Treatment for hydrocephalus has advanced considerably in the last 20 years, although no known cure or prevention yet exists.
Surgery is the only treatment option for hydrocephalus. Surgery outcomes have significantly improved combined with early intervention and advanced diagnostic protocols.
Hydrocephalus is most commonly treated with a brain shunt. In some situations, a non-shunt treatment – an endoscopic third ventriculostomy (ETV) – may be sufficient. We explain both treatment options below.
Prompt and effective treatment of hydrocephalus, on which we pride ourselves at ANA, is the determining factor in long-term prognosis.
What Is Brain Shunt Surgery?
A shunt, which has been used to treat hydrocephalus since the 1950s, is a device that allows excess cerebrospinal fluid (CSF) to get “shunted” (moved) to another area of the body.
As the pressure of CSF increases inside the brain, the one-way valve opens and the excess fluid drains to a downstream cavity.
CSF Shunting Surgery
Shunts are the most common and successful treatment option for those with hydrocephalus. Shunting entails the placement of a tube (shunt) in one of the brain’s ventricles or into the space of fluid in the spine.
In order for the brain or spinal fluid to be safely absorbed, the shunt extends to the peritoneal cavity (the area which houses the organs in the belly), the chest cavity, or the heart.
Are Brain Shunts Permanent?
As there is no cure for hydrocephalus, shunt treatments are, in fact, permanent. However, they allow patients to lead normal lives without limitations.
Different Types of Brain Shunts
The choice of brain shunt depends on the type and blockage location that results in the hydrocephalus. The type of shunt system is named by the inflow and outflow locations.
Most patients undergo the following types of shunt placements:
Ventriculo-peritoneal (VP) shunt
This is the most common treatment, which shifts fluid from the brain into the peritoneal cavity (a fluid-filled gap between the walls of the abdomen and the organs in the abdomen).
Ventriculo-pleural (VPL) shunt
Shifts fluid from the brain into the pleural cavity (space between the two pleura of the lungs).
Ventriculo-atrial (VA) shunt or “vascular shunt”
Shifts fluid from the brain to the right atrium of the heart.
Ventriculo-gallbladder (VGB) shunt
This shunt shifts fluid from the brain to the gallbladder. It is not common but may be used in cases when treatment with other shunt locations is not possible. This might be due to infection, previous shunt failure, or if there is a congenital abnormality in the more common shunt locations.
Subdural-peritoneal shunt (SDP)
This shunt shifts fluid from subdural space to the peritoneal cavity.
These shunts have the following additional features:
- Fixed pressure shunt (most common) – regulates the flow-rate of the fluid based on a predetermined pressure setting; it is used for specific situations in which fluid output needs to be regulated.
- Programmable shunt – adjusts how much fluid is drained by a patient’s VP shunt, even after that shunt has been placed, because it is externally adjustable by a magnetic device.
Although a shunt works well and saves many lives, at ANA, we recognize that complications may occur with its use. These include infection, malfunction, or shunt failure. A shunt may also disconnect, or become outgrown.
Our neurosurgeons are fully equipped to help avoid and rectify any shunt problems. We explain more about recovery and emergencies here. You can also download this PDF which summarizes FAQs about shunts.
Other Treatment Options for Hydrocephalus
The neurosurgeons at ANA are pioneers in endoscopic third ventriculostomy (ETV), a minimally invasive procedure relevant for patients for whom hydrocephalus follows certain criteria.
In ETV, surgeons make an opening in the floor of the brain’s third ventricle, allowing trapped fluid to drain through its normal pathway. However, if the ETV fails a shunt placement would be needed. We go into more detail about this alternative hydrocephalus treatment.
Endoscopic Third Ventriculostomy (ETV)
ETV is a minimally invasive treatment option for hydrocephalus, without involving a shunt. The neurosurgeons at ANA are adept at this procedure, relevant for patients for whom the condition follows certain criteria.
ETV employs a tiny camera (neuro-endoscope) and tiny surgical instruments to make an opening in the floor of the brain’s third ventricle, traditionally a difficult area to reach via surgery. This fiber optic technology allows the neurosurgeon to view the surface of the ventricle.
Trapped fluid can drain through its normal pathway. When this procedure is successful, neither a shunt nor further treatment is required.
The success rate of this non-shunting alternative depends on numerous factors, which our physicians explain in detail.
This can be an option for some cases of obstructive or non-communicating hydrocephalus, and potentially other situations depending on age, cause or type of hydrocephalus, and state of the brain.
What Happens During Shunt Surgery?
In shunt surgery, one catheter is threaded into the fluid space in the brain through a tiny opening in the skull. The other catheter goes behind the ear.
This tube travels down the neck, then chest and abdomen, allowing excess fluid to drain into the abdominal cavity where the body absorbs it. A tiny pump (also referred to as a valve) is then attached between both catheters.
All of this is placed under the skin. When the pressure in the ventricles is increased, the valve will automatically activate to shunt the fluid out of the brain.
Shunt surgery takes less than an hour. In addition, as the entire shunt is implanted either within the skull or under the skin, no components of the shunt are visible outside of the body.
At ANA, we are a highly experienced multidisciplinary team that treats hundreds of hydrocephalus patients annually. Our team walks each patient through the shunt implantation surgical process from beginning to end.