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Your Questions Answered: HYDROCEPHALUS


doi: 10.1097/01.NNN.0000299034.99478.aa
Department: Ask the Experts

Answers to your questions about arteriovenous malformation, body myositis, hydrocephalus, and the effect of statins on memory.

Harold L. Rekate, M.D., is chair of pediatric neurosciences and director of pediatric and congenital neurosurgery at the Barrow Neurologic Institute in Phoenix, AZ.

Q What are the latest and best treatments for hydrocephalus?

Figure. D

Figure. D

A People with hydrocephalus have an excessive accumulation of cerebrospinal fluid, which is the clear fluid surrounding the brain and spinal cord. When cerebrospinal fluid accumulates, it can cause an abnormal expansion of the spaces in the brain known as ventricles, and this dilation can cause harmful pressure on brain tissue. Symptoms usually include overly rapid head growth in babies, severe headaches with vomiting and irritability in children and young adults, and balance difficulties and memory loss in the elderly.

The good news is that over the past two decades advances in technology have, for the first time, allowed neurosurgeons to return the brain and spinal fluid to a normal state. Neurosurgeons can now use imaging technology, such as MRI, to pinpoint the site or sites of obstruction causing hydrocephalus.

It's possible to treat hydrocephalus through a technique called endoscopic third ventriculostomy: a tubular instrument called an endoscope is inserted into the third ventricle of the brain, allowing the surgeon to visualize the obstruction causing the hydrocephalus. The surgeon then makes a hole in the membrane of the ventricle to adjust the flow of the cerebrospinal fluid. While not without risk, the likelihood of severe damage from this procedure is very low.

Another option is the placement of a shunt system, consisting of a shunt (a flexible but sturdy tube), a catheter, and a valve. These instruments are used to redirect the flow of the cerebrospinal fluid to another part of the body where it is absorbed as part of the normal circulatory process. The use of programmable valves allows fine-tuning of the release of the cerebrospinal fluid and more precise control of intracranial pressure. These adjustable valves are sometimes paired with add-on devices that prevent overdrainage. For most people, these advances make it possible for them to go on to live long and productive lives.

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