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Hydrocephalus

Back pain that shoots down the leg, neck pain that radiates into the arm, weakness or numbness that makes ordinary tasks impossible these are the hallmarks of a herniated disc pressing on a spinal nerve. Also known as a slipped or prolapsed disc, a herniated disc occurs when the soft inner nucleus of an intervertebral disc pushes through its outer fibrous ring and compresses adjacent nerve roots.

At Shree Hospitals, our sciatica and nerve compression specialists deliver comprehensive Herniated Disc treatment in Mumbai, India from accurate spinal disc prolapse diagnosis and minimally invasive care to microdiscectomy surgery and rehabilitation programmes that get patients back to pain-free movement as swiftly and safely as possible.

(24×7 Emergency Care)

1800-268-4000

(24×7 Emergency Care)

1800-268-4000

Our Approach to Managing Hydrocephalus

Restore the flow. Protect the brain. Support for life.

Hydrocephalus is not a single condition: it is a final common pathway that many different diseases arrive at through different routes. Post-haemorrhagic hydrocephalus in a premature infant, obstructive hydrocephalus from a posterior fossa tumour in a child, communicating hydrocephalus after meningitis in an adult, and normal pressure hydrocephalus in an elderly patient with the triad of gait instability, cognitive decline, and urinary incontinence - each requires a different diagnostic approach, a different surgical strategy, and a different follow-up programme.

Our approach to paediatric and adult hydrocephalus diagnosis and neurosurgical care at Shree Hospitals addresses this entire spectrum. Our raised intracranial pressure specialists bring together neurosurgeons skilled in both ventriculoperitoneal shunt placement and endoscopic third ventriculostomy, ensuring every patient receives the most appropriate, least invasive, and most durable treatment available.

1. Comprehensive Hydrocephalus Evaluation

Precise diagnostic classification forms the backbone of effective oncological decision-making. Every patient undergoes advanced imaging and diagnostic evaluation to guide treatment planning:

MRI brain with ventricular volumetry to characterising ventricular size, aqueduct patency, periventricular oedema, and underlying aetiology
CT brain for emergency assessment of acute hydrocephalus with raised intracranial pressure
Cine MRI of the aqueduct to assessing CSF flow dynamics to differentiate obstructive from communicating hydrocephalus
Intracranial pressure monitoring for complex or uncertain cases, including lumbar puncture drainage test for normal pressure hydrocephalus diagnosis
Isotope cisternography for communicating hydrocephalus where absorption abnormality needs confirmation
Ophthalmological examination for papilloedema assessment for chronic raised intracranial pressure monitoring

2. Emergency Temporary CSF Diversion

For acute hydrocephalus with dangerous intracranial pressure elevation:

External ventricular drain (EVD) insertion via bedside procedure placing a catheter directly into the lateral ventricle for immediate CSF drainage
Lumbar drain for communicating hydrocephalus without ventricular outlet obstruction
Tight intracranial pressure monitoring and CSF output management in our Neurosurgical ICU
Urgent treatment of underlying cause, including tumour resection, haematoma evacuation, or infection treatment, to allow definitive hydrocephalus management
Weaning and removal of EVD once CSF normalises or definitive surgery is planned

3. Ventriculoperitoneal (VP) Shunt Surgery

The most commonly performed definitive hydrocephalus treatment at Shree Hospitals:

Ventriculoperitoneal shunt utilizing a valve-regulated catheter system diverting CSF from the lateral ventricle to the peritoneal cavity for absorption
Programmable valve shunts with externally adjustable pressure settings avoiding the need for revision surgery when pressure targets need changing
Anti-siphon devices preventing over-drainage in the upright position, particularly important in paediatric patients
Image-guided ventricular catheter placement using fluoroscopy or neuronavigation ensuring accurate catheter tip positioning
Peritoneal catheter laparoscopic placement for obese patients or those with prior abdominal surgery
Antibiotic-impregnated or silver-coated catheters significantly reducing shunt infection rates

4. Endoscopic Third Ventriculostomy (ETV)

For obstructive hydrocephalus, where CSF cannot pass through a blocked aqueduct, endoscopic third ventriculostomy creates a new pathway for CSF to bypass the obstruction:

Neuroendoscope introduced into the lateral ventricle through a small frontal burr hole
A perforation created in the floor of the third ventricle, allowing CSF to flow directly into the basal cisterns
Eliminates the need for a shunt entirely, avoiding lifelong shunt dependency and its associated risks
ETV success score calculated pre-operatively to predicting likelihood of success based on age, aetiology, and prior shunt history
ETV combined with choroid plexus cauterisation (ETV-CPC) for infants with communicating hydrocephalus, increasing success rates in the youngest patients

5. Shunt Revision & Complication Management

Shunt complications are the most common cause of re-admission in hydrocephalus patients:

Shunt obstruction as the most frequent complication, presenting with return of hydrocephalus symptoms and treated by shunt revision
Shunt infection (Staphylococcus epidermidis most common) requiring shunt removal, EVD, IV antibiotics, and new shunt insertion after infection clearance
Over-drainage causing subdural haematoma or hygroma from excessive CSF removal, managed by valve pressure adjustment or anti-siphon device addition
Distal catheter complications such as peritoneal pseudocyst or bowel perforation, requiring revision or alternative shunt pathway (ventriculoatrial, ventriculopleural)
Shunt series X-ray and CT brain as first-line investigations for suspected shunt malfunction

6. Normal Pressure Hydrocephalus (NPH) Management

Continuous longitudinal care to preserve quality of life and handle disease progression promptly:

Classic triad identification: gait apraxia, cognitive impairment, and urinary incontinence in an elderly patient with enlarged ventricles on imaging
Lumbar puncture drain test, where improvement in gait after removing 30 to 50 ml of CSF strongly predicts surgical response
Ventriculoperitoneal shunt insertion, with gait improvement being most dramatic and rapid, while cognition improves more slowly
Regular post-shunt valve pressure optimisation using programmable valves allowing non-invasive tuning to maximise clinical benefit
Cognitive and gait rehabilitation alongside surgical Hydrocephalus treatment in Mumbai, India, including physiotherapy and occupational therapy for NPH patients

Happy Patients & Their Case Stories

A three-month-old infant with rapidly enlarging head circumference and a bulging fontanelle was referred to Shree Hospitals with post-haemorrhagic hydrocephalus. VP shunt insertion with a programmable valve restored normal intracranial pressure. At 18 months, her development is progressing well within normal limits.

Mr. Satish M

A 10-year-old boy with a posterior fossa tumour presented with acute obstructive hydrocephalus and vomiting. Emergency EVD insertion stabilised him overnight. After tumour resection, endoscopic third ventriculostomy was performed, eliminating the need for a permanent shunt entirely.

Mr. Ravi P

How to Identify Hydrocephalus?

The location of the herniated disc determines the symptom pattern precisely, making a careful history one of the most powerful diagnostic tools available:

Symptoms vary markedly by age, and recognising the age-specific presentation is critical to timely diagnosis:

In Infants:

Rapidly increasing head circumference: Crossing centile lines on the growth chart - the most reliable early sign in infants whose skull sutures have not yet fused.
Bulging or tense fontanelle: The soft spot on the top of the head becomes firm and prominent rather than pulsatile and soft.
Downward deviation of the eyes (sunset sign): A characteristic sign of significant raised intracranial pressure in infants.
Prominent scalp veins: Venous engorgement from intracranial hypertension visible through the thin infant scalp.
Irritability, poor feeding, and vomiting: Non-specific but consistent features of elevated intracranial pressure.

In Children & Adults:

Headache: Typically worse in the morning and on waking; relieved by upright posture in some forms - a classic feature evaluated by a raised intracranial pressure specialist.
Nausea and vomiting: Accompanying the headache, particularly in acute or subacute hydrocephalus.
Visual disturbance: Blurred vision, double vision, or papilloedema-related visual loss from chronic intracranial pressure elevation.
Cognitive decline and memory impairment: Particularly prominent in communicating hydrocephalus and NPH.
Gait disturbance: Wide-based, shuffling, magnetic gait in NPH - as if the feet are stuck to the floor.
Urinary incontinence: Combined with gait and cognitive change, completing the NPH triad.

Emergency Signs:

Rapid deterioration in consciousness: Cushing's triad (rising BP, falling pulse, irregular respiration) indicating brainstem compression from acutely raised intracranial pressure - a neurosurgical emergency.

Important FAQs: Hydrocephalus

Is hydrocephalus curable?

Hydrocephalus is managed rather than cured in most cases. A ventriculoperitoneal shunt or endoscopic third ventriculostomy effectively controls intracranial pressure and prevents brain damage allowing patients to live full, normal lives. The underlying cause tumour, haemorrhage, or infection is treated separately and may independently reduce the hydrocephalus burden.

How long does a VP shunt last?

Shunts can function for many years some for a lifetime. However, they can fail at any time through obstruction, infection, or mechanical disconnection. Children frequently require revisions as they grow. Regular follow-up with our raised intracranial pressure specialist team and clear education on shunt malfunction symptoms is essential for all shunted patients.

What is the difference between ETV and VP shunt?

Endoscopic third ventriculostomy creates a natural bypass for CSF without implanting a device eliminating shunt hardware risks entirely. It is effective only for obstructive hydrocephalus with a patent subarachnoid space. Ventriculoperitoneal shunt is more broadly applicable across all hydrocephalus types. Our team selects the most appropriate option for each patient individually.

Can hydrocephalus cause permanent brain damage?

Untreated or late-treated hydrocephalus can cause irreversible brain injury from sustained pressure on developing or adult neural tissue. Early paediatric and adult hydrocephalus diagnosis and neurosurgical care prevents most long-term complications which is why prompt evaluation of symptoms is so important.

How do I know if my child's shunt has stopped working?

Return of the symptoms that preceded shunt placement headache, vomiting, drowsiness, bulging fontanelle in infants should trigger immediate hospital assessment. Shunt malfunction can present subtly over days or dramatically over hours. For Hydrocephalus treatment in Mumbai, India, our neurosurgical emergency team is available around the clock.

Treatments for Hydrocephalus at Shree Hospitals

Hydrocephalus treatment relieves excess fluid buildup in the brain to reduce pressure and prevent complications. Depending on the condition, treatment may include shunt surgery or endoscopic third ventriculostomy (ETV) to restore normal cerebrospinal fluid flow.

Ventriculoperitoneal (VP) Shunt

The most widely performed definitive treatment for hydrocephalus. A valve-regulated ventriculoperitoneal shunt system diverts excess CSF to the peritoneal cavity. Programmable valves at Shree Hospitals allow non-invasive pressure adjustment post-operatively, optimising drainage without further surgery as part of CSF shunt surgery and hydrocephalus management in Mumbai.

Endoscopic Third Ventriculostomy (ETV)

The preferred treatment for obstructive hydrocephalus in suitable candidates, creating a CSF bypass through the third ventricle floor without a permanent implant. Endoscopic third ventriculostomy eliminates lifelong shunt dependency and its associated revision and infection risks for appropriate patients.

External Ventricular Drain (EVD)

Emergency temporary CSF drainage for acute hydrocephalus with dangerous intracranial pressure, inserted at the bedside in our neurosurgical unit. Provides immediate pressure relief while the underlying cause is identified and definitive surgical treatment is planned.

Shunt Revision Surgery

For patients with shunt malfunction, infection, or over-drainage, prompt revision is performed with neuronavigation-guided catheter replacement, valve pressure adjustment, or anti-siphon device addition. Our experienced team minimises revision rates through meticulous initial shunt placement technique and antibiotic-impregnated hardware use.