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What is Hydrocephalus?

Hydrocephalus is a condition where brain spinal fluid pressure is not controlled. Traditionally, the condition is divided into either communicating or non-communicating hydrocephalus. In non-communicating hydrocephalus, there is a blockage in the normal spinal fluid pathways leading to a backup of spinal fluid upstream. If left untreated, this condition can be very serious and even fatal. Communicating hydrocephalus involves the situation where brain spinal fluid is either over-produced, which is rare, or not reabsorbed into the bloodstream resulting in a backup of spinal fluid without the presence of a particular block in the spinal fluid pathway. Both forms can be serious if left untreated.

While hydrocephalus is typically a disease that strikes children, there are several forms that can affect adults.Neurosurgeon Dr. Matthew Ewend leads the physician team for hydrocephalus.

Learn more about pediatric hydrocephalus treatment at UNC Health.

Hydrocephalus Treatment - UNC Neurosurgery

Treatment for Hydrocephalus at UNC Health

UNC offers state-of-the-art treatment for patients suffering from hydrocephalus. Traditional treatments include medical therapy (less common), shunt placement or endoscopic third ventriculostomy. The latter is a procedure where a small opening is made with a scope to communicate the inside of the fluid spaces of the brain with the outer surface of the brain where the spinal fluid is reabsorbed. Our adult and pediatric programs are dedicated to providing the best possible therapy.

At UNC Health, we use a team that includes neurologists, neurosurgeons, physical therapists and speech therapists to perform a lumbar drain trial in patients being considered for shunting. The patients are admitted to the hospital for testing of their gait and cognitive function. A lumbar spinal drain is then placed and several days of spinal drainage is performed. If patients have significant improvement, as judged by their physical therapy and cognitive testing by their physician’s and family’s evaluations, a ventriculoperitoneal shunt is often placed. If the patients do not benefit from the lumbar drain, then it is presumed that the permanent shunting procedure would not benefit the patient and other treatments are explored.

Adult Hydrocephalus

The most common forms of adult hydrocephalus are obstructive hydrocephalus, normal pressure hydrocephalus, and pseudotumor cerebri (idiopathic intracranial hypertension). The evaluation and treatment of these conditions is often quite different.

In adult onset of obstructive hydrocephalus, there is usually a mechanical blockage of the spinal fluid flow including tumors, webbings, Chiari malformation or prior hemorrhage. The usual treatment involves either endoscopic third ventriculostomy or shunting. If an MRI or CAT scan shows hydrocephalus and the patient is asymptomatic, immediate evaluation is appropriate.

The condition of normal pressure hydrocephalus (NPH) is different than many forms of hydrocephalus. This disease typically is seen in older patients. The three classic symptoms are gait difficulties, memory difficulties, and difficulty controlling one’s bladder. These symptoms can also be seen in many forms of dementia, so careful evaluation is needed in order to decide whether a particular patient would benefit from shunting, which is the only treatment for NPH.

Pseudotumor cerebri is a third and distinct form of adult hydrocephalus that involves high brain pressures without dilatation of the brain spaces. It is frequently seen in younger women with primary symptoms being headaches and visual difficulties. In severe cases, swelling in the back of the eyes, termed papilledema, can be seen by a skilled ophthalmologist. Initial treatment is usually medicine to reduce spinal fluid production, but if this is unsuccessful, shunting procedures can be necessary to protect the patient’s vision. At UNC, we have traditionally performed an image-guided, stereotactically-placed ventriculoperitoneal shunt for treatment of this condition primarily in patients for whom vision loss or impending vision loss is the primary issue.

If you would like to make an appointment with one of our neurosurgeons, please call 984-974-4175 to schedule.