Hydrocephalus, also termed as ‘water in the brain’, is a neuro medical condition where there is an abnormal build-up of CSF (cerebrospinal fluid) within the cavities (ventricles) of the brain.
Types of Hydrocephalus
- Communicating hydrocephalus - In this condition, there is no obstruction to the CSF flow. There is either an increase in production or a decrease in the absorption of the CSF.
- Non-communicating hydrocephalus - There is an obstruction to CSF flow. It causes the ventricles to enlarge and put pressure on the rest of the brain.
- Normal-pressure hydrocephalus - In this, the CSF pressure is normal, but the volume is more. The increased volume enlarges the ventricles. More common in the elderly.
- Hydrocephalus Ex-Vaco - There is an enlargement of the ventricles, while the other tissues in the brain tend to shrink. It is more common in elderly degenerative conditions like Alzheimer’s disease.
Surgery is the most common treatment for hydrocephalus. Shunt surgery and third ventriculostomy are the main options.
The goal is to reduce the pressure on the brain by creating a different channel for draining the CSF.
1. Shunt Surgery
In this, the neurosurgeon will insert a shunt that connects the third ventricle with another part of your body. A shunt system has two catheters or flexible tubes and a valve that connects them. The valve allows the CSF to flow only in one direction, which is away from the ventricle.
The most common area of the body for draining the CSF is the peritoneum, which lines your abdominal cavity. This type of shunt is called a Ventriculo-Peritoneal (V-P) shunt. Other areas of drainage are the pleural space(Ventriculo-Pleural) shunt or the right atrium of the heart. (Ventriculo- atrial shunt).
Before Surgery- What ToDo?
You will have a few tests to identify the intensity of your symptoms. Tests will also check your general health regarding your fitness for surgery. If you take blood thinners or herbal supplements, you need to stop them a few days before surgery. The same goes for smoking and drinking as well. You will have to report to the hospital the day before surgery.
You will have general anesthesia during surgery. Once you are asleep, your surgeon will make a small hole in your skull behind the ear. Through this opening, the surgeon will place one catheter in the ventricle of your brain.
The other end has a connection to the valve which lies behind the ear. Near the valve is a reservoir which is a small bulge in the catheter. Your doctor can measure your intracranial pressure through the reservoir. It helps to adjust the valves regarding how much CSF should pass through it.
The neurosurgeon will then connect the second catheter to the valve. The remaining part of this catheter will run inside your skin towards the peritoneum lining the abdominal cavity.
You will be in the hospital for two to three days after surgery. You will have pain killers to control the pain for a couple of days after surgery.
You will have to start walking around your room from the day after surgery. It helps to improve your blood flow, which makes your recovery faster.
Once you are back home, you will have to avoid strenuous activities. Proper wound care is critical to prevent infections.
Your symptoms will show improvement within a few days of surgery.
Risks & Complications
Apart from the usual surgical risks like pain, swelling, bleeding infections, etc., there are some specific risks. They include
- Increase or decrease in CSF drainage- Both can cause problems for you. Your surgeon will adjust the valves to prevent it.
- Infections of the shunt
- Shunt Blockage
2. Endoscopic Third Ventriculostomy
It is a minimally invasive surgery where your surgeon will use an endoscope to do the surgery.The neurosurgeon will insert the endoscope through a small hole in your skull towards the ventricle. Using miniature surgical instruments, the neurosurgeon will make a small hole at the base of your third ventricle. The CSF will flow from the third ventricle to the fluid chamber below the brain for absorption to the bloodstream.
The main advantage is that there is no need to have a foreign body like a shunt in your body