Hydrocephalus: All You Need to Know

When it comes to neurological health, there is a lesser-known condition that silently but significantly alters the lives of those it affects: Hydrocephalus. Though not always apparent to the casual observer, this neurological condition brings with it a myriad of complexities that extend far beyond the physiological realm. In this article, we take a closer look at hydrocephalus, shedding light on not only the clinical aspects of this disorder, including types, symptoms and treatment options. Let’s start with some basics.

What is Hydrocephalus? 

In the general population, hydrocephalus has been commonly called “water on the brain”. The water in hydrocephalus is actually cerebrospinal fluid (CSF), which has pooled in the brain due to an imbalance in the amount produced vs. the amount the body can absorb. Normally, CSF continuously flows through brain cavities, acting as a shock absorber and delivering vital nutrients before being absorbed into the blood. Hydrocephalus interrupts this healthy flow of CSF, causing an accumulation that puts pressure on the brain.

What Causes Hydrocephalus?

Although the exact cause of hydrocephalus isn’t always evident, it can result from congenital factors, developmental issues, infections, tumours, bleeding within the brain, or other conditions that interfere with the normal flow or absorption of CSF. As far as the origin of the condition is concerned, it could be either congenital, i.e. present before birth, or acquired, which develops after birth (as a result from a head injury, infection, brain tumour or a brain haemorrhage). 

What Are the Types of Hydrocephalus?

Broadly classifying, there are two types of hydrocephalus: Communicating Hydrocephalus and Non-communicating Hydrocephalus. 

Communicating Hydrocephalus

In communicating hydrocephalus, there is a disturbance in the normal absorption of cerebrospinal fluid (CSF) within the subarachnoid space. The communication pathways between the ventricles of the brain and the subarachnoid space are open, but the fluid is not adequately absorbed. This type is often associated with conditions such as subarachnoid haemorrhage, meningitis, or other forms of inflammation.

Non-communicating Hydrocephalus

Non-communicating hydrocephalus, also called obstructive hydrocephalus, occurs when there is an obstruction that blocks the normal flow of CSF within the ventricular system of the brain. This obstruction can be caused by various factors, including tumours, cysts, or congenital abnormalities. The blockage prevents the fluid from flowing freely, leading to an accumulation and enlargement of the ventricles.

What Is Normal Pressure Hydrocephalus?

Normal pressure hydrocephalus (NPH) is a type of communicating hydrocephalus that typically occurs in the elderly and causes memory difficulties that are commonly misdiagnosed as Alzheimer’s disease. The NPH is often undiagnosed, and less than 20% receive an appropriate diagnosis and treatment. For this reason, it’s essential to consult a neurologist with extensive experience diagnosing NPH, like those at Max Hospital. Usually, this type of hydrocephalus is caused by injury, infection, tumour, or inflammation.

What Are the Symptoms of Hydrocephalus?

Hydrocephalus manifests differently depending on the cause and type. Symptoms commonly found in young adults include:

• Chronic headaches
• Blurred or double vision
• Difficulty walking
• Impaired bladder control
• Memory loss
• Vomiting, nausea and drowsiness

Later in life, normal pressure hydrocephalus may affect the neurological areas that control the legs and bladder, along with cognitive processes, causing:

• Dementia (affecting memory, concentration, and interest in daily activities).
• Difficulty walking
• Urinary incontinence

How Is Hydrocephalus Treated?

The treatment of hydrocephalus typically involves interventions to manage the excessive accumulation of cerebrospinal fluid (CSF) within the brain. The choice of treatment depends on the underlying cause, the type of hydrocephalus, and the severity of symptoms. There are a few prevailing methods, each one appropriate for different situations. But by addressing it early, a patient can fully recover with no future complications. Treatment options for hydrocephalus include:

Shunt Placement Surgery

Shunt placement is a common and effective surgical intervention for hydrocephalus. A shunt system comprises a catheter, a one-way valve, and a distal catheter. The catheter is inserted into a brain ventricle to drain excess cerebrospinal fluid (CSF). The one-way valve regulates CSF flow, and the distal catheter carries the fluid to another part of the body, usually the abdominal cavity or the heart.

Performed under general anaesthesia, shunt placement involves a small incision in the scalp to access the affected brain ventricle. The catheter is carefully inserted into the ventricle, and the valve is positioned beneath the skin. Regular monitoring and follow-up care are essential to ensure the shunt's proper function and address any potential complications.

Endoscopic Third Ventriculostomy

The primary alternative to shunt systems, endoscopic third ventriculostomy (ETV) eliminates a patient’s shunt dependency. This minimally-invasive procedure uses an endoscope to release CSF build up by puncturing the third ventricle, allowing fluid to bypass the obstruction and flow freely around the surface of the brain, reabsorbing as it should.

Shunts have proven effective in a variety of cases, but studies show that ETV can deliver a 65-70% success rate in cases of shunt malfunction. It’s a one-time procedure, where shunts may require revision, and it can be preferable in cases involving an obstruction like a tumour. Plus, it keeps all of CSF around the brain and spinal cord without diverting it to other parts of the body.

Medications

Certain medications, specifically Acetazolamide and furosemide, appear to reduce CSF levels by acting on the choroid plexus, the intraventricular tissue that produces this fluid. However, relying solely on medication to treat hydrocephalus is not good, and it’s better used temporarily, or in cases when other procedures aren’t possible.

Note: The choice of the treatment option depends on age, health, prior surgeries and other factors. The most common and well-documented are shunt systems, but in certain cases (like obstructive hydrocephalus), ETV may be a better option. In the end, it’s up to the patient’s disease and the neurosurgeon’s choice to evaluate a menu of treatments and determine which one is best for unique circumstances.

Pre- and Post-operative Care

Pre-operative Care

• Comprehensive Evaluation: Patients undergo a thorough preoperative assessment, including medical history, physical examination, and diagnostic imaging to determine the severity of hydrocephalus and identify any underlying conditions.
• Patient Education: Educating the patient and their family about the surgery, potential risks, expected outcomes, and postoperative care is crucial for informed decision-making and preparation.
• Nutritional Support: Ensuring adequate nutrition and hydration is essential for optimal recovery. In some cases, nutritional support may be provided before surgery.
• Medication Management: Medications that may interfere with blood clotting or anaesthesia are adjusted or temporarily discontinued before surgery.
• Infection Prevention: Preoperative measures are taken to minimise the risk of infection, including proper skin preparation and, in some cases, preoperative antibiotics.

Post-operative Care

• Monitoring: Continuous monitoring of vital signs, neurological status, and intracranial pressure (ICP) is maintained in the immediate postoperative period.
• Pain Management: Adequate pain management is crucial for patient comfort. Pain medications are administered as needed, and the patient's pain level is regularly assessed.
• Preventing Complications: Careful monitoring for potential complications, such as infections or shunt malfunctions, is essential as early detection allows for prompt intervention.
• Fluid and Electrolyte Balance: Fluid and electrolyte balance is monitored closely, especially if the patient underwent ventriculostomy or has a shunt in place.
• Mobility and Rehabilitation: Depending on the type of surgery, gradual mobilisation and rehabilitation may be initiated to promote optimal recovery and prevent complications such as deep vein thrombosis.
• Follow-up Care: Regular follow-up appointments with the neurosurgeon are scheduled to assess the effectiveness of the surgery, monitor for any signs of recurrence, and make any necessary adjustments to the treatment plan.

Both preoperative and postoperative care for hydrocephalus surgery are collaborative efforts involving the healthcare team, the patient, and their family to ensure the best possible outcome and long-term well-being.

What’s the Outlook for Patients?

If addressed early and with the appropriate treatment, hydrocephalus has a fairly high survival rate. Many patients go on to live long and unrestricted lives. Shunt treatment can even reverse the symptoms of dementia in elderly patients. Unfortunately, hydrocephalus isn’t something that disappears on its own, so it’s crucial that you schedule a doctor’s appointment and get the necessary treatment if you begin exhibiting symptoms.

The neurosurgeons at Max Hospitals, are caring experts, well-versed in the most advanced treatments. With extensive experience treating neurosurgical conditions, your diagnosis and treatment couldn’t be in better hands. Contact us to schedule a consultation appointment today.

Frequently Asked Questions About Hydrocephalus

Q. Can Hydrocephalus affect cognitive function?

Yes, hydrocephalus can impact cognitive function, especially if left untreated. Cognitive impairments may include difficulties with memory, attention, and problem-solving. However, with proper management, some cognitive functions may improve.

Q. Can Hydrocephalus affect mobility?

Yes, hydrocephalus can affect mobility, particularly in cases where increased intracranial pressure leads to gait disturbances. Addressing the underlying cause and effectively managing hydrocephalus can improve mobility in many cases.

Q. Can Hydrocephalus be cured?

While there is no cure for hydrocephalus, timely and appropriate treatment can effectively manage symptoms and improve the quality of life for individuals with the condition.

Q. Is Hydrocephalus a lifelong condition?

In many cases, hydrocephalus is a chronic condition that requires ongoing management. Regular medical follow-up and adjustments to treatment may be necessary throughout a person's life.

Q. Can Hydrocephalus be treated without surgery?

In some cases, non-surgical approaches may be considered, especially for milder forms of hydrocephalus or when surgery poses significant risks. However, surgery is often the primary and most effective treatment for hydrocephalus.

Q. What is the primary treatment for Hydrocephalus?

The primary treatment for hydrocephalus is typically surgical intervention. Shunt placement or endoscopic third ventriculostomy (ETV) are common procedures aimed at redirecting or facilitating the drainage of excess cerebrospinal fluid to alleviate pressure within the brain.

Q. Can one fully recover from Hydrocephalus?

The extent of recovery varies based on factors such as the underlying cause, the severity of symptoms, and the timeliness of intervention. While surgical treatments can effectively manage symptoms and improve quality of life, complete recovery to a pre-hydrocephalus state may not always be possible.

Q. How successful is Hydrocephalus surgery?

Hydrocephalus surgery, particularly shunt placement and ventriculostomy, is generally successful in relieving symptoms and preventing complications. Success rates depend on various factors, including the type of hydrocephalus, the underlying cause, and the overall health of the individual.

Q. Can Hydrocephalus come back after surgery?

While hydrocephalus surgery has a high success rate, complications or the recurrence of symptoms can occur. Regular follow-up with the healthcare provider, therefore, is crucial to monitor for any signs of recurrence.

Q. What are the complications of Hydrocephalus treatment?

Complications associated with hydrocephalus treatment can include infections, shunt malfunctions, bleeding, over-drainage or under-drainage of cerebrospinal fluid, and in rare cases, neurological damage. 

Q. Can Hydrocephalus be diagnosed before birth?

Yes, hydrocephalus can be diagnosed prenatally through foetal ultrasound or advanced imaging techniques. Early diagnosis allows for proactive planning and intervention, including surgical options if needed, after birth.

Q. How is Hydrocephalus managed in infants?

Hydrocephalus in infants is often managed with surgical interventions, including shunt placement, to alleviate pressure on the developing brain. Regular monitoring and adjustments to the treatment plan are essential as the child grows.