Introduction
Hydrocephalus is a neurological condition in which excess cerebrospinal fluid (CSF) accumulates within the ventricles of the brain, leading to increased pressure inside the skull. This fluid plays a crucial role in cushioning the brain, removing waste, and maintaining chemical stability. However, when its circulation or absorption is disrupted, it causes the ventricles to enlarge, which can damage brain tissues. Hydrocephalus may be present at birth (congenital) or acquired later due to trauma, tumors, infections, or bleeding in the brain.
If untreated, hydrocephalus can lead to progressive brain damage, developmental delays in children, vision problems, loss of balance, and even death. Therefore, surgical intervention becomes necessary to relieve the pressure and restore proper fluid drainage. The most common treatment is hydrocephalus surgery, which includes either inserting a shunt system or performing an endoscopic third ventriculostomy (ETV). These hydrocephalus surgery procedures are designed to manage the condition effectively and significantly improve the quality of life. Understanding the hydrocephalus surgery procedure is crucial for patients and families facing this diagnosis.
Hydrocephalus Surgery Procedure
Ventriculoperitoneal (VP) Shunt Surgery
This is the most widely used surgical procedure for hydrocephalus. A VP shunt is a device that diverts excess cerebrospinal fluid from the brain to the abdominal cavity, where the fluid can be absorbed by the body.
Step-by-step procedure:
-
Anesthesia Administration :- The patient is put under general anesthesia to ensure they are unconscious and pain-free during the procedure.
-
Making the Incision :- A small incision is made behind the ear. A burr hole is drilled into the skull to access the brain’s ventricles.
-
Inserting the Ventricular Catheter :- A thin catheter is gently inserted into one of the brain’s lateral ventricles to allow CSF to drain.
-
Attaching the Valve :- A valve is connected to the ventricular catheter and positioned just under the scalp. The valve controls the flow of CSF and prevents over-drainage.
-
Tunneling the Distal Catheter :- Another catheter is tunneled under the skin from the valve area, down the neck, chest, and into the abdominal cavity (peritoneum). This distal catheter allows the fluid to exit the brain and get absorbed into the body’s natural systems.
-
Final Inspection and Closure :- The entire shunt system is tested to ensure fluid is flowing correctly. Once confirmed, all incisions are closed using sutures or staples, and sterile dressings are applied.
-
Postoperative Imaging :- A CT scan or MRI may be performed to confirm correct catheter placement and proper ventricular size reduction.
This procedure typically takes between 1.5 to 2 hours. It is most often used in both children and adults, especially in communicating hydrocephalus where fluid absorption is impaired but flow is not physically blocked.
Endoscopic Third Ventriculostomy (ETV)
This is an alternative to shunt surgery and is more commonly used in non-communicating (obstructive) hydrocephalus. ETV does not require permanent implantation of a device and offers a long-term solution for select patients.
Step-by-step procedure:
-
Anesthesia Administration :- General anesthesia is administered to keep the patient asleep and pain-free throughout the surgery.
-
Creating the Burr Hole :- A small hole is drilled into the skull, usually in the frontal region, to access the brain using an endoscope.
-
Inserting the Endoscope :- A thin, flexible tube equipped with a camera and light is inserted through the burr hole and navigated into the third ventricle of the brain.
-
Creating the Stoma (Opening) :- A small perforation is made at the bottom of the third ventricle using specialized instruments passed through the endoscope. This new opening allows CSF to bypass the obstruction and flow into the subarachnoid space, where it is absorbed naturally by the body.
-
Inspection and Hemostasis :- The area is inspected for proper flow and any bleeding. Bleeding, if present, is controlled using irrigation or cauterization.
-
Closing the Incision :- The endoscope is carefully withdrawn, and the scalp incision is closed with sutures.
-
Postoperative Monitoring :- A CT scan may be done after surgery to check the success of the procedure. In the following days, the patient is observed for neurological improvements.
ETV usually takes about 1 hour. Since there’s no foreign device implanted, there’s less risk of long-term complications like infection or shunt failure. However, it may not be suitable for all types of hydrocephalus, particularly in very young infants.
Conclusion
Hydrocephalus is a serious condition that demands timely medical intervention. Surgical treatment through either VP shunt placement or endoscopic third ventriculostomy plays a pivotal role in managing the disease. These procedures are designed not to cure hydrocephalus but to control its effects, reduce brain pressure, and prevent further neurological damage. While both procedures aim to restore the balance of cerebrospinal fluid, the choice between them depends on the patient’s age, type of hydrocephalus, and overall health.
Surgical outcomes for hydrocephalus have significantly improved due to advances in medical imaging, neuro-navigation systems, and endoscopic tools. With appropriate postoperative care, many patients lead a near-normal life after surgery. Parents, caregivers, or patients themselves should stay alert for any recurrence of symptoms such as headaches, vision problems, nausea, or behavioral changes, which may indicate the need for revision or further evaluation.
Ultimately, hydrocephalus surgery is a life-saving, function-restoring intervention that allows individuals of all ages—from infants to the elderly—to regain their quality of life and reduce long-term complications from untreated cerebrospinal fluid buildup.
