How is Hydrocephalus Treated?

Treatment for Hydrocephalus aims firstly to ease the CSF (Cerebrospinal Fluid) build-up, and then to ensure that the same situation does not reoccur. Commonly, surgical intervention is required by diverting the excess fluid by placing a synthetic tube (shunt) into the ventricle. Less common is a surgical procedure called Endoscopic Third Ventriculostomy (ETV) which may be a useful alternative to shunting in some cases of Hydrocephalus.
 
What is Endoscopic Third Ventriculostomy (ETV)?
 
 
Endoscopic Third Ventriculostomy (ETV) is a one-time procedure; an opening is created in the floor of the third ventricle using an endoscope placed within the ventricular system through a burr hole. This allows the movement of cerebrospinal fluid (CSF) out of the blocked ventricular system and into the interpenducular cistern (a normal CSF space) thereby shortcutting any obstruction. ETV is used to treat certain forms of obstructive Hydrocephalus, such as aqueductal stenosis.
 
The objective of this procedure is to normalise pressure on the brain without using a shunt. ETV is not a cure for Hydrocephalus, but rather an alternative treatment.
 
Although open ventriculostomies were performed as early as 1922, they became a less common method of treating Hydrocephalus in the 1960s, with the advent of shunt systems. 
 
Despite recent advances in shunt technology and surgical techniques, however, shunts remain inadequate in a number of cases. Specifically, extracranial shunts are subject to complications such as blockage, infection, and over-drainage, often necessitating repeated surgical revisions. For this reason, in selected cases, a growing number of neurosurgeons are recommending endoscopic third ventriculostomy in place of shunting.
 
What is a shunt?
 
 
A shunt is a mechanical device designed to transport the excess CSF from or near the point of obstruction to a re-absorption site and it is implanted under the skin. A shunt is a tube that diverts the excess fluid from the expanded brain cavity (ventricle) to another part of the body. This procedure re-directs the fluid to another body cavity such as the abdomen. This is called a VP shunt (Ventricular-Peritoneal shunt). In some cases, the fluid is diverted one of the chambers of the heart. This is called a VA shunt (Ventricular-Atrial shunt).
 
A shunt is usually composed of three parts: a silicone catheter that enters the enlarged ventricle; a one-way valve that only allows flow away from the ventricle; and tubing which enters the cavity that is to receive the fluid. Each valve is designed to operate at a set pressure, so that a high-pressure valve will allow less fluid to flow through it than a low-pressure valve. A variety of valve designs are available and efforts are constantly underway to improve them.
 
Newborns and infants often are implanted with a fixed shunt, when they are older and in need of a revision, the doctor may then decide to replace the valve and reservoir unit with a programmable one.
 
Although, shunting systems represent a major medical breakthrough, some are still left vulnerable to complications, most notably obstruction or infection of the shunt. However, most people diagnosed with Hydrocephalus live full and active lives.
 
Newborns and infants often are implanted with a fixed shunt, when they are older and in need of a revision, the doctor may then decide to replace the valve and reservoir unit with a programmable one.
 
Although, shunting systems represent a major medical breakthrough, some are still left vulnerable to complications, most notably obstruction or infection of the shunt. However, most people diagnosed with Hydrocephalus still manage to live full and active lives.

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