Management

The cause of hydrocephalus should be eliminated if possible - e.g. colloid cysts of the 3rd ventricle, intraventricular meningioma, other obstructive causes.

The definitive treatment of hydrocephalus involves diversion of cerebrospinal fluid out of the ventricles of the brain to prevent increase in intracranial pressure (1).

• this is achieved by the implantation of a permanent ventriculoperitoneal shunt - via a burr hole, a silicone tube is placed in the lateral ventricle of the brain which drains CSF subcutaneously into the peritoneum
• alternatives include :
  • ventriculoatrial - lateral ventricle to internal jugular vein)
  • ventriculopleural - lateral ventricle to pleural space
  • lumboperitoneal (lumbar intradural space to peritoneum) (1)

Endoscopic third ventriculostomy has become a more recent, and important, treatment option for occlusive hydrocephalus associated with aqueductal stenosis or space-occupying lesions of or around the posterior third ventricle and upper brainstem (2,3):

• this procedure appears to be more successful in adults than in young children
• it is efficacious in both previously shunted and non shunted patient
• complication and mortality rates compare favorably with those for shunts
• has also been increasingly used as an alternative treatment option for shunt complications

Lumbar puncture may be used to relieve pressure in an acute communicating hydrocephalus.

Reference:

• (1) Kandasamy J, Jenkinson MD, Mallucci CL. Contemporary management and recent advances in paediatric hydrocephalus. BMJ. 2011;343:d4191
• (2) Buxton N et al. Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases. Surg Neurol 2001;55:p. 74–78.
• (3) Boschert J et al. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow-up and review. J Neurosurg 2003;98 :1032–1039