Hydrocephalus (Water on the Brain)
Abnormal Fluid Accumulation
Hydrocephalus, or “water on the brain,” is a condition caused by a buildup of cerebrospinal fluid (CSF) in the skull. In a healthy person, CSF circulates around the brain and spinal cord, supplying nutrients, removing waste, cushioning the brain and regulating brain pressure. In a patient with hydrocephalus, the normally free circulation of CSF and re-absorption by the bloodstream is disrupted. Fluid begins to accumulate in brain ventricles, increasing the pressure on brain tissue.
While hydrocephalus can occur at any age, it is most common in infants, young children and adults over age 60.
Diagnosing the Condition
Diagnosis of hydrocephalus begins with a complete physical and neurological exam to detect problems of brain function. Sophisticated imaging tests like MRI, CT scan and ultrasound (for infants) are then used to detect obstructions and determine hydrocephalus severity. On rare occasions when other tests fail to reveal the disease cause, a transducer is inserted to measure intracranial pressure.
Treatments for Hydrocephalus
If hydrocephalus is not creating symptoms, or if it is due to temporary obstruction, treatment may consist of monitoring the condition instead of intervening. In most cases, though, hydrocephalus is treated with surgery. The type of surgery depends on the cause of the condition and its severity.
When hydrocephalus is the result of a tumor or cyst blocking the flow of cerebrospinal fluid, removal of the obstruction is the best course of action. If obstructions cannot be surgically removed. treatment involves surgery to divert the flow of CSF and avoid increased brain pressure. Diversion is not a cure for the condition, but it can alleviate symptoms and allow for satisfactory long-term management of hydrocephalus.
Surgical Diversion Methods
Shunt surgery: Short and relatively uncomplicated, this procedure inserts a small, flexible plastic tube into the ventricle passages in the brain and sends excess CSF into another area of the body where it can safely be absorbed. Although shunt surgery is effective for treating hydrocephalus, there are drawbacks. Shunts can malfunction, clog, become infected or be outgrown by children, requiring replacement surgery.
Ventriculoscopy (ETV): A relatively new, minimally invasive procedure, ETV involves insertion of a tiny telescopic camera (an endoscope) into the ventricle to view the fluid and locate the obstruction. The surgeon then creates a hole in the membrane at the bottom of the ventricle, allowing CSF to detour around the obstruction and flow freely into the rest of the brain for re-absorption.
Successful ETV avoids the need for a shunt, and it has a lower long-term complication rate than shunts. However, the procedure is not recommended for children under two. Ventriculoscopy is more complicated than shunt surgery and requires a neurosurgeon specially trained in endoscopic techniques.
Advanced Treatments at Princeton Brain & Spine
PBS neurosurgeons are at the height of surgical innovation and are trained and experienced in advanced techniques like ventriculoscopy. Through our association with leading NJ and PA hospitals, we also have access to state-of-the-art surgical facilities and equipment.
Our compassionate, patient-focused practice provides the knowledge clients need to make informed healthcare decisions. To learn more about treatment options for hydrocephalus or to schedule an appointment with our neurosurgical providers, call 215.741.3141 in Pennsylvania, 609.921.9001 in New Jersey, or contact PBS online.
Request an Appointment
Submit an appointment request on our patient portal or contact our New Jersey and Pennsylvania campuses to speak with a patient advocate.