Diagnosis and Treatment of Hydrocephalus

If you or a loved one shows signs of hydrocephalus, getting clear answers is the first step toward feeling better. Understanding how the condition is diagnosed and treated can help you know what to expect and where to seek help.

At Banner Health, our neurologists and neurosurgeons listen to your symptoms, perform a thorough exam and review pertinent diagnostic tests to develop a personalized care plan. From diagnosis to treatment and long-term follow-up, we are here to guide you through each stage with expertise and compassion. 

Diagnosing hydrocephalus

Because hydrocephalus can cause many various symptoms like headaches, trouble walking or memory problems, finding it early can help prevent brain damage, guide treatment and lead to better long-term results. 

Your health care provider will begin by asking about your medical history and doing a physical exam. They will ask about your symptoms, when they started and how they have changed. For babies and children, specialists may check for rapid head growth or changes in head shape. 

To confirm a diagnosis, your provider may use imaging tests and neurological exams, including:

• Ultrasound: For babies whose skull bones aren't fully closed yet, ultrasound is a painless way to see the ventricles and check for fluid buildup.
• Magnetic resonance imaging (MRI scan): This test uses strong magnets and radio waves to make detailed images of your brain. It can show if the spaces in your brain called ventricles are enlarged or if there is too much fluid. MRI scans don’t hurt but they can be loud and you must stay very still during the scan.
• Computed tomography (CT scan): A CT scan is a test that takes pictures of the inside of the brain. It can show if a fluid called cerebrospinal fluid (CSF), which is clear and helps nourish the brain, is collecting in certain areas. The scan is quick and painless. During the test you must stay very still, so a child might be given a mild sedative to help them relax.
• Lumbar puncture (spinal tap): In some cases, specialists remove a small amount of CSF to measure pressure or test how your body responds to fluid drainage. 
• CSF flow studies: These tests measure how CSF moves through the brain and spinal cord to help identify blockages or abnormal flow.
• Intracranial pressure (ICP) monitoring: A small sensor measures pressure inside the skull. This helps specialists understand how the fluid is affecting the brain. 
• Gait or walking tests: For adults with suspected normal pressure hydrocephalus (NPH), your provider might test how you walk before and after a small amount of fluid is removed. This helps show if drainage could improve your movement or balance. 
• Extralumbar Drain (ELD): In some cases, if a lumbar puncture is not successful, longer-term drainage may be used. A small flexible tube is placed in the lower spine to drain spinal fluid over several days to see if your walking and other symptoms improve. If this drainage helps, you may be a candidate for shunt surgery to help improve walking abilities.

Ruling out other causes

Many conditions can mimic hydrocephalus, such as Parkinson’s disease, Alzheimer’s disease and other movement disorders. Imaging and testing help your care team tell the difference and choose the best treatment plan for you.

Treating hydrocephalus

Hydrocephalus is usually treated with surgery. The goal is to fix the flow of fluid in the brain, lower pressure and avoid long-term health problems. The type of surgery depends on your age, overall health and what caused the fluid buildup.

Shunt placement

The most common treatment is a device called a shunt. A shunt is a small, flexible tube that helps drain extra fluid from the brain to another part of the body, usually the abdomen, where the body can absorb it naturally. 

A shunt system has three main parts:

• A thin catheter that sits in one of the brain’s ventricles
• A valve that controls how much fluid drains
• Another catheter that carries the fluid to another part of the body

This operation can quickly help with problems like headaches, balance problems, thinking difficulties, vision changes, and/or urinary problems. It is safe for infants, older children and adults.

Most people stay in the hospital for a few days after surgery and get better in a few weeks. Since many people need a shunt for their whole life, they might need to have it fixed or replaced later on. 

Endoscopic third ventriculostomy (ETV)

Some people might be good candidates for a surgery called endoscopic third ventriculostomy (ETV). In this surgery, your neurosurgeon makes a small opening in the floor of the third ventricle. This helps CSF flow normally around the brain without the need for a shunt. 

ETV works best for some kinds of hydrocephalus, like when there's a blockage that stops fluid from flowing properly. This is called obstructive or non-communicating hydrocephalus.

ETV with choroid plexus catheterization (ETV-CPC)

In infants and children, a combined procedure called ETV-CPC might be done. The doctor removes some tissue that produces CSF. This helps lower fluid buildup and may prevent future problems.

Managing symptoms

Sometimes, medicine can help to lower the amount of fluid made by the brain or help with symptoms for a short time. But surgery is still the best long-term option. 

After surgery, you will keep visiting your care team for checkups. If you have a shunt, you might need imaging tests from time to time to make sure everything is working well.

Living with hydrocephalus

Life with hydrocephalus can be different for each person. Some people recover completely, while others might have lasting problems that need therapy or support. But many children and adults live full and active lives after treatment.

Physical and occupational therapy

If you find it hard to walk, move or do daily tasks, your care team might suggest physical therapy or occupational therapy. These therapies can help you get stronger, improve coordination and get back to activities you enjoy.

School and learning support

Children with hydrocephalus might need extra help in school, especially with concentration or memory. With proper educational support and ongoing care, most children adapt well and keep up with their classmates. 

Emotional and mental health

Living with a long-term condition can bring emotional ups and downs. You might feel anxious about your surgery or your child’s future. Counseling or joining a support group can make a difference. Talking openly with your care team can also help you find resources that meet your needs. 

Healthy living tips

You can't totally stop hydrocephalus, but you can support your health and recovery by:

• Going to follow-up appointments
• Watching for signs of shunt problems
• Protecting your head from injury
• Eating a balanced diet and staying active
• Asking your care team before starting new activities or contact sports

For children, regular pediatric checkups are important to track growth and development. For adults, ongoing neurological care helps detect and treat any changes early. 

Complications

Even after successful treatment, it’s important to know what symptoms could signal a problem. See your health care provider or go to the emergency room if you experience:

• Severe or worsening headache
• Fever or redness along your shunt
• Nausea or vomiting
• Trouble walking or keeping balance
• Blurred vision or double vision
• Vision loss
• Confusion or unusual drowsiness

These symptoms could mean a shunt infection or break or that the ETV has closed, all of which need quick medical attention.

How Banner Health can help

Hydrocephalus doesn't just affect your brain. It can also impact your life, your independence and your family. That’s why our care team focuses on the whole person, not just the condition.

Our team of neurosurgeons, neurologists, therapists, rehabilitation specialists, social workers and more is here to help you with compassion, experience and teamwork.

Find a Banner Health neurosciences specialist.