Hydrocephalus Surgery: Treatment Options and Specialist Expertise

Hydrocephalus Surgery

Dear Doctor, my mother had a minor car accident that resulted in a mild intracranial hemorrhage and subarachnoid hemorrhage.
After the blood was absorbed, she continued to experience headaches, dizziness, eye fatigue, and some blurriness when looking upward for half a month.
She also had unsteady walking.
A subsequent CT scan revealed that the bleeding had resolved, but there were signs of hydrocephalus, and the doctor recommended surgery.
The doctor briefly explained the procedure for ventricular-peritoneal shunt placement.
After researching, we found that there is also a lumbar drain option.
I would like to ask if surgery is always necessary for hydrocephalus? Additionally, do neurosurgeons in larger hospitals in Taiwan typically perform hydrocephalus surgeries? I noticed that some doctors list hydrocephalus as their specialty while others do not.
Should we seek a doctor who explicitly states expertise in hydrocephalus treatment, as we are concerned about the current surgeon's experience with this procedure? Lastly, are both drainage methods commonly used now? Thank you for your response!

Mr. Chen, 30~39 year old female. Ask Date: 2016/09/06

Dr. Zhang Junwei reply Neurosurgery

If it is confirmed to be hydrocephalus, surgery is necessary.
Typically, a ventriculoperitoneal shunt procedure is performed.
This drainage surgery is quite simple and is commonly performed by neurosurgeons!

Reply Date: 2016/09/06

More Info

Hydrocephalus, commonly referred to as "water on the brain," is a condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. This condition can lead to increased intracranial pressure, which can cause a range of neurological symptoms. When it comes to treatment, surgical intervention is often necessary, particularly in cases where the hydrocephalus is symptomatic or progressive.

Surgical Options for Hydrocephalus
The primary surgical treatment for hydrocephalus is the placement of a shunt system, which helps to redirect the flow of CSF to another part of the body where it can be absorbed. The two most common types of shunt procedures are:
1. Ventriculoperitoneal (VP) Shunt: This involves placing a catheter from the ventricles of the brain into the peritoneal cavity (the space within the abdomen). This is the most frequently performed procedure for hydrocephalus.

2. Lumboperitoneal (LP) Shunt: This procedure involves placing a catheter from the lumbar region of the spinal canal to the peritoneal cavity. It is less commonly used but can be effective in certain cases, particularly when the VP shunt is not suitable.

Both procedures are generally considered safe and effective, but they do carry risks, including infection, shunt malfunction, and the potential for over-drainage or under-drainage of CSF.

Necessity of Surgery
Not all cases of hydrocephalus require surgical intervention. The decision to operate typically depends on the severity of symptoms, the underlying cause of the hydrocephalus, and the overall health of the patient. In cases where the hydrocephalus is asymptomatic or mild, doctors may opt for careful monitoring rather than immediate surgery. However, given your mother's symptoms of persistent headaches, dizziness, and instability, surgical intervention seems warranted.

Expertise of Neurosurgeons
In Taiwan, most neurosurgeons in larger hospitals are trained to perform shunt procedures for hydrocephalus. However, the level of experience can vary. It is advisable to seek out a neurosurgeon who has specific expertise in treating hydrocephalus, as this can significantly impact the outcomes of the surgery. If a surgeon lists hydrocephalus as a specialty, it is a good indication that they have experience in managing this condition.

Availability of Shunt Procedures
Both VP and LP shunt procedures are well-established and widely practiced in neurosurgery. They are considered standard treatment options for hydrocephalus and are performed in many hospitals across Taiwan. However, the choice between these procedures will depend on the specific clinical scenario, including the patient's anatomy and the underlying cause of the hydrocephalus.

Conclusion
In summary, hydrocephalus often necessitates surgical intervention, particularly when symptoms are present. The choice of procedure—VP or LP shunt—depends on various factors, including the patient's condition and the surgeon's expertise. It is crucial to consult with a neurosurgeon who specializes in hydrocephalus to discuss the best treatment options for your mother. Additionally, ensure that you are comfortable with the surgeon's experience and approach to managing hydrocephalus, as this can greatly influence the outcome of the surgery.

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