By Dr. Ramandeep S. Dang, Neurosurgery
Hydrocephalus is a condition of the brain which is characterized by accumulation of cerebrospinal fluid. This results in an increase in the pressure inside the skull. It occurs predominantly in children.
In case of adults, symptoms include double vision, poor balance, changes in personality, persistent and sharp headaches. Once diagnosed, it requires prompt medical treatment. Treatment in the case of Hydrocephalus is exclusively surgical. Since there are no cures for the condition and no way to prevent it, surgery is essential to relieve the pressure exerted by the fluid on the brain. Any delay to do so could result in permanent brain damage.
There are two surgical treatments for hydrocephalus. They are-
- Shunt Surgery: The preferred surgery for the condition by most neurosurgeons around the world, it is the insertion of a shunt to drain the excess fluid. A shunt is a flexible, long tube consisting of a valve that helps the cerebrospinal fluid flow in the correct direction and at the right rate. Usually placed as a part of the ventricular system it diverts the fluid to a different region of the body. This is more often than not, the abdominal cavity where the fluid can be easily absorbed. A valve on the shunt helps maintain the pressure within the brain ventricles. This shunt system will require regular monitoring throughout one’s life.
- Endoscopic Third Ventriculostomy (ETV): The alternative to shunt surgery is Endoscopic Third Ventriculostomy which involves using an endoscope to puncture the membrane of one of the ventricles to create a pathway for the cerebrospinal fluid to flow. The rate of success for this treatment is dependent on a number of factors. These include the age of the person, whether it was congenital or acquired, and the direction of the flow of the fluid. Like other endoscopic surgeries, the time required to perform the surgery is short and the recovery quicker.
As with any kind of surgery, one should be cautious of possible complications-
- A shunt, since it is a delicate piece of medical equipment is susceptible to malfunction caused by infections or blockages. Bleeding may also occur if the shunt has not been positioned properly. In such cases the shunt will have to be replaced.
- In the case of an ETV, the aperture that has been created might close. Also the brain might find it difficult to absorb the fluid that is draining through it. In such cases, the procedure will have to be repeated.
After surgery one needs rehabilitative therapies and emotional support.