Diagnosis

Hydrocephalus may be suggested by symptoms; however, imaging studies of the

brain are the mainstay of diagnosis. Computed tomography (CT scan) and
magnetic resonance imaging (MRI scan) typically reveal enlarged ventricles and
may indicate a specific cause. Abnormalities such as tumors and hemorrhages
can also be detected.
Small abnormalities that may not be detected using CT scan, such as cysts and
abscesses, are often seen with MRI. These studies can also help the
neurosurgeon differentiate between communicating and noncommunicating
hydrocephalus. In cases of suspected normal pressure hydrocephalus, a spinal
tap may help determine CSF pressure.
A cisternagram evaluates the dynamics of CSF flow in the brain and spinal
chord. In this procedure, a diagnostic dye is injected into the subarachnoid space
around the brain. A series of pictures is taken once the dye has circulated through
the entire CSF path. Cisternography can reveal CSF concentration, obstruction,
leakage, and pressure.
In older people, pressure in the head can cause papilledema, swelling of the
optic nerve. Papilledema can often be seen while examining the eyes.
Unfortunately, it typically indicates hydrocephalus that is well developed. In rare
cases, long standing hydrocephalus causes blindness.
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Treatment
Treatment usually requires draining the excess fluid from the brain by diverting it
to another place in the body.
Shunt
A shunt is a soft, flexible tube usually made of silicone rubber or plastic. Most
shunts consist of a valve that promotes drainage and a catheter, a tube that
connects the drainage site to the deposit site. If there is high intracranial
pressure, a small sensor may be added near the valve. This sensor allows the
neurosurgeon to monitor pressure levels.
The shunt used for treating hydrocephalus is usually permanent. The shunt is
inserted with one tip in one of the ventricles of the brain and the other tip in the
abdominal (peritoneal) cavity. This is known as a ventriculoperitoneal (VP)
shunt. Less commonly used drainage sites include the right ventricle of the heart,
the gall bladder, and the pleural space around the lungs. Depending on the
location of the obstruction, fluid also may be drained from the subarachnoid space
that surrounds the brain.
Although insertion and immediate operation of the shunt is usually
uncomplicated, the following problems can arise:

Abdominal problems:

o Bowel twisting
o Excess fluid collection
Blockage of the shunt
Brain injury:
o Clots on brain surface
o Loss of sensation
o Memory loss
o Paralysis
o Seizures
o Speech problems
Headaches caused by overdraining
Mechanical failure (e.g., separation of parts, valve failure)

Other complications include bleeding, problems with anesthesia, and infection.

The body may react negatively to the shunt because it is made of foreign
material.
Approximately 70% of shunts fail within 10 years of placement. To accommodate
normal growth and to ensure long term function, shunts in infants and children
are replaced frequently until adulthood. A child may require as many as five
shunts during this period. A neurosurgeon periodically checks shunt function in
adults.
Third Ventriculostomy
Third ventriculostomy involves entering the brain through the bones at the top of
the skull. The neurosurgeon passes an endoscope (a thin telescopic instrument)
through the lateral ventricle into the third ventricle and uses a laser to make a
hole in its floor. Excess fluid drains through the hole into the subarachnoid space.
The overall success rate of third ventriculostomy is about 65%. When used to
treat blockage caused by tumor or by aqueductal stenosis, success rates are
slightly higher. In hydrocephalus caused by hemorrhaging or infection, they are
slightly lower.
There are few risks associated with third ventriculostomy. CSF drains through a
hole in the ventricle floor instead of a valve, so there is no risk of overdrainage.
The absence of a tube eliminates the risk associated with a shunt.
Rarely, the basal artery near the third ventricle is injured during the procedure,
which can cause life threatening hemorrhaging in the brain. However, use of the
endoscope has lowered this risk.
Spinal Tap
In patients with normal pressure hydrocephalus, repeated spinal taps are
performed to remove excess CSF. If this results in improvement, inserting a
permanent shunt may be appropriate.
Prognosis
Hydrocephalus is usually a lifelong disorder. Prognosis depends on a number of
factors, including the underlying condition that resulted in hydrocephalus, its
duration and degree, as well as response to treatment.