From the Guidelines
Hydrocephalus is primarily managed by neurosurgeons, often working within a multidisciplinary team that may include neurologists, neuroradiologists, and rehabilitation specialists. The cornerstone of treatment is typically surgical intervention, most commonly the placement of a ventriculoperitoneal (VP) shunt, which diverts excess cerebrospinal fluid (CSF) from the brain ventricles to the peritoneal cavity where it can be absorbed. Alternative surgical approaches include endoscopic third ventriculostomy (ETV), particularly useful in obstructive hydrocephalus, which creates a new pathway for CSF flow within the brain.
Key Management Points
- Medical management with acetazolamide (250-1000 mg daily in divided doses) or furosemide may temporarily reduce CSF production in select cases, but these are generally considered temporizing measures rather than definitive treatments 1.
- Regular follow-up with neurosurgeons is essential to monitor shunt function through clinical assessment and neuroimaging.
- Patients and caregivers should be educated about potential shunt complications, including infection, obstruction, or mechanical failure, with symptoms like headache, vomiting, lethargy, or vision changes requiring immediate medical attention.
- The management approach is determined by the underlying cause, age of the patient, and specific presentation of hydrocephalus, as highlighted in guidelines for the management of aneurysmal subarachnoid hemorrhage 1.
Considerations for Specific Patient Groups
- For patients with increased ICP at the time of diagnosis, medical therapy and repeated lumbar punctures are recommended as initial management, with early magnetic resonance imaging (MRI) of the brain and neurosurgical consultation also advised 1.
- The need for permanent CSF diversion has been associated with older age, early ventriculomegaly, intraventricular hemorrhage, poor clinical condition on presentation, and female sex, as noted in studies on aneurysmal subarachnoid hemorrhage 1.
From the Research
Management of Hydrocephalus
The management of hydrocephalus involves a range of medical professionals, including:
- Neurosurgeons, who perform surgical procedures such as ventriculoperitoneal shunt surgery 2 and endoscopic third ventriculostomy (ETV) technique with or without choroid plexus cauterization (CPC) 3
- Pediatricians, who manage hydrocephalus in infants and children, and may use medical therapy with acetazolamide and furosemide to avoid cerebrospinal fluid shunts 4
- Neurologists, who diagnose and manage the condition, and may provide symptomatic relief with pharmacological treatments 5
Treatment Strategies
Treatment strategies for hydrocephalus include:
- Surgical shunt placement, which is a common procedure for managing hydrocephalus, but has high failure risks and complications 3, 2
- Endoscopic third ventriculostomy (ETV) technique with or without choroid plexus cauterization (CPC), which is a surgical intervention that has shown promise in managing hydrocephalus 3
- Medical therapy with acetazolamide and furosemide, which can be an effective alternative to shunting in some cases 4
- Innovative and low-cost, accessible treatment strategies, such as pharmacological, gene therapy, and nano-based technologies, which are currently being researched and developed 5
Healthcare Professionals Involved
The management of hydrocephalus involves a multidisciplinary team of healthcare professionals, including:
- Neurosurgeons, who perform surgical procedures and manage the condition
- Pediatricians, who manage hydrocephalus in infants and children
- Neurologists, who diagnose and manage the condition
- Other healthcare professionals, such as nurses and therapists, who provide supportive care and rehabilitation services 6, 2