Hydrocephalus is a neurological condition in which an abnormal accumulation of cerebrospinal fluid (CSF) occurs within the spaces of the brain called ventricles. This excess fluid can increase pressure inside the skull and, if left untreated, may affect brain function.
Hydrocephalus can occur at any age, including newborns, children, adults, and older people. The causes, symptoms, and appropriate treatment can vary depending on the patient’s age and the underlying cause.
What Causes Hydrocephalus?
Cerebrospinal fluid normally circulates through the brain and spinal cord and is continuously produced and absorbed. Hydrocephalus can develop when the normal circulation or absorption of CSF is disrupted.
Possible causes include:
- Congenital abnormalities affecting the brain or spinal fluid pathways
- Blockage of CSF circulation
- Brain tumors
- Brain or spinal infections
- Meningitis
- Intracranial bleeding
- Head injury
- Previous brain surgery
- Certain developmental conditions
- Problems with CSF absorption
In some patients, the exact cause of hydrocephalus may not be immediately apparent.
Types of Hydrocephalus
Hydrocephalus can be classified in several ways depending on its cause and mechanism.
Congenital Hydrocephalus
Congenital hydrocephalus is present at birth and may result from developmental abnormalities affecting the brain or the normal circulation of cerebrospinal fluid.
Acquired Hydrocephalus
Acquired hydrocephalus develops later in life and may occur because of conditions such as brain tumors, infections, bleeding, or head injuries.
Communicating Hydrocephalus
In communicating hydrocephalus, CSF can generally flow through the ventricular system, but its absorption into the bloodstream is impaired.
Non-Communicating or Obstructive Hydrocephalus
This occurs when the normal flow of CSF is blocked within the ventricular system. A tumor, narrowing of a CSF pathway, or another structural abnormality may cause such obstruction.
Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus (NPH) is a condition that typically affects older adults. It may be associated with a characteristic combination of:
- Difficulty walking or changes in gait
- Problems with memory or thinking
- Loss of bladder control
Because these symptoms can overlap with other neurological conditions, proper clinical evaluation and diagnostic testing are important.
Symptoms of Hydrocephalus
The symptoms of hydrocephalus vary depending on the patient’s age, the underlying cause, and how quickly the condition develops.
Symptoms in Infants
Possible symptoms may include:
- Rapid increase in head size
- A bulging or tense soft spot on the head
- Vomiting
- Irritability
- Poor feeding
- Excessive sleepiness
- Seizures
- Delayed developmental milestones
- Downward deviation of the eyes
Symptoms in Older Children and Adults
Symptoms may include:
- Headache
- Nausea or vomiting
- Blurred or double vision
- Balance and walking difficulties
- Memory or concentration problems
- Excessive sleepiness
- Difficulty with coordination
- Seizures in some cases
- Changes in behavior or mental function
Sudden or rapidly worsening symptoms can require urgent medical assessment.
How Is Hydrocephalus Diagnosed?
A neurosurgeon or neurologist may evaluate the patient’s symptoms, medical history, and neurological condition before recommending appropriate investigations.
CT Scan
A CT scan of the brain can provide information about the size of the ventricles and may help identify conditions causing obstruction or other abnormalities.
MRI of the Brain
An MRI can provide more detailed information about the brain, ventricular system, CSF pathways, and possible underlying causes of hydrocephalus.
In selected cases, additional tests may be required to determine whether a patient is likely to benefit from a particular treatment.
Hydrocephalus Treatment
The treatment of hydrocephalus depends on its cause, type, severity, age of the patient, and overall neurological condition.
Treatment may include observation in selected cases, treatment of the underlying cause, or a surgical procedure to restore or divert the flow of cerebrospinal fluid.
Two commonly used surgical approaches include CSF shunt surgery and endoscopic treatment.
Shunt Surgery for Hydrocephalus
A CSF shunt is a medical device designed to divert excess cerebrospinal fluid from the brain to another part of the body where the fluid can be absorbed.
A commonly used system is the ventriculoperitoneal (VP) shunt, which diverts CSF from the brain’s ventricles into the abdominal cavity.
Shunt surgery may be recommended for selected patients depending on the type and cause of hydrocephalus.
Endoscopic Treatment of Hydrocephalus
Endoscopic Third Ventriculostomy (ETV) is a minimally invasive neurosurgical procedure used in selected patients with obstructive hydrocephalus.
During ETV, a small opening is created in the floor of the third ventricle using an endoscope, allowing cerebrospinal fluid to bypass the site of obstruction and restore its circulation.
ETV is not suitable for every patient. The decision depends on the cause of hydrocephalus, the patient’s age, anatomy, clinical condition, and other factors.
Is Hydrocephalus Curable?
Hydrocephalus can often be effectively managed when it is diagnosed appropriately and treated according to its cause and type.
Some patients may require long-term follow-up after surgery, particularly those treated with shunt systems. Regular clinical assessment may be important to monitor symptoms and identify possible complications or changes in the condition.
The outcome varies from patient to patient and depends on factors such as the underlying cause, duration of the condition, age, neurological status, and response to treatment.
When Should You Consult a Neurosurgeon?
Medical evaluation is important when symptoms such as persistent headaches, repeated vomiting, seizures, progressive difficulty walking, changes in memory or behavior, visual disturbances, or developmental problems in children are present.
In infants, rapid head growth, a bulging fontanelle, persistent vomiting, unusual sleepiness, or developmental concerns should be evaluated promptly.
Early diagnosis can help identify the underlying cause and determine whether treatment is necessary.
Hydrocephalus Treatment by Prof. Dr. Haradhan Deb Nath
Prof. Dr. Haradhan Deb Nath, Professor of Neurosurgery, has extensive experience in the diagnosis and surgical management of complex neurological conditions, including hydrocephalus, brain tumors, and spinal disorders.
He evaluates patients with hydrocephalus based on their clinical symptoms, neurological findings, brain imaging, and the underlying cause of CSF accumulation. Depending on the patient’s condition, appropriate treatment may include CSF shunt surgery or endoscopic neurosurgical procedures, when clinically indicated.
With extensive experience in neurosurgery and the management of complex brain and spinal conditions, Prof. Dr. Haradhan Deb Nath provides individualized treatment planning with an emphasis on accurate diagnosis, appropriate surgical decision-making, and patient safety.
If you or your child has been diagnosed with hydrocephalus or is experiencing symptoms suggestive of the condition, consultation with an experienced neurosurgeon can help determine the underlying cause and the most appropriate treatment approach.