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Hydrocephalus (fluid on the brain) is treated with surgery.

Babies born with hydrocephalus (congenital) and adults or children who develop it (acquired) usually need prompt treatment to reduce the pressure on their brain. 

If hydrocephalus is not treated, the increase in pressure will cause brain damage.

Both congenital and acquired hydrocephalus are treated with either shunt surgery or neuroendoscopy.

Shunt surgery

During shunt surgery, a thin tube called a shunt is implanted in the brain. The excess cerebrospinal fluid (CSF) in the brain flows through the shunt to another part of the body, usually the tummy. From here, it's absorbed into your bloodstream.

Inside the shunt there's a valve that controls the flow of CSF and ensures it does not drain too quickly. You can feel the valve as a lump under the skin of your scalp.

The operation

Shunt surgery is carried out by a neurosurgeon, a specialist in brain and nervous system surgery. The procedure is carried out under general anaesthetic and usually takes 1 to 2 hours.

You may need to stay in hospital for a few days after the operation to recover.

If you have stitches, they may dissolve or need to be removed. Some surgeons use skin staples to close the wound, which will need to be removed after a few days.

After the shunt has been installed, further treatment for hydrocephalus may be needed if it becomes blocked or infected. Shunt repair surgery will then be necessary.

Endoscopic third ventriculostomy (ETV)

An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV).

Instead of inserting a shunt, the surgeon makes a hole in the floor of the brain to allow the trapped CSF to escape to the brain's surface, where it can be absorbed.

ETV is not suitable for everyone, but it could be an option if the build-up of CSF in your brain is caused by a blockage (obstructive hydrocephalus). The CSF will be able to drain through the hole, avoiding the blockage.

The operation

ETV is carried out under general anaesthetic. The neurosurgeon makes a small hole in your skull and uses an endoscope to look inside the chambers of your brain. An endoscope is a long, thin tube with a light and camera at one end.

A small hole is made inside your brain with the help of the endoscope. After removing the endoscope, the wound is closed using stitches. The procedure takes around 1 hour.

There's less risk of infection after ETV than with shunt surgery. However, as with all surgical procedures, there are some risks.

Read more about the complications of hydrocephalus

The long-term results of treatment with ETV are similar to those for a shunt operation. As with shunts, there's a risk of a blockage months or years after surgery, which will cause your symptoms to return.

Normal pressure hydrocephalus (NPH)

Normal pressure hydrocephalus (NPH), which usually affects older people, can sometimes be treated with a shunt, although not everyone with the condition will benefit from shunt surgery.

As there's a risk of complications with shunt surgery, you'll need tests to assess whether the potential benefits of surgery outweigh the risks.

Lumbar drainage or a lumbar infusion test, or both, can be used to determine whether shunt surgery will benefit you.