What are the surgical options for treatment of hydrocephalus?

Updated: Jun 04, 2018
  • Author: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

Surgical treatment is the preferred therapeutic option in patients with hydrocephalus. [4] Most patients eventually undergo shunt placements, such as the following:

  • Ventriculoperitoneal (VP) shunt (most common)

  • Ventriculoatrial (VA) shunt (or "vascular shunt")

  • Lumboperitoneal shunt: Only used for communicating hydrocephalus, CSF fistula, or pseudotumor cerebri)

  • Torkildsen shunt (rarely): Effective only in acquired obstructive hydrocephalus (ventriculocisternostomy)

  • Ventriculopleural shunt (second-line therapy): Used if other shunt types contraindicated

Rapid-onset hydrocephalus with ICP is an emergency. The following procedures can be done, depending on each specific case:

  • Ventricular tap in infants

  • Open ventricular drainage in children and adults (EVD, external ventricular drain)

  • Lumbar puncture (LP) in posthemorrhagic and postmeningitic hydrocephalus

  • VP or VA shunt

Repeat LPs can be performed for cases of hydrocephalus after intraventricular hemorrhage (which can resolve spontaneously). If reabsorption does not resume when the CSF protein content is less than 100 mg/dL, spontaneous resorption is unlikely to occur. LPs can be performed only in cases of communicating hydrocephalus.

Alternatives to shunting include the following:

  • Choroid plexectomy or choroid plexus coagulation

  • Opening of a stenosed aqueduct

  • Endoscopic fenestration of the floor of the third ventricle (however, contraindicated in communicating hydrocephalus)


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