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2. Management of Hydrocephalus
The best line of treatment of hydrocephalus is to
remove the cause of disease, such as
fulguration of choroid plexus papilloma or
removal of post fossa tumor.
This is not possible in the majority of cases i.e. we
can not correct congenital malformation or
remove glioma from brain stem, so in these
cases we divert CSF pathway to overcome site
of obstruction by using shunt ( fig. 7 & 8 ).

3. Figure 7 & 8: Shunting in Hydrocephalus

4. Management of Hydrocephalus (Cont.)
Shunt is still the most common method
used to treat hydrocephalus. This is
done by implanting a tube in the lateral
ventricle and the distal end of the tube
is put in the right atrium of the heart
through internal jugular vein (V–A
shunt), or pass subcutaneously in
front of the chest wall to be implanted
in the peritoneal cavity (V–P shunt).

5. Management of Hydrocephalus (Cont.)
Recently with advancement of
endoscopic surgery we can use special
neuro endoscope to create an opening
in the floor of third ventricle to bypass
obstructed Aqueduct and allow CSF to
pass from Lateral ventricles to the
third ventricle and then to the
subarachnoid space.
This is called Endoscopic Third
Ventriculostomy ( ETV ), this method is
a new method, needs special training
and equipment and it is not suitable for
all cases.

6. Management of Hydrocephalus (Cont.)
Although shunt is the commonest method for
treatment it has some disadvantages:
 Shunt system is expensive.
 It is a foreign body, so during implantation if exposed to
contamination, this may lead to meningitis or encephalitis
which may be lethal and in such cases shunt should be
removed.
 It is a narrow tube, so it is liable for obstruction (either
proximal or distal end).
 It may over drain the CSF so devices must be selected
properly according to the estimated intra-ventricular pressure
of the patients.

7. Management of Hydrocephalus (Cont.)
Medical treatment have no role in the
management of hydrocephalus, so
using carbonic anhydrase inhibitor
( Diamox ), will decrease the rate of
secretion of CSF to some extent, but
does not relief the obstruction so
medical treatment may be used in
doubtful cases or if there is
contraindication for surgery such as
bronchopneumonia or infection at the
site of operation.

8. Questions?
Learn more about Spina Bifida and hydrocephalus at
http://www.spinabifida.net