What Is the Best Treatment for Hydrocephalus?

By Dr. Amit Gupta in Neurosurgery

Oct 26 , 2020 | 3 min read


In general population hydrocephalus has been commonly called “water on the brain”. The water in hydrocephalus is actually cerebrospinal fluid (CSF), which has pooled in the brain due to an imbalance in the amount produced vs. the amount the body can absorb. Normally, CSF continuously flows through brain cavities, acting as a shock absorber and delivering vital nutrients before being absorbed into the blood. Hydrocephalus interrupts this healthy flow of CSF, causing an accumulation that puts pressure on the brain.

Hydrocephalus can be either congenital – present before birth – or acquired, which develops after birth. There are two types: communicating and non-communicating. In a case of communicating hydrocephalus, CSF is blocked after leaving the brain’s ventricles. Non-communicating cases involve a blockage between one ventricle and another.


One to two out of every 1,000 people is born with hydrocephalus. Although the exact cause isn’t always evident, it can stem from genetic abnormalities or developmental disorders. This can lead to complications and symptoms well into adult life. Acquired hydrocephalus, on the other hand, can result from a head injury, infection, brain tumor or a brain haemorrhage.

Normal pressure hydrocephalus (NPH) is a type that occurs more frequently in the elderly and causes memory difficulties commonly misdiagnosed as Alzheimer’s disease. The NPH is often undiagnosed, and less than 20% receive an appropriate diagnosis and treatment. For this reason, it’s essential to consult expert neurospecialist with extensive experience diagnosing NPH, like those at Max Hospital, Shalimar Bagh. Usually, this type of hydrocephalus is caused by injury, infection, tumor, or inflammation.


Hydrocephalus manifests differently depending on the cause and type. Symptoms commonly found in young adults include:

Chronic headaches

Blurred or double vision

Difficulty walking

Impaired bladder control

Memory loss

Vomiting, nausea and drowsiness

Later in life, normal pressure hydrocephalus may affect the neurological areas that control the legs and bladder, along with cognitive processes, causing:

Dementia (affecting memory, concentration, and interest in daily activities)

Difficulty walking

Urinary incontinence


There are a few prevailing methods, each one appropriate for different situations. But by addressing it early, a patient can fully recover with no future complications.


The primary alternative to shunt systems, the primary goal of endoscopic third ventriculostomy (ETV) is to eliminate a patient’s shunt dependency. This minimally-invasive procedure uses an endoscope to release CSF build up by puncturing the third ventricle, allowing fluid to bypass the obstruction and flow freely around the surface of the brain, reabsorbing as it should.

Shunts have proven effective in a variety of cases, but studies show that ETV can deliver a 65-70% success rate in cases of shunt malfunction. It’s a one-time procedure, where shunts may require revision, and it can be preferable in cases involving an obstruction like a tumor. Plus, it keeps all of CSF around the brain and spinal cord without diverting it to other parts of the body.


Certain medications, specifically Acetazolamide and furosemide, appear to reduce CSF levels by acting on the choroid plexus, the intraventricular tissue that produces this fluid. However, relying solely on medication to treat hydrocephalus is not good, and it’s better used temporarily, or in cases when other procedures aren’t possible.

So, which one is best? There isn’t one overarching answer. It completely depends on age, health, prior surgeries and other factors. The most common and well-documented are shunt systems, but in certain cases (like obstructive hydrocephalus), ETV may be a better option. In the end, it’s up to patient disease and neurosurgeon’s choice to evaluate a menu of treatments and determine which one is best for unique circumstances.


If addressed early and with the appropriate treatment, hydrocephalus has a fairly high survival rate. Many patients go on to live long and unrestricted lives. Shunt treatment can even reverse the symptoms of dementia in elderly patients. Unfortunately, hydrocephalus isn’t something that disappears on its own, so it’s crucial that you schedule a doctor’s appointment and get the necessary treatment if you begin exhibiting symptoms.

The neurosurgeons at Max Hospital, Shalimar Bagh are caring experts, well-versed in the most advanced treatments. With extensive experience treating neurosurgical conditions, your diagnosis and treatment couldn’t be in better hands. Contact us to schedule a consultation appointment today.