Hydrocephalus

When you have hydrocephalus, clear, colorless spinal fluid (cerebrospinal fluid or CSF) builds up inside your brain. It does this instead of reabsorbing into your body. It can happen from a head injury, brain or spinal tumors, a stroke or an infection like meningitis.

The more fluid collects in your brain, the more the harmful pressure increases. And this can keep your brain from working the way it should. There are four main types:

• Communicating hydrocephalus: This happens when the CSF flow is blocked from leaving your brain through areas called ventricles. It can still flow between ventricles.
• Non-communicating hydrocephalus (obstructive hydrocephalus): The spinal fluid flow is blocked in narrow passages connecting the ventricles and can’t move between them.
• Normal pressure hydrocephalus (NPH): This happens when spinal fluid slowly builds up and enlarges the ventricles without increasing pressure. Sometimes bleeding in the brain (hemorrhage) or complications from surgery can cause this kind of hydrocephalus.
• Hydrocephalus ex-vacuo: Brain damage from a head injury or a stroke can shrink brain tissue around the ventricles. This causes them to enlarge, but pressure usually stays the same.

If you have hydrocephalus, you may have a headache or feel nauseated. Or even be super tired. You might have balance problems or trouble walking (gait disturbances). You might be forgetful or even develop mild dementia.

These signs of acquired hydrocephalus can look like those of other conditions. So, it’s important to get checked out by experienced healthcare providers. It’s the best way to diagnose if you have hydrocephalus or something else. Left untreated, hydrocephalus can be fatal. So, early (and correct) diagnosis improves the chance for good results.

What to expect at your first appointment

We diagnose hydrocephalus in a few different ways. Your provider will go over all of this during your first appointment. They’ll ask about symptoms, if you’ve had any testing so far and if you’ve had any accidents or injuries. They’ll also go over your health history before doing physical and neurological exams.

They’ll also order tests to help confirm a diagnosis — or rule out other conditions. You may have imaging tests like:

• CT scan (computed tomography scan).
• MRI (magnetic resonance imaging).
• Spinal tap (lumbar puncture).

We may also do intracranial pressure monitoring (ICP) to measure pressure in your brain. And you may have a fundoscopic exam so our team can look at the optic nerve at the back of your eye.

Meet Our Hydrocephalus Team

Diagnosing and treating hydrocephalus takes the experience of a team of providers from different specialties working closely together. This means you’ll have a care team of skilled providers, like:

• Neurologists.
• Neurosurgeons.
• Neurophysiologists.
• Radiologists.
• Ophthalmologists.
• Physical therapists.
• Occupational therapists.

The only treatment for hydrocephalus is brain surgery. We know this may sound scary. But you can rest assured you’ll get the best and most experienced care from our neurology providers.

There are two types of brain surgery used to treat this serious condition:

Shunt

This is the most common way to treat hydrocephalus. Our surgical team will place a flexible tube called a shunt in your brain. It will drain built-up spinal fluid to another area of your body so it can be absorbed.

Endoscopic third ventriculostomy (ETV)

Your surgical team will make a small hole in a very thin portion of a fluid cavity in your brain called the third ventricle. They do this with an endoscope — a thin, lighted tube with a video camera on one end. This treatment doesn’t damage any nerves and creates an open path for spinal fluid to flow normally in and around your brain, which relieves pressure and swelling.

Life After Hydrocephalus Treatment

Any surgery comes with the chance of risks and complications. A shunt could fail. An ETV opening could close. Infections happen. That’s why it’s important to stay current with all follow-up visits with our team, and any tests they order.

Follow-up care helps us make sure your treatment remains successful. And if you do have complications down the road, it lets us start new treatments right away.

Taking the Next Step

A hydrocephalus diagnosis is serious. And it means you’ll need brain surgery and some time to recover. But it also means you’ll have a better quality of life. At Cleveland Clinic, we give you the support and care you need to make this a reality.