Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the fluid-containing cavities or ventricles of the brain. The term hydrocephalus is derived from the Greek words “hydro” meaning water and “cephalus” meaning the head. Although it translates as “water on the brain,” the word actually refers to the buildup of cerebrospinal fluid, a clear organic liquid that surrounds the brain and spinal cord. CSF is in constant circulation within the ventricles of the brain and serves many crucial functions: 1) it acts as a “shock absorber” for the brain and spinal cord; 2) it acts as a vehicle for delivering nutrients to the brain and removing waste from it; and 3) it flows between the cranium and spine to regulate changes in pressure.
When CSF builds up around the brain, it can create harmful pressures on the tissues of the brain confined within the skull. The accumulation of CSF occurs due to either an increase in production of the fluid, a decrease in its rate of absorption or from a condition that blocks its normal flow through the ventricular system.
Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older. According to the National Institute of Neurological Disorders and Stroke (NINDS), hydrocephalus is believed to affect approximately one to two in every 1,000 children born in the U.S. The majority of these cases are often diagnosed before birth, at the time of delivery or in early childhood.
Acquired Hydrocephalus: This is the type of hydrocephalus that develops at birth or in adulthood and is typically caused by injury or disease.
Congenital Hydrocephalus: It is present at birth and may be caused by events that occur during fetal development or as a result of genetic abnormalities.
Communicating Hydrocephalus: This type of hydrocephalus occurs when there is no obstruction to the flow of CSF within the ventricular system. The condition arises either due to inadequate absorption or due to an abnormal increase in the quantity of CSF produced.
Non-communication (Obstructive) Hydrocephalus: It occurs when the flow of CSF is blocked along one of more of the passages connecting the ventricles, causing enlargement of the pathways upstream of the block and leading to an increase in pressure within the skull.
Normal Pressure Hydrocephalus: It is a form of communicating hydrocephalus that can occur at any age, but is most common in the elderly. It is characterized by dilated ventricles with normal pressure within the spinal column.
Hydrocephalus Ex-vacuo: It primarily affects adults and occurs when a degenerative disease, like Alzheimer’s disease, stroke or trauma, causes damage to the brain that may cause the brain tissue to shrink.
- Unusually large head size
- Rapidly increasing head circumference
- Bulging and tense fontanelle or soft spot
- Prominent scalp veins
- Downward deviation of eyes or sunset sign
Children and Adolescents
- Nausea and vomiting
- Swelling of the optic disc or papilledema
- Blurred or double vision
- Balance and gait abnormalities
- Slowing or loss of developmental progress
- Changes in personality
- Inability to concentrate
- Poor appetite
- Urinary incontinence
- Nausea and vomiting
- Difficulty walking or gait disturbances
- Loss of balance or coordination
- Bladder incontinence
- Impaired vision
- Impaired cognitive skills
- Memory loss
- Mild dementia
Hydrocephalus can be treated in a variety of ways. Based on the underlying etiology, the condition may be treated directly by removing the cause of CSF obstruction or indirectly by diverting the excess fluid. Hydrocephalus is most commonly treated indirectly by implanting a device known as a “shunt” to divert the excess CSF away from the brain. The shunt is a flexible tube which, along with a catheter and a valve, is placed under the skin to drain excess CSF from a ventricle inside the brain to another body cavity such as the peritoneal cavity (the area surrounding the abdominal organs).
Once inserted, the shunt system usually remains in place for the duration of a patient’s life (although additional operations to revise the shunt system are sometimes needed). The shunt system continuously performs its function of diverting the CSF away from the brain, thereby keeping the intracranial pressure within normal limits. In some cases, two procedures are performed, the first to divert the CSF and another at a later stage to remove the cause of obstruction (e.g. a brain tumor).
A limited number of patients can be treated with an alternative operation called endoscopic third ventriculostomy. In this procedure, a surgeon utilizes a tiny camera (endoscope) with fiber optics to visualize the ventricles and create a new pathway through which CSF can flow.
Dante F. Vacca
Jay K. Morgan
MD, PhD, FAANS
Frequently Asked Questions
What is Neurosurgery?
Most people think of neurosurgeons as brain surgeons, and this is true! However, neurosurgeons are more broadly defined as highly trained medical specialists who diagnose and treat disorders of the entire nervous system – including our brain, spinal cord, skull and the spine (bony vertebral column). Of course, they operate on the brain, but they actually spend more of their time helping patients with spine and peripheral nerve disorders.
Do I need surgery if I am being referred to a neurosurgeon?
Not necessarily. Your referring physician most likely believes that you have a disease or disorder which would benefit from diagnoses, testing and treatment by a neurosurgeon. The decision whether or not to recommend surgery is a complex one, best handled by your neurosurgeon and his/her team.
What is the difference between an orthopedic surgeon and a neurosurgeon?
Each of these surgical specialists has their own areas of expertise however, their skill and expertise overlap in the area of spinal surgery. Both specialties require 5-7 years of residency training, followed in some cases by additional time in fellowship training. Neurosurgeons perform spinal operations dealing with the cervical discs, nerves, and the bony spine, while orthopedic surgeons handle surgeries limited to the bony spine, such as spinal fusion.
How do I make an appointment with Sierra Neurosurgery Group?
What is the difference between a neurologist and a neurosurgeon?
A neurologist and a neurosurgeon are similar to a cardiologist and a cardiac surgeon: the neurosurgeon can offer a surgical solution to neurologic disorders, while the neurologist identifies neurological disorders through diagnostic testing and uses non-surgical treatment options.
Do you offer X-rays and MRI’s?
Sierra Neurosurgery offers comprehensive imaging services at our Reno office on Kietzke Lane, including X-Ray services and MRI scans with & without contrast. This provides a quick, easy and no-hassle way to complete necessary imaging as part of your treatment plan.
What to Expect From Your Visit
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