast treatment are key. Without treatment, hydrocephalus can cause lasting brain damage, disability, or death.
For most patients, treatment is a long-term process. Many need regular check-ups, and some may need extra procedures for recurring symptoms or complications. Still, with proper care, many people with hydrocephalus live much better lives.
Surgical Treatment: The Cornerstone of Management
Surgery aims to drain the extra CSF and lower pressure on the brain. Two main surgery types are used:
1. Shunt Placement
The most common surgery is to put in a ventriculoperitoneal (VP) shunt. This is a soft silicone tube that moves excess fluid from the brain to another part of the body, usually the belly, where it is absorbed.
The shunt has a valve to control the fluid flow and stop too much or too little drainage.
In young children, the shunt can be adjusted or replaced as they grow.
Other shunt types drain to the heart (ventriculoatrial) or chest (ventriculopleural).
Shunts can save lives and greatly improve symptoms but come with risks. Shunts may fail, block, get infected, or need multiple surgeries over time. Patients usually need lifelong check-ups.
Some shunts are programmable, letting doctors change flow rates without surgery.
2. Endoscopic Third Ventriculostomy (ETV)
ETV is a surgery option for blocked hydrocephalus. A surgeon makes a small hole in the brain’s third ventricle floor. This hole lets CSF bypass the blockage and flow normally to the brain’s surface for absorption.
ETV avoids using a shunt, which lowers infection and mechanical failure risks.
It works better in older children and adults than in babies.
Sometimes, doctors use ETV with choroid plexus cauterisation (ETV-CPC) in infants to lower CSF production.
ETV is not suitable for all cases, especially if the problem is poor CSF absorption, but it offers a shunt-free option for some patients.
Additional Surgical Considerations
If hydrocephalus is caused by tumors, cysts, or brain problems, more surgery may be needed to fix the cause. For example:
- Removing tumors may fix CSF flow.
- Infections may need temporary drainage with an external device until healed.
- Birth defects like aqueductal stenosis might need surgery along with CSF drainage.
Medical and Supportive Treatments
Surgery handles the fluid build-up, but other care helps with lasting effects.
a. Medications
Medicines do not cure hydrocephalus but help in certain cases:
- Diuretics like acetazolamide may lower CSF temporarily in premature babies or while waiting for surgery.
- Antibiotics treat infections, especially around shunts.
- Anti-seizure drugs control seizures caused by hydrocephalus.
Medicines support but do not replace surgery.
b. Rehabilitation Therapy
Many patients, especially kids, need physiotherapy, occupational therapy, or speech therapy to improve movement, thinking, or speaking. Early therapy is key for better development.
Rehab helps people gain independence and improve daily skills, especially if brain damage happened before treatment.
c. Psychological and Educational Support
Hydrocephalus may affect thinking and behavior long term. Support from psychologists and learning specialists helps children succeed at school and socially.
Adults may benefit from counselling for mood changes, depression, or memory problems.
Long-Term Monitoring and Follow-Up
Monitoring is a big part of hydrocephalus care. Shunts can fail suddenly, and ETV holes may close. Signs like headaches, nausea, blurry vision, or behavior changes need quick check-ups.
Follow-up includes:
- Regular brain exams
- MRI or CT scans
- X-rays or pressure checks for programmable shunts
- Growth and development tracking in children
Many patients need lifelong care, but new surgical tools and tests improve results.
Special Considerations for Normal Pressure Hydrocephalus (NPH)
NPH usually affects older adults and shows as walking problems, memory loss, and bladder control issues.
Treatment often means shunt surgery, especially if tests show CSF removal helps. Not all patients improve, so careful diagnosis and clear expectations matter.
Teams of neurologists, geriatricians, and rehab specialists usually manage care.
Emerging and Future Therapies
New treatments are being studied, including:
- Shunts that break down safely in the body
- Better valves to prevent over-draining
- Drugs to protect the brain from damage
- Devices to better control CSF flow
These advances may lower risks and improve life quality over time.
Conclusion
Treatment for hydrocephalus combines surgery with ongoing care, rehab, and emotional support. While there is no cure, most people manage the condition well and live full lives. Advances in surgery and technology bring hope for even better results in the future.
