Hydrocephalus, known as “water on the brain” (in Greek, “hydro” means “water” and “cephalus” means “head”) is an abnormal buildup of fluid in the cavities (ventricles) deep within the brain.

The fluid is cerebrospinal fluid (CSF), which provides the brain with nourishment, waste removal, and protection. Excess fluid increases the size of the ventricles and puts pressure on the brain, which can cause brain dysfunction.

The condition is most common in infants, but anyone at any age can develop the condition. According to the Hydrocephalus Association, 1 out of every 770 babies will develop hydrocephalus, and more than 1 million Americans have the condition.

Although hydrocephalus has no known cure, nor is it preventable, it is treatable. In the Athens area, Dr. Woodall and his partners at Georgia Neurological Surgery have the skill and experience to surgically treat hydrocephalus in patients of any age.

Causes and Symptoms of Hydrocephalus

The exact cause of hydrocephalus is not well understood, but fluid buildup may occur due to:

  •  A blockage between areas where CSF flows, such as between ventricles or between ventricles and other areas of the brain
  • The body not absorbing CSF properly
  • The body overproducing CSF

Hydrocephalus can be congenital (appearing at or shortly after birth) or acquired (developing overtime or the result of disease or injury). About two in every thousand infants are born with hydrocephalus. Some conditions that can lead to hydrocephalus include stroke, traumatic brain injury, and meningitis.

Hydrocephalus can also be classified as communicating, meaning CSF can still flow between ventricles, and non-communicating, meaning the normal flow of CSF is blocked. A form of communicating hydrocephalus is normal pressure hydrocephalus (NPH), which is more common among the elderly.

In infants, the most noticeable symptom of hydrocephalus is an enlarged or rapidly growing head, or a head with a bulge on the soft spot of the head (the fontanel). Other symptoms include vomiting, irritability, and seizures.

Older children and young to middle-aged adults may experience neurological conditions including headaches, blurred or double vision, memory loss, and sleep issues, as well as bladder control problems.

Older adults—usually older than 60, who are more likely to experience NPH—may also experience mental impairment, but the condition might be misdiagnosed as Alzheimer’s disease, Parkinson’s disease, dementia, or simply a result of the aging process. NPH may be caused by a subarachnoid hemorrhage, head trauma, an infection, a tumor or complications of surgery. Symptoms of NPH can also include gait disturbance (trouble walking) or impaired bladder control. When correctly diagnosed and treated, NPH patients often return to full functioning.

A complete neurological exam, including brain imaging and other tests, can diagnose hydrocephalus and rule out other possible conditions. If left untreated, hydrocephalus can be fatal, so early diagnosis and treatment are important.

Treatment of Hydrocephalus with Endoscopic Surgery

The most common treatment for hydrocephalus is surgery to place a long, flexible tube called a shunt into the ventricle. This creates a drainage system that flows excess CSF under the skin and drains into another part of the body—such as the abdomen, the atrium of the heart, or the chest cavity near the lungs—where it will be safely reabsorbed. Draining the excess CSF lowers pressure and reduces pressure on the brain.

The shunt will remain inside the patient, and may not last forever. Shunt recipients need to be monitored due to potential complications—such as mechanical failure, malfunction, or infection—that may result in the return of symptoms or the need for further surgery. 

Dr. Woodall offers an alternate treatment option for hydrocephalus called endoscopic third ventriculostomy (ETV). ETV is a surgical procedure using an endoscope (a small tube with a light and small video camera) to puncture a membrane in the floor of the third ventricle. This reduces pressure by creating a pathway for CSF flow within the cavities in the brain. When an ETV is performed, there is no need for an implanted foreign body (shunt catheter), which reduces the risk of infection and future complications.

For ETV surgery, you’ll likely remain in the hospital for a day. The first few days after surgery, you may have a headache or discomfort from the incision. If you feel sick at your stomach shortly after surgery, you will be given IV fluids to help you feel better.

Contact M. Neil Woodall, MD, Today

If you or your family member requires treatment for hydrocephalus, or if you have questions regarding the difference between shunt placement and endoscopic third ventriculostomy (ETV), Dr. Woodall has the skill, care, and experience to ensure you receive the treatment you need—without leaving the Athens area. Contact our office today.