Hydrocephalus
Hydrocephalus is a condition characterised by excessive accumulation of cerebrospinal fluid (CSF) within the brain's ventricles (fluid-filled spaces). This buildup can increase pressure inside the skull and, if untreated, cause brain damage. While the diagnosis can be concerning, modern neurosurgical treatments are highly effective at managing hydrocephalus and preventing complications.
Dr Joseph Garcia Redmond provides expert evaluation and treatment of hydrocephalus in both adults and children. His comprehensive neurosurgical training and experience enable him to offer the full range of treatment options, from shunt placement to advanced endoscopic procedures.
Dr Garcia Redmond takes a personalised approach to each patient, carefully considering the type of hydrocephalus, underlying cause, and individual circumstances to develop the most appropriate treatment plan. He works closely with rehabilitation teams and paediatric specialists, to ensure comprehensive, coordinated care.
What is Hydrocephalus?
Hydrocephalus occurs when cerebrospinal fluid (CSF) accumulates in the brain's ventricles, causing them to enlarge. CSF is a clear fluid that normally circulates around the brain and spinal cord, providing cushioning, delivering nutrients, and removing waste. In hydrocephalus, this fluid balance is disrupted.
Types of Hydrocephalus:
Congenital Hydrocephalus: Present at birth, often due to developmental abnormalities, genetic factors, or infections during pregnancy. May be detected on prenatal ultrasound or after birth.
Acquired Hydrocephalus: Develops after birth, resulting from injury, infection, bleeding, or tumors that affect CSF flow or absorption.
Communicating Hydrocephalus: CSF can flow between ventricles but is not adequately absorbed. Often caused by subarachnoid hemorrhage, meningitis, or head trauma.
Non-Communicating (Obstructive) Hydrocephalus: Physical blockage prevents CSF flow between ventricles. Caused by tumors, cysts, blood clots, or congenital malformations.
Normal Pressure Hydrocephalus (NPH): A specific type occurring primarily in older adults where ventricles enlarge but pressure readings may be normal or only intermittently elevated. Causes a characteristic triad of symptoms: walking difficulty, cognitive decline, and urinary incontinence.
Hydrocephalus Ex-Vacuo: Ventricular enlargement due to brain tissue loss (from stroke, injury, or degenerative diseases) rather than true CSF accumulation. This is not true hydrocephalus and typically doesn't require treatment.
The information on this website is intended as a general guide and should not replace professional medical advice. Every patient's situation is unique. Please schedule a consultation with Dr Garcia Redmond for personalised assessment and recommendations.
What Are the Symptoms of Hydrocephalus?
Symptoms vary significantly depending on age, type of hydrocephalus, and how quickly it develops.
Infants and Young Children:
Rapidly increasing head circumference (head size)
Bulging or tense soft spot (fontanelle) on top of the head
Downward deviation of the eyes ("setting sun sign")
Seizures
Vomiting
Sleepiness or lethargy
Irritability or poor feeding
Developmental delays
Older Children and Adults (Acute Hydrocephalus):
Severe headache
Nausea and vomiting
Vision problems (blurred or double vision)
Balance and coordination difficulties
Lethargy or drowsiness
Cognitive difficulties or confusion
Seizures
Changes in personality or behaviour
Normal Pressure Hydrocephalus (Older Adults): The classic triad of symptoms:
Gait disturbance: Difficulty walking, shuffling gait, feeling "stuck to the floor," frequent falls
Cognitive impairment: Memory problems, slowed thinking, difficulty concentrating (often mistaken for dementia)
Urinary incontinence: Urgency, frequency, or loss of bladder control
Symptoms typically develop gradually over months to years. Not all three symptoms may be present initially.
How is Hydrocephalus Diagnosed?
Clinical Assessment: Neurological examination, developmental assessment (in children), gait and cognitive assessment (for NPH), head circumference measurements (in infants and young children).
Imaging Studies:
CT scan: Rapid imaging showing enlarged ventricles and brain structure
MRI scan: Detailed imaging providing more information about cause and CSF flow
Ultrasound: Used in infants before skull bones fuse to assess ventricular size
Specialised Tests for Normal Pressure Hydrocephalus:
Lumbar puncture (spinal tap): Removal of CSF to assess whether symptoms temporarily improve (high tap test)
Lumbar drain trial: Temporary drainage of CSF over several days to predict shunt response
CSF infusion studies: Assessment of CSF dynamics and absorption
Gait and cognitive testing: Before and after CSF removal to document improvement
Additional Tests:
ICP monitoring: May be used to measure intracranial pressure patterns
Shunt series X-rays: To check shunt hardware integrity if shunt malfunction suspected
Dr Garcia Redmond will review all diagnostic information with you and explain the findings and treatment implications.
How Do You Treat Hydrocephalus?
Treatment aims to restore normal CSF circulation and reduce pressure on the brain. The specific approach depends on the type and cause of hydrocephalus.
Conservative Management
Observation: Some cases of mild hydrocephalus, particularly in premature infants, may resolve spontaneously with careful monitoring.
Medications:
Acetazolamide or furosemide: May temporarily reduce CSF production, occasionally used as a bridge to surgery or in select cases
Treatment of underlying cause: Antibiotics for infection, management of tumors
These are rarely definitive treatments but may be used in specific circumstances.
Surgical Treatment Options
Ventriculoperitoneal (VP) Shunt: The most common treatment for hydrocephalus. A thin, flexible tube (shunt) is placed in the ventricle to drain excess CSF into the abdominal cavity, where it's naturally absorbed. The shunt includes a valve to regulate flow and prevent over-drainage.
Endoscopic Third Ventriculostomy (ETV): A minimally invasive procedure creating a new pathway for CSF flow within the brain, bypassing the obstruction. Particularly effective for obstructive hydrocephalus. ETV is most successful in patients with obstructive hydrocephalus and may be combined with choroid plexus cauterization in infants.
ETV with Choroid Plexus Cauterization (ETV/CPC): Combines ETV with cauterization of the tissue that produces CSF, sometimes used in infants in resource-limited settings or specific cases.
Treatment of Underlying Cause:
Tumor removal if causing obstruction
Treatment of infection or bleeding
Repair of congenital malformations
Dr Garcia Redmond will discuss the most appropriate surgical approach for your specific type of hydrocephalus.
Your Recovery and Aftercare
Recovery varies depending on the procedure performed, duration and severity of hydrocephalus, and age. Dr Garcia Redmond and his team will support you throughout your recovery journey.
After Shunt Placement:
Hospital Stay: Typically 2-4 days, depending on recovery progress and any complications.
Recovery: Small incisions heal within 1-2 weeks, gradual improvement in symptoms (may take days to weeks). Activity restrictions for 4-6 weeks (no heavy lifting, contact sports). Cognitive and physical improvements may continue for months.
After Endoscopic Third Ventriculostomy:
Hospital Stay: Typically 2-4 days.
Recovery: Faster recovery than shunt placement in many cases, no permanent hardware to maintain. Symptoms improve over days to weeks. Activity restrictions for 4-6 weeks (no heavy lifting, contact sports).
Long-Term Management:
Shunt Monitoring: Shunts are permanent devices that require lifelong monitoring. Some patients require shunt revisions or replacements (tubing may need lengthening as children grow, or components may fail), valve pressure adjustments for programmable shunts, treatment of shunt complications (infection, malfunction), and rehabilitation for any residual neurological deficits.
Support Services:
Living with hydrocephalus can present challenges. Support services may include:
Hydrocephalus associations and support groups
Educational support for children with learning difficulties
Neuropsychological services
Social work assistance
Disability services if needed
Frequently Asked Questions About Hydrocephalus
What Are the Risks Associated with Hydrocephalus and Its Treatment?
Risks of Untreated Hydrocephalus:
Progressive brain damage
Vision loss
Cognitive impairment
Physical disabilities
Seizures
Death (if pressure critically elevated)
Shunt Surgery Risks:
Immediate Complications:
Bleeding (within brain or along shunt tract)
Infection (2-15% risk, highest in first few months)
Shunt malfunction requiring immediate revision
Injury to brain tissue
Cerebrospinal fluid leak
Anesthesia complications
Long-Term Complications:
Shunt malfunction: Most patients require at least one shunt revision during lifetime; some require multiple revisions
Shunt infection: May require shunt removal, antibiotics, and replacement
Over-drainage: Can cause headaches, subdural hematomas
Under-drainage: Inadequate treatment of hydrocephalus
Abdominal complications: Rare issues with peritoneal catheter
Shunt Dependency: Most patients require their shunt for life. Sudden shunt failure can be life-threatening.
Endoscopic Third Ventriculostomy Risks:
Immediate Complications:
Bleeding (small risk of significant hemorrhage)
Infection (lower risk than shunt placement)
Injury to surrounding brain structures
Memory problems (rare)
Diabetes insipidus (usually temporary)
ETV failure requiring shunt placement
Long-Term Complications:
ETV closure (can occur months to years later, requiring shunt placement)
Overall lower long-term complication rate than shunts as no hardware to malfunction
Normal Pressure Hydrocephalus Treatment Risks:
Some patients don't improve with shunt placement despite positive predictive testing
Over-drainage can cause subdural hematomas (more common in NPH patients)
Risk of improvement in only some symptoms (may improve walking but not cognition)
Dr Garcia Redmond will discuss your individual risk profile and answer any questions about treatment risks versus benefits.
Is hydrocephalus curable?
Hydrocephalus is generally not cured but is highly treatable. Shunts and ETV effectively manage the condition, allowing most patients to live normal, productive lives. Some cases, particularly in premature infants, may resolve spontaneously. ETV can sometimes provide a permanent solution without ongoing hardware, though the opening can occasionally close over time.
Will my child outgrow hydrocephalus?
Children typically do not outgrow hydrocephalus. Most require lifelong shunt maintenance or have had successful ETV. However, with appropriate treatment, most children with hydrocephalus can attend regular schools, participate in activities, and lead full lives. Early treatment and ongoing monitoring are key to optimal developmental outcomes.
How often will the shunt need to be replaced?
This varies greatly. Some patients have shunts that function for decades without revision, while others require multiple revisions. Children often need revisions as they grow (tubing needs lengthening) and may require 2-3 or more revisions during childhood. Adults may go many years between revisions or never need one. Overall, about 40-50% of shunts require revision within the first two years.
Can you live a normal life with a shunt?
Yes! Most people with shunts live completely normal lives. They can attend school, work, play sports (with some precautions for contact sports), travel, and participate in all regular activities. The key is knowing warning signs of shunt malfunction and seeking prompt attention if problems arise. Many successful professionals, athletes, and others live full lives with shunts.
What activities should be avoided with a shunt?
Most activities are safe. General guidelines include:
Contact sports: Discuss with your neurosurgeon; protective headgear often allows participation
Diving/altitude changes: Usually fine, though discuss concerns with your doctor
MRI scans: Safe, but inform medical staff about your shunt (especially programmable valves which may need rechecking after MRI)
Most daily activities, swimming, exercise: Completely safe
The shunt valve can usually be felt under the skin behind the ear—avoid excessive pressure directly on the valve.
What causes shunt infections and how are they treated?
Shunt infections usually occur within the first few months after placement when bacteria enter during surgery. Symptoms include fever, headache, redness along the shunt tract, and irritability. Treatment typically requires shunt removal, intravenous antibiotics for 1-2 weeks, temporary external drainage, and then new shunt placement. Infection risk is 2-15% depending on various factors.
Can Normal Pressure Hydrocephalus be reversed?
Many NPH patients experience significant improvement with shunt placement, particularly in walking and urinary symptoms. Cognitive improvements can be more variable. Early treatment provides better outcomes. Not all patients improve despite positive predictive testing, and some respond to only certain symptoms. The earlier NPH is diagnosed and treated, the better the potential outcomes.
How do you know if a shunt is working properly?
When working properly, symptoms of hydrocephalus should be controlled. Shunt malfunction causes return of original symptoms (headache, vomiting, lethargy, vision changes, balance problems). Regular follow-up imaging and clinical assessments help ensure proper function. Programmable shunts can have settings checked non-invasively. Any return of symptoms should prompt immediate medical evaluation.
Are there alternatives to shunt surgery?
ETV (endoscopic third ventriculostomy) is an alternative for some patients with obstructive hydrocephalus, offering treatment without permanent hardware. However, not all patients are candidates for ETV. Some types of hydrocephalus (particularly communicating hydrocephalus) generally require shunts. Dr Garcia Redmond will assess whether ETV is appropriate for your specific situation.
Why Choose Rivercity Brain & Spine for Hydrocephalus Treatment?
Comprehensive Expertise: Dr Garcia Redmond has extensive training and experience managing all types of hydrocephalus in both adults and children.
Full Treatment Spectrum: Offers both shunt surgery and endoscopic procedures, ensuring treatment is tailored to your specific type of hydrocephalus rather than limited by available expertise.
Advanced Surgical Techniques: Utilises modern neurosurgical techniques, neuronavigation, and endoscopic technology for optimal outcomes.
Paediatric and Adult Care: Experience treating hydrocephalus across all age groups, from newborns to elderly patients with NPH.
Long-Term Partnership: Provides ongoing monitoring and management throughout your life, including prompt attention to complications.
Multidisciplinary Collaboration: Works with neurologists, pediatric specialists, endocrinologists (for diabetes insipidus), and rehabilitation teams.
Emergency Availability: Responsive to urgent concerns about shunt malfunction or hydrocephalus complications.
Patient and Family Education: Ensures you understand your condition, recognize warning signs, and know when to seek help.
SCHEDULE A CONSULTATION
Neurosurgery Brisbane
If you or your child has been diagnosed with hydrocephalus, or if you're experiencing symptoms suggesting this condition, expert neurosurgical evaluation is essential.
Contact Rivercity Brain & Spine today to schedule your consultation.