How is hydrocephalus treated?

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 11, 2024
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Hydrocephalus is caused by the continuous increase of cerebrospinal fluid in the ventricular system of the brain. There are two types of hydrocephalus: obstructive hydrocephalus and communicating hydrocephalus, each with different treatment methods. Obstructive hydrocephalus is caused by obstructions such as tumors or blood clots, so removing tumors or clearing blood clots can relieve the obstruction and treat the hydrocephalus. On the other hand, communicating hydrocephalus usually has no obstruction; it is primarily caused by excessive production or insufficient absorption of cerebrospinal fluid. A common treatment is ventriculoperitoneal shunt surgery, which diverts cerebrospinal fluid from the ventricles to the abdominal cavity to treat hydrocephalus.

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Written by Chen Yu Fei
Neurosurgery
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Is hydrocephalus easy to treat?

For patients with hydrocephalus, it is generally recommended to treat the condition surgically. Before the surgery, the patient should undergo a cranial CT or MRI to assess the type and severity of the hydrocephalus. If possible, a lumbar puncture should also be performed before the surgery to determine whether there is a significant increase in intracranial pressure, and a small amount of cerebrospinal fluid should be collected for routine and biochemical analysis of the cerebrospinal fluid. If there are no obvious contraindications to surgery, clinically, it is generally recommended to choose a ventriculoperitoneal shunt surgery. Most patients respond well to the surgery, and the morphology of the ventricular system gradually returns to normal.

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Written by Tang Li Li
Neurology
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How to relieve headache caused by hydrocephalus?

Hydrocephalus causing headaches is generally related to high pressure in the brain. Hydrocephalus leads to an enlargement of the ventricular system, compressing the surrounding brain tissue. Since the volume of the skull is fixed, increased accumulation of fluid can cause a rapid rise in internal pressure, leading to headaches. In severe cases, it may cause nausea, vomiting, and disturbances in consciousness, making the patient drowsy, stuporous, or even comatose. In such cases, the main treatment is to reduce the pressure inside the brain. Dehydrating agents, such as mannitol, can be used; however, mannitol mainly removes water from inside the cells and is more effective for cerebral edema than for hydrocephalus. Furosemide can be used to reduce the secretion of cerebrospinal fluid and may have some effect on hydrocephalus. However, the key treatment is likely to be surgical, such as lateral ventricular drainage, which can fundamentally resolve the problem of fluid accumulation but can also lead to complications like infections.

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Written by Chen Yu Fei
Neurosurgery
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Is hydrocephalus serious?

Hydrocephalus is relatively serious. When hydrocephalus occurs, it gradually affects the patient's motor functions of the limbs, causing weakness in one or both sides, difficulty in lifting, walking impairments, difficulty performing fine motor actions, and ataxia. It may even lead to frequent falls. Additionally, there are significant cognitive impairments, characterized by reduced intelligence levels, decreased computational abilities, and even certain degrees of language dysfunctions. Patients may also exhibit significant personality changes, such as feelings of anxiety, depression, apathetic expressions, and a dislike for communication and interaction with others.

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Written by Jiang Fang Shuai
Neurosurgery
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Causes of Hydrocephalus

Under normal conditions, the secretion, circulation, and absorption of cerebrospinal fluid (CSF) maintain a dynamic balance. In some pathological states, this balance is disrupted, leading to an excessive accumulation of CSF within the ventricular system, a condition known as hydrocephalus. Hydrocephalus can be classified into obstructive hydrocephalus and communicating hydrocephalus. The causes of obstructive hydrocephalus mainly include obstructions in the ventricular system, such as congenital malformations or abnormal development of the cerebral aqueduct, which are the most common causes of hydrocephalus in infants. In adults, tumors, bleeding, blockages, or compression of the ventricular system are also common causes of hydrocephalus. Communicating hydrocephalus results primarily from acquired diseases, such as cranial infections or blockages of arachnoid granulations by subarachnoid hemorrhage, leading to impairments in CSF absorption.

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Early manifestations of infant hydrocephalus

Infant hydrocephalus initially manifests as an enlarged head, beginning from birth with progressive increase in head circumference that is disproportionate to body growth. Upon examination, bulging fontanelles, thin scalp, and clearly visible scalp veins can be observed, with widened or even separated sutures. Additionally, due to increased intracranial pressure, symptoms such as irritability, recurrent vomiting, refusal to eat, abnormal behavior, and seizures may present as early indicators.