Hydrocephalus Treatment
Management of excess cerebrospinal fluid around the brain when it causes pressure or neurological symptoms
What is hydrocephalus treatment?
Cerebrospinal fluid is made continuously inside the chambers of the brain, flows through narrow passages between them, washes over the surface and is absorbed back into the bloodstream. Roughly half a litre is produced every day, and the whole volume is replaced several times over.
Hydrocephalus is what happens when that circuit is interrupted. Either a passage is blocked, so fluid backs up behind the obstruction, or the fluid reaches the surface normally and is not absorbed. The chambers enlarge in both cases, and in an adult, whose skull cannot expand, the pressure inside rises with them.
In an infant the skull can still give, so the head grows and the fontanelle bulges before the pressure climbs. In older adults there is a third pattern, where the chambers are large and the measured pressure is close to normal, and the problem shows itself in walking, memory and bladder control instead.
What you might notice
- A baby's head growing faster than the rest of them
- Walking that has become unsteady
- A headache that is worst on waking
- Forgetting recent conversations and events
How it is diagnosed
A CT or MRI shows the size of the chambers, and an MRI can also show where a passage is blocked and whether fluid is being forced into the surrounding brain. In infants the head circumference is plotted on a growth chart at every visit, and crossing upwards through the lines carries more weight than any single measurement.
The back of the eye is examined for swelling of the optic disc, which is the most reliable bedside sign that pressure has been raised for some time. Vision and visual fields are recorded so that any later change has something to be compared against.
Where the chambers are large but the pressure is normal, imaging alone cannot decide whether draining will help. A measured volume of fluid is removed by lumbar puncture, or a drain is left in for a few days, and walking is formally timed before and after. That response is the best available guide to whether a permanent diversion is worth doing.
Recovery
Expect two to five days in hospital, most of it observation. The wounds are on the head and, where a tube has been run to the abdomen, on the abdomen too, and both are kept dry for a fortnight.
Improvement can be immediate or can take weeks, depending on how long the pressure had been up. In older adults treated for the walking and memory pattern, the gait usually improves first and thinking improves last, if it improves at all.
You will be told which signs mean the diversion has stopped working, and they matter: a return of the symptoms that brought you in, drowsiness, vomiting, a temperature, or redness along the line of the tube. All of these need assessment the same day. Keep the card describing your valve setting with you, because MRI scanners can alter it.
If it is left untreated
Untreated raised pressure damages the optic nerves before it does anything else, and that visual loss becomes permanent once the discs have been swollen for long enough. Beyond that, the brain is progressively compressed, consciousness falls, and an acute obstruction can be fatal within hours.
In infants, the developing brain is thinned against the inside of the skull and the developmental cost of that is not recoverable. In older adults with the walking and memory pattern, the deterioration is slower, and it also passes a point beyond which draining the fluid no longer restores what was lost, so the timing of assessment matters.
Some people have chambers that are large, stable and causing nothing at all, and the right course there is interval scanning and no intervention. That is a decision made on repeated imaging and examination together, and it is revisited if anything changes.
Questions about hydrocephalus treatment
Is a shunt permanent?
In most people, yes. Once fluid is being diverted, the body does not usually recover the capacity to handle it on its own, so the system stays in for life and is treated as part of you. The parts do fail eventually: tubes block, disconnect or become infected, and revisions are common enough that everyone with a shunt should know the warning signs. An endoscopic third ventriculostomy is the alternative in the right anatomy, since it creates a new route for the fluid and leaves no hardware behind, though it can close over and it does not suit every cause.
What does a blocked shunt feel like?
It usually feels like whatever brought you to hospital in the first place, returning. Headache that is worse on waking, vomiting, drowsiness, double vision or, in a child, irritability and a change in feeding are the common ones. In an older adult it may show as the walking becoming unsteady again. Any of these mean the same day assessment with a scan and a look at the valve, and it is better to be checked and sent home than to wait and see.
Can hydrocephalus in an older person be mistaken for dementia?
It frequently is. Normal pressure hydrocephalus presents with a slow, wide, shuffling walk, problems with memory and attention, and loss of bladder control, and every one of those is put down to age or to Alzheimer's disease at first. The difference matters because this one is treatable. The way to settle it is to drain a measured volume of fluid by lumbar puncture and time the walking before and after, and a clear improvement makes the case for a permanent diversion.
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InpatientTalk to a care coordinator about hydrocephalus treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one