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Neurosurgery for Hydrocephalus

Practice Essentials

Hydrocephalus, a condition first described by Hippocrates, is the abnormal rise in cerebrospinal fluid (CSF) volume and, usually, pressure, that results from an imbalance of CSF production and absorption. Hydrocephalus is classified as communicating hydrocephalus and non-communicating hydrocephalus. In communicating hydrocephalus (also referred to as nonobstructive hydrocephalus), full communication between the ventricles and subarachnoid space exists.  Non-communicating hydrocephalus occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.  

Normal-pressure hydrocephalus (NPH), a form of communicating hydrocephalus, may result from subarachnoid hemorrhage caused by an aneurysm rupture or a traumatic brain injury (TBI), encephalopathy, infection, tumor or complication of surgery. The increase in cerebrospinal fluid in NPH occurs slowly enough that the tissues around the ventricles compensate and the fluid pressure inside the head does not increase. The classic triad of symptoms consists of abnormal gait, urinary incontinence, and dementia. NPH can be mistaken for Alzheimer disease.

Hydrocephalus was not treated effectively until the mid-20th century, when the development of appropriate shunting materials and techniques occurred. At the beginning of the 20th century, doctors (including urologists) attempted to introduce scopes into the ventricular system. Attempts were also made to remove the choroid plexus, which generates much of the CSF, in an attempt to treat hydrocephalus. 

Hydrocephalus research and treatment have advanced tremendously in the last 20 years. Today, the focus of hydrocephalus research is on pathophysiology, shunting (eg, new shunt materials and programmable valve design), and minimally invasive techniques of treatment. Areas of research include the following:

Transplantation of tissue, such as vascularized omentum, to reestablish normal CSF could be the best method for treating communicating hydrocephalus

Third ventriculostomies and aqueductoplasty eliminate the need for shunting in noncommunicating cases of hydrocephalus; new optics and smaller scopes are expanding this field

For patient education information, see Hydrocephalus Directory.

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