Hydrocephalus Surgery: Options and Risks Explained

Surgical Methods for Hydrocephalus

Hello Dr.
Chang! My father is 70 years old and was previously paralyzed in bed due to a stroke.
He currently has hydrocephalus (which existed before the stroke but was untreated due to the stroke) and is experiencing seizures.
He is taking anticonvulsant medication to manage the symptoms.
The prescribing doctor mentioned that hydrocephalus can affect brain electrical activity and is unlikely to be cured, only managed.
My father still occasionally has seizures, and I am looking for a definitive treatment option for him.
Could you please explain how the surgery for hydrocephalus is performed? Is it an open brain surgery, or is it done using a needle to drain fluid? Is it very dangerous? I would appreciate your help in answering these questions.
Thank you! The hydrocephalus was caused by a previous subdural hematoma (located just above the right forehead), and the drainage tube was removed after six months.

Tang, 40~49 year old female. Ask Date: 2009/12/29

Dr. Zhang Yuanyi reply Neurosurgery

Hello, Miss Chun-Ying.
It is commonly said that hydrocephalus can occur in two situations: one is ventricular enlargement leading to hydrocephalus, and the other is subdural hematoma.
The surgical approach for the former involves the placement of a ventriculoperitoneal shunt, with primary risks including intracranial hemorrhage and bowel injury, as well as the potential for postoperative over-drainage causing subdural hematoma.
For the latter, a direct craniotomy for drainage may be performed initially.
If recurrence occurs, repeated drainage or the placement of a subdural-peritoneal shunt may be considered, with similar risks of intracranial hemorrhage.
Each surgical option carries its own risks, and whether the surgery can completely alleviate symptoms remains uncertain.
It is advisable to discuss this in detail with your physician.
Wishing you safety and health.
Sincerely, Dr.
Zhang Yuan-Yi, Attending Neurosurgeon, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2009/12/29

More Info

Hydrocephalus, or the accumulation of cerebrospinal fluid (CSF) in the brain, can lead to increased intracranial pressure and various neurological symptoms, including seizures. In your father's case, given his history of stroke and current symptoms, it's understandable that you're seeking more information about treatment options and the associated risks.

Surgical Options for Hydrocephalus
1. Ventriculoperitoneal (VP) Shunt: This is the most common surgical procedure for treating hydrocephalus. It involves placing a catheter into the ventricles of the brain to drain excess CSF into the peritoneal cavity (the space within the abdomen). The procedure typically requires general anesthesia and involves making a small incision in the scalp to access the brain.

2. Endoscopic Third Ventriculostomy (ETV): This is another option, particularly if the hydrocephalus is due to obstruction of CSF flow. In this procedure, a small hole is made in the third ventricle of the brain to allow CSF to flow freely. This can sometimes be done without the need for a shunt.

3. Lumbar Puncture: While this is not a definitive treatment for hydrocephalus, it can be used to relieve pressure temporarily by draining CSF. However, it is not a long-term solution and is generally not recommended for chronic cases.

Risks of Surgery
- General Anesthesia: As your father is 70 years old and has a history of stroke, the risks associated with general anesthesia must be carefully considered. Potential complications include respiratory issues, cardiovascular events, and postoperative confusion, especially in older adults.

- Infection: Any surgical procedure carries a risk of infection. In the case of a VP shunt, there is a risk of meningitis or shunt infection, which can be serious and may require additional treatment.

- Shunt Malfunction: Shunts can become blocked or malfunction, leading to a recurrence of symptoms. Regular follow-up is necessary to monitor the function of the shunt.

- Neurological Risks: There is a risk of neurological complications, including worsening of existing symptoms or new deficits, particularly if there are complications during the surgery.

Potential Benefits of Surgery
- Symptom Relief: Successful surgery can alleviate symptoms associated with increased intracranial pressure, such as headaches, nausea, and seizures. This can significantly improve your father's quality of life.

- Prevention of Further Damage: By reducing pressure on the brain, surgery can help prevent further neurological damage and complications.

Postoperative Care and Monitoring
After surgery, your father will require close monitoring for signs of infection, shunt malfunction, and neurological status. Regular follow-ups with the neurosurgeon will be essential to ensure the shunt is functioning properly and to manage any complications that may arise.

Conclusion
While surgery for hydrocephalus carries risks, it can also provide significant benefits, particularly in terms of symptom management and quality of life. Given your father's age and medical history, a thorough discussion with his healthcare team, including a neurosurgeon, is crucial. They can provide tailored advice based on his specific condition and overall health status. It’s also important to weigh the potential benefits against the risks and to consider your father's wishes and quality of life in making treatment decisions.

Similar Q&A

Understanding Hydrocephalus: Surgical Options and Alternatives Explained

Hello, my mother underwent surgery for a brain hemorrhage six months ago. A few days later, she had a second surgery due to ventricular bleeding, during which a piece of her skull was removed. After recovery, she was able to care for herself. To avoid putting her through another ...

Dr. Du Haojie reply Neurology
If hydrocephalus continues to worsen, a drainage surgery must be performed to alleviate the accumulation of cerebrospinal fluid in the brain, in order to prevent intracranial pressure.

Understanding Risks of Hydrocephalus Surgery: A Guide for Families

Hello, doctor! Recently, I have read many articles that only describe symptoms, sequelae, and surgical methods. I am inquiring about the risks during the surgical process. The patient has experienced elevated intracranial pressure and has undergone one surgery to remove part of t...

Dr. Hong Weibin reply Neurology
1. General anesthesia typically involves the use of intravenous and inhalational anesthetics to block pain. In a normal human body, the brainstem's respiratory center sends signals to the respiratory muscles to facilitate breathing. However, during the administration of anes...

Do All Brain Hemorrhages Require Surgery? Risks and Alternatives Explained

Hello, doctor: Is surgery always necessary for hemorrhage in the lateral ventricles and the fourth ventricle? Is the risk of surgery significant? Are there other methods for treatment?

Dr. Zhang Yuanyi reply Neurosurgery
Hello, if there is associated hydrocephalus or a low level of consciousness, surgery is usually required. Generally, brain surgery carries risks; however, if a drainage procedure is performed for hydrocephalus, the risks are considered lower compared to other types of brain surge...

Hydrocephalus: To Operate or Not? Understanding Your Options

Due to my father's previous fall, he has developed a brain hemorrhage that has now led to hydrocephalus. The doctor mentioned that surgery is an option, but it's not urgent since the fluid accumulation is not significant at this time. If we choose not to have surgery, w...

Dr. Zhang Junwei reply Neurosurgery
A physician must not administer treatment, prescribe medication, or provide a diagnosis without personally examining the patient. If there are no obvious neurological abnormalities, it is recommended to observe the patient for a while longer.