Surgical Management of Adult Hydrocephalus

Abstract

The management of adult hydrocephalus spans a broad range of disorders and ages. Modern management strategies include endoscopic and adjustable cerebrospinal fluid shunt diversionary techniques. The assessment and management of the following clinical conditions are discussed: 1) the adult patient with congenital or childhood-onset hydrocephalus, 2) adult slit ventricle syndrome, 3) multicompartmental hydrocephalus, 4) noncommunicating hydrocephalus, 5) communicating hydrocephalus, 6) normal pressure hydrocephalus, and 7) the shunted patient with headaches. The hydrodynamics of cerebrospinal fluid shunt diversion are discussed in relation to mechanisms of under- and overdrainage conditions. A rationale for the routine implementation of adjustable valves for adult patients with hydrocephalus is provided based on objective clinical and experimental data. For the condition of normal pressure hydrocephalus, recommendations are offered regarding the evaluation, surgical treatment, and postoperative management of this disorder.

Effect of infusion tests on the dynamical properties of intracranial pressure in hydrocephalus

“…Adult hydrocephalus encompasses a heterogeneous group of disorders occurring in a wide range of ages, severity of symptoms and physiological states [1]. Patients with hydrocephalus generally show clinical symptoms, ventriculomegaly and anomalous cerebrospinal fluid (CSF) dynamics [1,2].…”

“…Patients with hydrocephalus generally show clinical symptoms, ventriculomegaly and anomalous cerebrospinal fluid (CSF) dynamics [1,2]. Normal pressure hydrocephalus (NPH) can appear as a primary condition [3] or as a consequence of subarachnoid haemorrhage, traumatic brain injury (TBI) or meningitis [1,3]. Implantation of a CSF shunt is the main treatment option [4].…”

“…Implantation of a CSF shunt is the main treatment option [4]. However, not all patients improve after surgery and their condition becomes challenging for neurosurgeons [1,5]. Despite the recent advances, treatment is sometimes based on a limited knowledge of the underlying pathophysiology [6].…”

Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

“…20 As such, each patient requires an individualized diagnostic and treatment approach. Traditionally, the treatment of hydrocephalus involved ventricular shunting, but because of the tendency of those systems to fail over time, whether from shunt malfunction or infection, 21 endoscopic techniques are emerging as possible alternatives.…”

“…These include ETV and septostomy, options that are most suitable for treating those patients with obstructive hydrocephalus. [20][21][22][23][24][25][26][27][28][29][30] ETV consists of creating a hole through the tuber cinereum in the floor of the third ventricle to allow CSF to flow into the interpeduncular and prepontine cisterns, thereby bypassing obstructions in the aqueductal area, 21,31-40 whereas septostomy involves placing the hole in the septum pellucidum. Another postulated mechanism involves the restoration of the pulsatility of ventricular walls as a result of the stoma, an effect that may help restore CSF dynamics by driving CSF flow from the ventricular system into the subarachnoid space.…”