BRAIN - HYDROCEPHALUS

Hydrocephalus Hydrocephalus is the abnormal enlargement of the ventricles in the brain due to excessive accumulation of cerebrospinal fluid (CSF) due to obstruction of flow, lack of absorption, or on occasion, overproduction of CSF. There are two main types of hydrocephalus, obstructive and communicating. Obstructive hydrocephalus indicates that there is something preventing flow of CSF. This is normally caused by a tumor, cyst or stenosis of the Sylvian aqueduct. Communicating hydrocephalus occurs when there is no obstruction to flow inside the ventricular system. However, there may be an obstruction outside of the ventricles or due to decreased absorption of the CSF over the surface of the brain.

Treatment is usually geared toward reducing the amount of fluid in the ventricles. This is usually achieved through placement of a shunt. The most common type of shunt is a ventriculoperitoneal shunt. This shunt is placed directly into the ventricles in the brain and runs subcutaneously to the abdomen where the fluid empties into the peritoneum and is reabsorbed by the body.

Hydrocephalus has signs and symptoms that one might expect with raised pressure within the skull. Headache, vomiting, visual changes, and altered mental status are a few of many symptoms that may occur. In older patients, hydrocephalus can develop without high pressure. This condition is called normal pressure hydrocephalus. Patients with normal pressure hydrocephalus may develop difficulty with thinking, trouble walking, and incontinence. A shunt can sometimes improve this condition. We often use programmable shunts for this condition, allowing greater control over the flow of spinal fluid.

With newer endoscopic equipment, some patients can avoid placement of a shunt altogether. Endoscopic ventriculostomy is a procedure that creates an alternative drainage pathway in the brain, allowing spinal fluid to be reabsorbed without a shunt. This procedure is not possible for all patients.