Treating hydrocephalus 

Hydrocephalus (fluid on the brain) is treated with surgery.

Congenital and acquired hydrocephalus

Babies born with hydrocephalus (congenital) and adults or children who develop hydrocephalus (acquired) usually need prompt treatment to reduce the pressure on their brain. If hydrocephalus isn't treated, the increase in pressure will cause brain damage.

Both congenital and acquired hydrocephalus will be treated with either shunt surgery or neuroendoscopy (see below).

Normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) can sometimes be treated with a shunt, although experience has shown that not everyone with the condition will benefit from shunt surgery.

Due to the risk of complications, you'll need tests to assess whether the potential benefits of surgery outweigh the risks. A lumbar drainage or lumbar infusion test, or both, can be used to determine whether shunt surgery will benefit you.

Shunt surgery

Shunt surgery involves implanting a thin tube, called a shunt, in the brain. The excess cerebrospinal fluid (CSF) in the brain runs through the shunt to another part of the body, usually the abdomen. From here, the fluid is absorbed into your blood stream. The shunt has a valve inside to control the flow of CSF and ensure it doesn't drain too quickly. You can feel the valve as a lump under the skin of your scalp.

The operation

Shunt surgery is carried out by a neurosurgeon (a specialist in brain and nervous system surgery). It's carried out under general anaesthetic before the operation and usually takes one to two hours. 

After the operation, you may need to spend a few days in hospital to recover. If you have stitches, they may dissolve or they may need to be removed. Some surgeons use skin staples to close the wound which will need to be removed after a few days.

After the shunt has been installed, further treatment for hydrocephalus may be needed if it becomes blocked or infected. Shunt repair surgery will then be necessary.

Endoscopic third ventriculostomy (ETV)

An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV).

Instead of inserting a shunt, ETV involves making a hole in the floor of the brain to allow the trapped CSF to escape to the surface of the brain where it can be absorbed.

An ETV isn't suitable for everyone. However, it could be an option if the build-up of CSF in your brain is due to a blockage (obstructive hydrocephalus). The CSF will be able to drain through the hole, avoiding the blockage.

The operation

An ETV is carried out under general anaesthetic. The neurosurgeon makes a small hole in your skull and uses an endoscope to look inside the chambers of your brain. An endoscope is a thin, long tube with a light and video camera at one end.

A small hole is made inside your brain with the help of the endoscope. After the endoscope has been removed, the wound is closed using stitches. The procedure takes around one hour.

There's less risk of infection after an ETV than with shunt surgery. However, as with all surgical procedures, there are some risks associated with ventriculostomy.

Read more about the complications of hydrocephalus

The long-term results for treatment with ETV are similar to those for a shunt operation. As with shunts, ETVs may become blocked months or years after surgery and the symptoms will return.

Page last reviewed: 19/01/2015

Next review due: 19/01/2017