Hydrocephalus

What hydrocephalus is

The brain floats within cerebrospinal fluid (CSF), which protects it. Fluid surrounds the brain beneath the skull and also fills spaces deep within it called the ventricles. It is produced inside the brain and circulates outwards, where it is absorbed by specialized structures.

Hydrocephalus is the accumulation of more of this fluid than there should be — either because it does not circulate properly, because too much is produced, or because it is not absorbed quickly enough. The excess fluid presses on the brain and can cause significant symptoms: difficulty with thinking, difficulty with movement and walking, and, if left untreated, it may be life-threatening.

Dr. Blionas managed cases of hydrocephalus in young patients as a consultant neurosurgeon at Mitera and Hygeia Hospitals.

Diagnosis

Beyond standard imaging (brain MRI and CT), diagnosis may involve a specialized CSF flow MRI, which demonstrates the circulation of fluid from the ventricles outwards and reveals any obstruction to it.

Lumbar puncture

The most informative test in the assessment of communicating hydrocephalus — in particular normal pressure hydrocephalus — is the lumbar puncture.

The spine houses the spinal cord and, lower down, the nerve roots, all of which lie within the same fluid that surrounds the brain, and for the same reason: protection. Spinal and cerebral CSF communicate freely, forming in practice a single reservoir at approximately the same pressure. Measuring the pressure in the lumbar spine therefore gives us a reliable estimate of the pressure within the head.

A lumbar puncture — the introduction of a needle into the CSF in the lumbar spine — serves two purposes here:

• Measuring the pressure. High pressures generally indicate a more difficult situation, though there are exceptions.
• Removing fluid. This is the more important of the two. By draining fluid we can see whether the patient improves clinically. If they do, we know with a high degree of confidence both that they might have a form of hydrocephalus and that surgery is likely to help them — since every surgical option for hydrocephalus works, in different ways, by diverting fluid away from the ventricles.

Important: lumbar puncture is not appropriate in every form of hydrocephalus. Where there is obstruction to CSF flow or a mass lesion, it can be hazardous, and the decision is made only after imaging has been reviewed.

Treatment

Once the diagnosis is confirmed, treatment should proceed. The treatment of hydrocephalus is surgical: repeated lumbar punctures to drain fluid are not a sensible long-term strategy, and the pharmacological options have very limited efficacy.

Careful, individualized treatment selection. For patients with hydrocephalus, every treatment option is assessed individually through the AI-supported Personalized Evidence-Based Treatment Analysis, drawing on the patient’s own clinical characteristics alongside the most recent, validated evidence. Beyond being fully informed of what the data show for each option and of what to expect, the patient has that evidence available within a very short time — and time is frequently critical when a prompt and correct surgical decision is required. Online consultations are also available.

See in detail: Surgical management of hydrocephalus — the options available to patients, with comparative data on the efficacy of each

See in detail: AI in treatment selection