The condition is caused by the buildup of cerebrospinal fluid in cavities (ventricles) deep inside the brain making them swell and push into the brain. Flowing through ventricles, the fluid normally provides a protective cushioning to the brain and spinal column. But an excessive of the fluid can damage brain tissues and cause a large spectrum of impairments in its function.Although hydrocephalus can occur at any age, it’s more common among infants and older adults. Surgical treatment can restore and maintain normal cerebrospinal fluid levels in the brain. A variety of interventions are often required to manage symptoms or functional impairments resulting from hydrocephalus. Excess cerebrospinal fluid in the ventricles occurs owing to one of the following reasons:
Obstruction: The most common problem is the partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption: Less common is a problem with the mechanisms that enable the blood vessels to absorb cerebral spinal fluid. This is often related to inflammation of brain tissues from disease or injury.
Over-production: Rarely, the mechanisms for producing cerebrospinal fluid create more than normal and more quickly than it can be absorbed.
A diagnosis of hydrocephalus is usually based on your answers to the doctor’s questions about signs and symptoms, a general physical, a neurological exam and brain imaging. The type of neurological exam will depend on a person’s age. The neurologist may ask questions and conduct relatively simple tests to judge reflexes, muscle strength, muscle tone, sense of touch, vision and eye movement, hearing, coordination, balance and mental status.
Brain imaging tests (MRI/CT Scan): can show enlargement of the ventricles caused by excess cerebrospinal fluid. They may also be used to identify underlying causes of hydrocephalus or other conditions contributing to the symptoms.
Ultrasound: This is often used especially among children for an initial assessment for infants because it’s a relatively simple, low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of a baby’s head. Ultrasound may also detect hydrocephalus prior to birth when the procedure is used during routine prenatal examinations.
One of the following two surgical treatments may be used to treat hydrocephalus:
Shunt: The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain’s ventricles and tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart.
Ventriculostomy: This is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain and makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.
Some people with hydrocephalus, particularly children, may need additional treatment, depending on the severity of long-term complications of hydrocephalus. At BRAINS, a care team for children includes a pediatrician who oversees the treatment plan and medical care; a pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children and a mental health provider, such as a psychologist or psychiatrist. Adults with more severe complications may also require the services of occupational therapists, social workers, specialists in dementia care or other medical specialists.