How is hydrocephalus treated?
Some forms of hydrocephalus require no
specific treatment. Other forms are temporary and do not require treatment on a
long-term basis. However, most forms do require treatment and this is usually
surgical. Drugs have been used for many years but they may have unpleasant side
effects and are not often successful.
The usual treatment is to insert a
shunting device. It is important to note that this does not ‘cure’ the
hydrocephalus and damage to the brain tissue remains. Shunting controls the
pressure by draining excess CSF, so preventing the condition becoming worse.
Symptoms caused by raised pressure usually improve but other problems of brain
damage will remain.
What is a shunt?
A shunt is simply a device which diverts the accumulated CSF
around the obstructed pathways and returns it to the bloodstream. It consists
of a system of tubes with a valve to control the rate of drainage and prevent
back-flow. It is inserted surgically so that the upper end is in a ventricle of
the brain and the lower end leads either into the heart (ventriculo-atrial) or
into the abdomen (ventriculo-peritoneal). The shunt may be a programmable
(adjustable) type.
The
device is completely enclosed so that all of it is inside the body. The fluid
which is drained into the abdomen passes from there into the bloodstream. Other
drainage sites such as the outer lining of the lungs (ventriculo-pleural shunt)
can also be used.
Possible
Complications
In most
cases, the shunts are intended to stay in place for life, although alterations
or revisions might become necessary from time to time. The tube or catheter may
become too short as the individual grows and an operation to lengthen it might
be necessary. Occasionally, as with any implant, there can be mechanical
failure. Also, it is important to be aware that problems can occur with
blockage or infection of the shunt.
What
symptoms should be looked for?
These
vary enormously between individuals. Previous personal experience of a shunt
problem is often a reliable guide as to what to look for.
Possible
signs of acute shunt blockage may include:
vomiting, headache, dizziness,
photophobia (sensitivity to light) and other visual disturbances, drowsiness
and fits.
Possible
signs of chronic shunt blockage may include:
fatigue, general malaise, visual problems, behavioural changes, decline in academic
performance, being just ‘not right’ from the carer’s point of view.
If a
shunt blockage is suspected, medical advice should be sought from your
neuro-surgical unit within four hours of acute symptoms starting.
In shunt
infections, symptoms vary with the route of drainage.
In
ventriculo-peritoneal shunts, the symptoms often resemble those of a blockage.
This is because the shunt becomes infected and the lower catheter is very often
then sealed off by tissue. There may be accompanying fever and abdominal pain
or discomfort or redness over the shunt site.