Treatments
The Columbia Adult Hydrocephalus multidisciplinary team is one of the most experienced and knowledgeable in the world, evaluating and treating hundreds of patients annually. Our neurosurgeons use the latest surgical techniques to treat hydrocephalus, resulting in the best possible outcomes.
Often hydrocephalus is a secondary condition, and therefore once the primary condition or disease is treated, hydrocephalus goes away too. For instance, brain tumors can obstruct the flow of cerebrospinal fluid (CSF), causing hydrocephalus. Once the brain tumor is surgically removed, CSF can flow normally and hydrocephalus goes away.
However, if hydrocephalus does not resolve after a primary condition or disease is treated, surgical treatment for the hydrocephalus itself is typically required. Most often, patients undergo ventricular shunt surgery. Some patients may be candidates for endoscopic third ventriculostomy or even endoscopic third ventriculostomy with choroid plexus cauterization.
Ventricular Shunt Surgery
If a patient’s symptoms improve with spinal fluid drainage, shunt surgery, which is usually brief and safe, is recommended. The goal of placing a shunt is to divert CSF into a region of the body where it can be absorbed, such as the peritoneal cavity or a vein just above the heart. The shunt is a soft tube that is just over 2 mm in diameter, and the synthetic material from which it is made is generally very well tolerated by the human body. The entire shunt is implanted either within the skull or under the skin; no components of the shunt are visible outside of the body.
Between the shunt catheter in the brain and the catheter that goes to the abdomen or bloodstream, there is a one-way valve that regulates CSF flow through the shunt. Regulating CSF flow is essential because if there is too much flow, the ventricles will collapse and bleeding can occur. If there is too little flow, the patient’s symptoms will not improve.
All shunts that our neurosurgeons implant contain a magnetically programmable valve. This allows us to fine-tune the shunt function over time to maximize patient safety and minimize complications.
Endoscopic Third Ventriculostomy
In some cases of noncommunicating hydrocephalus, the blockage can be bypassed using endoscopic surgery. In this type of surgery, an endoscope and microinstruments are manipulated through a minimally invasive, computer-guided approach into the ventricle. A small hole is made in the floor of the third ventricle, allowing CSF to flow out of the brain. When successful, this type of surgery corrects the hydrocephalus without requiring a shunt implantation.
Endoscopic Third Ventriculostomy With Choroid Plexus Cauterization
For some infants, endoscopic third ventriculostomy can be performed with the addition of choroid plexus cauterization. After this procedure, the choroid plexus produces less CSF.
Ventricular Shunt Surgery Complications and Follow-Up
Although shunting is a relatively straightforward procedure, complications can arise, which underscores the importance of selecting a neurosurgeon experienced in treating this condition. The most common possible complications are infection and shunt failure.
Patients treated at Columbia have access to world-renowned neurosurgeons experienced in treating hydrocephalus. Our neurosurgeons have strict protocols in place to keep infection rates as low as possible and to select only the shunt implants best for their patients.
Our center has an overall complication rate in hydrocephalus shunt surgery of less than 5 percent. This is far better than the 10 to 25 percent rates reported in large studies in the medical literature.
Patients who are surgically treated for hydrocephalus will need long-term follow-up to optimize shunt function and minimize complications. Shunt valves may need to be reprogrammed overtime to ensure patients are getting the best clinical benefit.