Materiały źródłowe

• #1 Hydrocephalus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hydrocephalus/diagnosis-treatment/drc-20373609

  One of two surgical treatments can be used to treat hydrocephalus. […] A shunt drains excess cerebrospinal fluid from the brain to another part of the body, such as the stomach, where it can be more easily absorbed. […] The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. […] People who have hydrocephalus usually need a shunt system for the rest of their lives. They require regular monitoring. […] Some people may have a surgery called endoscopic third ventriculostomy. The surgeon uses a small video camera to see inside the brain. Then the surgeon makes a hole in the bottom of a ventricle. This allows cerebrospinal fluid to flow out of the brain.

• #1 Hydrocephalus Treatment Options | Children’s Pittsburgh

  https://www.chp.edu/our-services/brain/neurosurgery/hydrocephalus/treatment

  The team at the Brain Care Institute at UPMC Childrens Hospital of Pittsburgh works hard to provide treatment, education, and guidance as each baby grows and develops. Our main goal for children with hydrocephalus is to determine the underlying cause of hydrocephalus, if present, and to promptly treat both the hydrocephalus and the reason for its development before irreversible changes in the brain occur. […] A team of specialists will determine if medications or additional procedures should be used. The key to caring for hydrocephalus in infants is early detection and treatment, and prevention of infection through frequent medical evaluations. […] For many children with hydrocephalus, surgery is needed. This may involve placing a shunt, which is a device used to help drain the extra CSF from the brain and redirect the extra fluid to another part of the body. A common type of shunt is the ventriculoperitoneal shunt. Insertion of the ventriculoperitoneal shunt is done under general anesthesia, which at Childrens is administered by pediatric anesthesiologists who specialize in treating children.

• #1 Hydrocephalus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hydrocephalus

  How is hydrocephalus treated? Hydrocephalus needs to be treated with surgery. There are three options: Shunt placement: This is the most common treatment for hydrocephalus. During the procedure, a shunt (a thin, flexible tube) is placed in the brain or spinal cord to drain the extra fluid. A one-way valve on the shunt regulates the flow of fluid. Many shunts can also be adjusted externally, using a magnetic device. Shunts need adjustment and replacement over time, and must be checked by a neurosurgeon on an ongoing basis. […] Endoscopic third ventriculostomy (ETV): This surgery may be an option for older children with hydrocephalus, especially for those who have a blocked connection between the third and fourth ventricles of the brain. This is a minimally invasive procedure that creates an opening in the floor of the third ventricle in the brain, allowing trapped fluid to escape into its normal pathway.

• #1 Hydrocephalus in Infants and Children: Diagnosis & Treatment

  https://www.hydroassoc.org/hydrocephalus-in-infants-and-children/

  The goal of treatment is to relieve the pressure inside your child’s head by regulating the amount of fluid within the ventricles. […] While there is currently no known way to prevent or cure hydrocephalus, there are three life-saving treatment options that require brain surgery. […] The most common treatment for hydrocephalus is a medical device called a shunt. The purpose of the shunt is to reduce the pressure inside your child’s brain by draining the excess fluid, cerebrospinal fluid (CSF). The shunt diverts the fluid to another part of your child’s body, most often the abdominal cavity or heart where it can be absorbed. […] A second surgical treatment option, ETV, is typically used for children over the age of 2 with non-communicating (obstructive) hydrocephalus; hydrocephalus caused by a blockage in the brain like aqueductal stenosis. The endoscope creates an alternative pathway for CSF to flow out of the ventricles and around the brain. A shunt is not needed. Not everyone is a candidate for ETV treatment.

• #1 Hydrocephalus – A Shunting Alternative Treatment for Hydrocephalus | Advanced Neurosurgery Associates

  https://ana-neurosurgery.com/hydrocephalus-awareness-month-a-shunting-alternative/

  Traditionally, hydrocephalus is treated with a shunt, a device that allows excess CSF to be shunted (moved) to another area of the body. […] If CSF abnormally accumulates in the brain because of a blockage, endoscopic third ventriculostomy (ETV) may be an effective course of action. An ETV is a minimally invasive surgery that normalizes brain pressure without the use of a shunt. […] During an ETV procedure, neurosurgeons create a small hole in the skull, behind the hairline. An endoscope is inserted into the area that houses cerebrospinal fluid. The surgeon creates an opening in the brain tissue, which allows drainage of the fluid to flow as it should. […] In a successful ETV, no further treatment for hydrocephalus is required. […] However, just like shunting, ETVs also have drawbacks, such as infection or the possibility of the closure of the hole that is made for CSF drainage.

• #1 Hydrocephalus in Infants and Children: Diagnosis & Treatment

  https://www.hydroassoc.org/hydrocephalus-in-infants-and-children/

  The third treatment option involves an ETV with the addition of a technique that burns or cauterizes the choroid plexus tissue to reduce the amount of fluid being introduced into the ventricles. This is referred to as choroid plexus cauterization or CPC. This treatment is primarily used in children under 2. Not everyone is a candidate for ETV/CPC treatment. ETV/CPC is a very technical surgery and should be performed by a neurosurgeon trained and experienced in the procedure.

• #1 Hydrocephalus Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1135286-treatment

  Medical treatment in hydrocephalus is used to delay surgical intervention. It may be tried in premature infants with posthemorrhagic hydrocephalus (in the absence of acute hydrocephalus). Normal CSF absorption may resume spontaneously during this interim period. […] Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure. […] Surgical treatment is the preferred therapeutic option. […] Repeat lumbar punctures (LPs) can be performed for cases of hydrocephalus after intraventricular hemorrhage, since this condition can resolve spontaneously. […] Alternatives to shunting include the following: Choroid plexectomy or choroid plexus coagulation may be effective in cases of CSF over-production.

• #1 Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4743412/

  Acetazolamide, a carbonic anhydrase inhibitor, decreases CSF flow and ICP in rabbits and cats. […] Acetazolamide was shown to reduce the lateral ventricle size of young adult rats, 1 day following injection of thrombin into the ventricle. […] Despite failed use in children, acetazolamide was proposed as an alternative to shunting for adults with NPH. […] Although there was no persisting effect on ICP, the transient reduction in ICP following an acetazolamide bolus was shown to be predictive of good response to shunting in NPH patients. […] A controlled study of children with myelomeningocele two decades later compared 14 treated with isosorbide and 17 managed without the drug. […] Although isosorbide allowed delay of the surgical closure, there was no difference in need for shunting; furthermore, side effects led the authors to conclude that it has no role in management of these children.

• #1 Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4743412/

  Furosemide has minimal effect on CSF formation in healthy cats and dogs, but CSF formation was reduced in preterm rabbits and in adult rabbits, albeit much less potently than acetazolamide. […] A randomized control trial of the acetazolamide/furosemide combination for premature infants with posthemorrhagic ventricular dilatation was conducted from 199296. […] Unfortunately it failed to show benefit. […] In summary, antagonism of the TGF-1 pathway has excellent rationale for prevention of post-hemorrhagic or post-meningitis hydrocephalus, but more preclinical experimentation is required. […] Despite over 5 decades research, no compelling non-surgical therapies have been developed for hydrocephalus.

• #1 Hydrocephalus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hydrocephalus/diagnosis-treatment/drc-20373609

  Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid. Or shunt systems may poorly regulate drainage because of mechanical problems, a blockage or infections. […] Some people with hydrocephalus, particularly children, might need supportive therapies. Need for these therapies depends on the long-term complications of hydrocephalus. […] Children’s care teams might include: Pediatrician or physiatrist, who oversees the treatment plan and medical care. […] Adults with more serious complications might need the services of occupational therapists or social workers. Or they may need to see specialists in dementia care or other medical specialists.

• #1 Hydrocephalus Treatment Options | Children’s Pittsburgh

  https://www.chp.edu/our-services/brain/neurosurgery/hydrocephalus/treatment

  Some children with certain types of hydrocephalus can be treated successfully in a minimally invasive manner through endoscopic intraventricular surgery. An endoscope is used to create bypass channels for fluid to flow around an area of obstruction (as in an endoscopic third ventriculostomy or an endoscopic septostomy) or to directly treat an obstructing lesion, such as endoscopic cyst fenestration. […] Although the benefits of these surgeries usually outweigh the risks, potential complications can arise, including: Infection, Shunt malfunction, resulting in underdrainage or overdrainage of the CSF, Bleeding, Fever, Vomiting, Irritability, Redness, Swelling along the area of the tubing, Decreased alertness or lethargy.

• #1 Hydrocephalus

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/hydrocephalus/

  If you suspect you or your baby has an infection, you must immediately notify your neurosurgeon or call 9-1-1 for transportation to the nearest emergency room. Shunt infections are extremely serious and can be life-threatening or cause brain damage. […] Infections generally appear one to six months after the placement of a shunt. These infections can quickly become serious, even to the point of causing permanent brain damage. […] If the shunt becomes partially or completely blocked, CSF cannot drain. This is an uncommon complication, because shunts are very durable. However, their components may become fractured through wear, or as a child grows. […] A blood clot following a shunt insertion is a very serious complication, occurring in about 5-10% of patients, according to The Hydrocephalus Association.

• #1 What is Hydrocephalus? Symptoms, Causes, and Treatments

  https://www.hydroassoc.org/about-hydrocephalus/

  This surgery, primarily performed in infants, involves the addition of choroid plexus cauterization (CPC) to the ETV. The choroid plexus is a network of vessels in the ventricles of the brain where cerebrospinal fluid is produced. […] It is important to understand that living with a shunt or ETV requires being well-informed and vigilant about potential complications. […] It is possible for a shunt to malfunction, fail, or become infected, which would then require a shunt revision (brain surgery). Likewise, an ETV can close unexpectedly and put an individual in an emergency situation. […] Yes, hydrocephalus is treatable with early detection and appropriate intervention.

• #1 A New Treatment for Normal Pressure Hydrocephalus? > News > Yale Medicine

  https://www.yalemedicine.org/news/new-treatment-normal-pressure-hydrocephalus

  Normal pressure hydrocephalus (NPH) a rare condition that causes cognitive and physical symptoms has traditionally been treated with surgery that involves drilling holes in the skull. […] Now, a Yale Medicine neurosurgeon is using a minimally invasive technique to treat this condition, which occurs when too much CSF accumulates in the brain, leading to a host of problems, including trouble walking and memory loss. […] With this minimally invasive approach, the eShunt is implanted between a vein in the neck and the base of the skull. […] Furthermore, the implant can be placed in the body through the femoral vein in a patient’s groin. […] Because it’s minimally invasive, there is also a reduction in the risk for complications and infection compared with the traditional surgery, he adds. […] This minimally invasive approach is a potential game-changer in treating normal pressure hydrocephalus, says Dr. Matouk.

• #1 New Insights by Mass General on the molecular mechanism of hydrocephalus could lead to the first-ever non-surgical treatment

  https://www.massgeneral.org/news/press-release/new-insights-by-mass-general-on-the-molecular-mechanism-of-hydrocephalus%20could-lead-to-the-first-ever-non-surgical-treatment

  Researchers have learned that the same molecular pathway is involved in both the infectious and hemorrhagic forms of acquired hydrocephalus, a life-threatening disease that triggers a massive neuroinflammatory response and swelling of the ventricles of the brain. […] An FDA-approved immune suppressant drug, rapamycin, was shown to block inflammation in the ventricles and prevent development of acquired hydrocephalus in animal models. […] Finding a nonsurgical treatment for hydrocephalus, given the fact neurosurgery is fraught with tremendous morbidity and complications, has been the holy grail for our field, says Kristopher Kahle, MD, PhD, a pediatric neurosurgeon at MGH and senior author of the study. […] We’re hopeful these findings will pave the way for approval of an anti-inflammatory drug to treat hydrocephalus, which could be a game-changer for populations in the U.S. and around the world that don’t have access to surgery.

• #1 Recovery & Support for Normal Pressure Hydrocephalus | NYU Langone Health

  https://nyulangone.org/conditions/normal-pressure-hydrocephalus/support

  Recovery from normal pressure hydrocephalus is possible with shunt surgery, but improvement varies from person to person. […] Walking problems, mild dementia, and bladder control issues usually show some improvement within days after surgery. […] However, it may take weeks or months to achieve the maximum benefit of the surgery. […] Many people find physical therapy helpful after surgery to improve their balance and ability to walk. […] Working with a physical therapist, many people see improvement with their walking within a few weeks of shunt surgery. […] The experts at Rusk Rehabilitation treat the cognitive challenges associated with normal pressure hydrocephalus through cognitive therapy. […] People may also benefit from working with an occupational therapist to address issues of safety, balance, coordination, and improved functioning in the home after surgery.

• #1 Recovery & Support for Normal Pressure Hydrocephalus | NYU Langone Health

  https://nyulangone.org/conditions/normal-pressure-hydrocephalus/support

  Occupational therapists at Rusk Rehabilitation help people with activities of daily living such as feeding, bathing, grooming, going to the bathroom, dressing, writing, and workplace activities. […] Outpatient psychological counseling is available to address any concerns related to the social and emotional impacts of normal pressure hydrocephalus and the challenges it may bring for both the patient and their family, including the effects of prolonged caregiving. […] People who have normal pressure hydrocephalus and their families may also benefit from meeting with our social workers to prepare for post-surgical expectations and develop discharge plans.

• #1 Hydrocephalus and Mobility Challenges | Loh Medical

  https://www.lohmedical.com/en/solutions/hydrocephalus-and-mobility-challenges

  The primary treatment for hydrocephalus is surgical intervention, which involves the placement of a shunt system to drain excess CSF from the brain to another part of the body. This can alleviate pressure on the brain and improve mobility-related symptoms. […] Physical therapy can help individuals with hydrocephalus improve their strength, balance, and coordination. This can improve overall mobility and decrease the risk of falls or other injuries. […] Occupational therapists can help individuals with hydrocephalus adapt to their mobility limitations by teaching them new ways to perform daily tasks and recommending assistive devices or home modifications to improve safety and independence. […] Depending on the severity of the mobility limitations, individuals with hydrocephalus may benefit from using assistive devices such as canes, walkers, or wheelchairs. These devices can provide additional support, stability, and confidence, particularly in situations where balance or strength may be compromised. […] Cognitive rehabilitation can help individuals with hydrocephalus address cognitive impairments that may impact their mobility. Techniques may include memory aids, time management strategies, or problem-solving exercises to improve cognitive function and daily living skills.

• #1 Hydrocephalus treatment | MIETHKE

  https://www.miethke.com/en/hydrocephalus/about-hydrocephalus/treatment/

  Most importantly, follow the instructions of your doctor, who knows best what is best. […] In principle, as after every operation, you should take it easy and refrain from increased exertion in the first few weeks after the operation. […] If severe headaches, dizzy spells, an unnatural gait or similar occur, a doctor should be consulted immediately. […] In addition, regular medical check-ups are recommended.

• #1 Hydrocephalus Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/hydrocephalus

  Although shunting is a relatively straightforward procedure, complications can arise, which underscores the importance of selecting a neurosurgeon experienced in treating this condition. […] Patients treated at Columbia have access to world-renowned neurosurgeons experienced in treating hydrocephalus. […] Patients who are surgically treated for hydrocephalus will need long-term follow-up to optimize shunt function and minimize complications. Shunt valves may need to be reprogrammed over time to ensure patients are getting the best clinical benefit.

• #1 Hydrocephalus – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hydrocephalus/symptoms-causes/syc-20373604

  Hydrocephalus can happen at any age, but it occurs more often among infants and among adults 60 and older. Surgery can restore and maintain healthy cerebrospinal fluid levels in the brain. Therapies can manage symptoms resulting from hydrocephalus. […] Without treatment, hydrocephalus leads to complications. Complications may include learning disabilities or developmental and physical disabilities. Complications of this condition also can result in death. When hydrocephalus is mild and it’s treated, there may be few, if any, serious complications.

• #1 Hydrocephalus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560875/

  Hydrocephalus is the symptomatic accumulation of cerebrospinal fluid inside the cerebral ventricles. This activity reviews the evaluation and treatment of hydrocephalus and highlights the role of the interprofessional team in evaluating and treating patients with this condition. […] Surgical treatment with a ventricular shunt placement is the first treatment option. Endoscopic third ventriculostomy (ETV) and choroid plexus cauterization are possible options in suitable forms of hydrocephalus. Acute hydrocephalus without prompt treatment can result in brain herniation and death. […] Initial treatment is directed to the etiology. In cases of intraparenchymal hemorrhage or tumors, surgical evacuation may resolve the hydrocephalus. When hydrocephalus persists, treatment is surgical with the insertion of a ventricular shunt. The shunt moves CSF to another part of the body where it can be absorbed. With treatment, many patients have healthy lives with few limitations.

• #2 Hydrocephalus: What It Is, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17334-hydrocephalus

  Hydrocephalus is treatable. While there currently isn’t a way to prevent or cure hydrocephalus, the condition can be treated with surgery. […] Currently, the only way to treat hydrocephalus is with brain surgery. There are two types of brain surgeries used to treat hydrocephalus: […] The most common type of treatment for hydrocephalus is the surgical placement of a medical device called a shunt. A shunt is a flexible tube that’s placed in your brain. It drains the excess CSF to another area of your body where it can be absorbed. […] With this surgery, a small hole is made in the floor of your third ventricle. This creates a pathway for CSF to flow in and around your brain as it would normally. This procedure is generally performed in children over the age of 2. […] Yes. Hydrocephalus is treatable.

• #2

  https://www.nhs.uk/conditions/hydrocephalus/treatment/

  Hydrocephalus (excess fluid in the brain) is treated with surgery. […] Both congenital and acquired hydrocephalus are treated with either shunt surgery or neuroendoscopy. […] Shunt surgery is done by a specialist in brain and nervous system surgery (neurosurgeon). […] After the shunt has been installed, further treatment for hydrocephalus may be needed if the shunt becomes blocked or infected. Shunt repair surgery will then be necessary. […] An alternative procedure to shunt surgery is an endoscopic third ventriculostomy (ETV). […] ETV is done under general anaesthetic. […] Normal pressure hydrocephalus (NPH), which usually affects older people, can sometimes be treated with a shunt. However, not everyone with NPH will benefit from shunt surgery.

• #2 Hydrocephalus Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/1135286-treatment

  Shunts eventually are performed in most patients. Only about 25% of patients with hydrocephalus are treated successfully without shunt placement. […] A ventriculoperitoneal (VP) shunt is used most commonly. […] Rapid-onset hydrocephalus with increased intracranial pressure (ICP) is an emergency. […] Patients with shunt-dependent hydrocephalus should be admitted for consideration of shunt revision if shunt malfunction or infection is suspected. […] In treatment of normal pressure hydrocephalus (NPH), gradual postoperative mobilization is recommended.

• #2 Treatment of Hydrocephalus | QLI

  https://qliomaha.com/blog/treatment-of-hydrocephalus/

  The procedure is conducted under general anesthesia procedure without complications to put a shunt in place generally only takes about 90 minutes open to close, so it is a relatively rapid process. […] Hospital recovery after implantation of a shunt is typically a two to three day process. […] The failure rate for shunts after placement is typically around 10 to 20% failure rate within the first year and around 5% thereafter. […] The craniectomy process, if the brain tissue itself is swelling, which is now squeezing off those narrow passageways, relieving that pressure can remove the need for having a shunt put in place. […] A craniectomy often will serve that purpose if the obstruction is secondary to brain tissue swelling. […] The only way to do it is taken off, palm sized piece of the skull or more to allow the brain to swell.

• #2 Hydrocephalus – AANS

  https://www.aans.org/patients/conditions-treatments/hydrocephalus/

  Hydrocephalus can be treated in a variety of ways. Based on the underlying etiology, the condition may be treated directly by removing the cause of CSF obstruction or indirectly by diverting the excess fluid. Hydrocephalus is most commonly treated indirectly by implanting a device known as a shunt to divert the excess CSF away from the brain. The shunt is a flexible tube which, along with a catheter and a valve, is placed under the skin to drain excess CSF from a ventricle inside the brain to another body cavity such as the peritoneal cavity (the area surrounding the abdominal organs). […] Once inserted, the shunt system usually remains in place for the duration of a patients life (although additional operations to revise the shunt system are sometimes needed). The shunt system continuously performs its function of diverting the CSF away from the brain, thereby keeping the intracranial pressure within normal limits. In some cases, two procedures are performed, the first to divert the CSF and another at a later stage to remove the cause of obstruction (e.g. a brain tumor). […] A limited number of patients can be treated with an alternative operation called endoscopic third ventriculostomy. In this procedure, a surgeon utilizes a tiny camera (endoscope) with fiber optics to visualize the ventricles and create a new pathway through which CSF can flow.

• #2 Hydrocephalus treatment​

  https://www.thechristhospital.com/services/neurosurgery/your-care-and-treatment/hydrocephalus/treatment

  The sooner hydrocephalus is diagnosed, the better your chances are for treatment and recovery. The goal of treatment is to reduce excessive fluid and pressure on the brain and restore the normal flow of cerebrospinal fluid. How a patient reacts to treatment for hydrocephalus depends on individual symptoms and a timely diagnosis. […] Two effective treatment options are: […] Shunta drainage system that is surgically inserted to help cerebrospinal fluid flow in the right direction and at a normal rate. Shunt surgery is typically well tolerated, often taking less than one hour. Under general anesthesia, a small hole (the diameter of a quarter) is drilled into the skull to pass a tiny catheter (tube) into the ventricle of the brain. This catheter is then attached to a valve that regulates the flow of the cerebrospinal fluid. The valve then drains the fluid elsewhere in the body, away from the brain. Typically a shunt starts working immediately, and often patients have improved symptoms within hours of surgery.

• #2 What is Hydrocephalus? Symptoms, Causes, and Treatments

  https://www.hydroassoc.org/about-hydrocephalus/

  Hydrocephalus is treatable with early detection and appropriate intervention. While brain surgery is currently the only form of treatment, many people find success in managing their hydrocephalus with one of the three following surgical options: […] The most common treatment for hydrocephalus is a medical device called a shunt. This is a flexible tube that is placed in the ventricular system of the brain that diverts the flow of CSF to another part of the body, most often the abdominal cavity, or heart, where it can be absorbed. The shunt system has a valve that maintains CSF at normal pressure within the ventricles. […] With this procedure, an endoscope (a small tube with a camera) is used to puncture a hole in the membrane on the floor of the third ventricle. This opens a natural pathway that allows CSF to flow out of the ventricles and around the brain, bypassing a blockage.

• #2 Hydrocephalus in Infants and Children: Diagnosis & Treatment

  https://www.hydroassoc.org/hydrocephalus-in-infants-and-children/

  The goal of treatment is to relieve the pressure inside your child’s head by regulating the amount of fluid within the ventricles. […] While there is currently no known way to prevent or cure hydrocephalus, there are three life-saving treatment options that require brain surgery. […] The most common treatment for hydrocephalus is a medical device called a shunt. The purpose of the shunt is to reduce the pressure inside your child’s brain by draining the excess fluid, cerebrospinal fluid (CSF). The shunt diverts the fluid to another part of your child’s body, most often the abdominal cavity or heart where it can be absorbed. […] A second surgical treatment option, ETV, is typically used for children over the age of 2 with non-communicating (obstructive) hydrocephalus; hydrocephalus caused by a blockage in the brain like aqueductal stenosis. The endoscope creates an alternative pathway for CSF to flow out of the ventricles and around the brain. A shunt is not needed. Not everyone is a candidate for ETV treatment.

• #2 Hydrocephalus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hydrocephalus

  Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC): This procedure can be used as the primary treatment for most infants with hydrocephalus. It combines ETV with CPC, which reduces the tissue in the ventricles (called choroid plexus) that pulsates with every heartbeat, creating pressure waves inside the brains ventricles, and also produces some of the cerebrospinal fluid. ETV/CPC is thought to work by reducing the rate of cerebrospinal fluid production and the strength of the pulsations, in addition to providing a new pathway for the fluid to escape. This surgery was pioneered by Benjamin Warf, MD, neurosurgeon at Boston Children’s Hospital and director of Neonatal and Congenital Anomaly Neurosurgery. […] While there is no cure for hydrocephalus, the treatments have an excellent success rate, especially with early diagnosis.

• #2 Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4743412/

  Pharmacological interventions have been tested experimentally and clinically to prevent hydrocephalus and avoid the need for shunting beginning in the 1950s. […] Clinical trials of varied quality have not demonstrated lasting and convincing protective effects through manipulation of cerebrospinal fluid production, diuresis, blood clot fibrinolysis, or manipulation of fibrosis in the subarachnoid compartment, although there remains some promise in the latter areas. […] Acetazolamide bolus seems to be useful for predicting shunt response in adults with hydrocephalus. […] Neuroprotection in the situation of established hydrocephalus has been tested experimentally beginning more recently. […] Therapies designed to modify blood flow or pulsation, reduce inflammation, reduce oxidative damage, or protect neurons are so far of limited success; more experimental work is needed in these areas.

• #2 Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4743412/

  Most patients are managed by shunting using a silicone tube and valve system, where CSF is diverted from the cerebral ventricles to another body site. […] Treatment by shunting is associated with frequent complications, particularly obstruction and infection in young infants, which add to morbidity and mortality. […] Surgical alternatives to ventriculo-peritoneal shunting, such as endoscopic third ventriculostomy (ETV), have become popular. […] In controlled trials, ETV has reasonable efficacy in pediatric hydrocephalus particularly for aqueduct stenosis. […] ETV requires more robust evidence for routine use in adult normal pressure hydrocephalus (NPH). […] Lumboperitoneal shunting also shows some promise in NPH. […] For more than six decades, researchers have been trying to develop nonsurgical means for management of hydrocephalus.

• #2 Hydrocephalus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560875/

  Ventriculoperitoneal (VP) shunt is the most common type of shunt. It usually drains CSF from the lateral ventricle to the peritoneal cavity; in children, it has the advantage that the distal peritoneal part may be left long and will not require changing during the growth of the child. […] There are alternatives to shunting that may be considered. Endoscopic third ventriculostomy (ETV) opens the floor of the third ventricle to permit the CSF in the third ventricle to enter the prepontine basal cistern. […] Acute hydrocephalus is a medical emergency. For those cases where a shunt cannot be placed urgently, an anterior fontanelle ventricular tap may be performed in infants. In adults and children, placement of external ventricular drain is the most common procedure performed in these cases. […] Acetazolamide, a carbonic anhydrase inhibitor, decreases CSF secretion by the choroid plexus and hence used in the treatment of hydrocephalus. It is mostly used in pseudotumor cerebri.

• #2 Hydrocephalus Medication: Carbonic anhydrase inhibitors, Loop diuretics

  https://emedicine.medscape.com/article/1135286-medication

  Acetazolamide (ACZ) and furosemide (FUR) treat posthemorrhagic hydrocephalus in neonates. Both are diuretics that also appear to decrease secretion of CSF at the level of the choroid plexus. ACZ can be used alone or in conjunction with FUR. The combination enhances efficacy of ACZ in decreasing CSF secretion by the choroid plexus. If ACZ is used alone, it appears to lower risk of nephrocalcinosis significantly. […] Medication as treatment for hydrocephalus is controversial. It should be used only as a temporary measure for posthemorrhagic hydrocephalus in neonates, or when shunting is not possible. Medications should not be used in patients with functional shunts. Medication is not effective in long-term treatment of chronic hydrocephalus, and it may induce metabolic consequences. […] If seizures occur, antiepileptic drugs are recommended. […] Used as adjunctive therapy with ACZ in temporary treatment of posthemorrhagic hydrocephalus in neonates.

• #2 Hydrocephaly: Medical Treatment | IntechOpen

  https://www.intechopen.com/chapters/59236

  Treatment of hydrocephaly depends on its cause. Medical treatment is used to delay surgical procedures in hydrocephaly. Medical treatment is not effective in long-term treatment of chronic hydrocephaly but can be resumed to balance CSF dynamics (production or absorption) during this interim period. Medications include decreasing CSF secretion by the choroid plexus (acetazolamide), increasing CSF reabsorption (isosorbide, furosemide), or osmotic diuretics which increase water excretion and are used to reduce intracranial pressure. […] In expert opinion, acetazolamide is the most suitable drug alone or in combination with furosemide for treatment of hydrocephaly. […] The major three mechanisms of medical treatment of patients with hydrocephaly are based on (i) reducing CSF production, (ii) decreasing brain water content, and (iii) increasing CSF. About two-thirds of CSF is formed at the choroid plexus, and the other third is formed in the brain and spinal cord. Carbonic anhydrase inhibitors are effective drugs still used to decrease the rate of CSF production in the choroid plexus. Loop diuretic agents, such as furosemide, have also been used to reduce CSF formation.

• #2 Get Hydrocephalus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/hydrocephalus-treatment

  Any surgery comes with the chance of risks and complications. A shunt could fail. An ETV opening could close. Infections happen. That’s why it’s important to stay current with all follow-up visits with our team, and any tests they order. […] Follow-up care helps us make sure your treatment remains successful. And if you do have complications down the road, it lets us start new treatments right away. […] A hydrocephalus diagnosis is serious. And it means you’ll need brain surgery and some time to recover. But it also means you’ll have a better quality of life. At Cleveland Clinic, we give you the support and care you need to make this a reality.

• #2 Hydrocephalus

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/hydrocephalus/

  If you suspect you or your baby has an infection, you must immediately notify your neurosurgeon or call 9-1-1 for transportation to the nearest emergency room. Shunt infections are extremely serious and can be life-threatening or cause brain damage. […] Infections generally appear one to six months after the placement of a shunt. These infections can quickly become serious, even to the point of causing permanent brain damage. […] If the shunt becomes partially or completely blocked, CSF cannot drain. This is an uncommon complication, because shunts are very durable. However, their components may become fractured through wear, or as a child grows. […] A blood clot following a shunt insertion is a very serious complication, occurring in about 5-10% of patients, according to The Hydrocephalus Association.

• #2 Hydrocephalus Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/hydrocephalus

  However, if hydrocephalus does not resolve after a primary condition or disease is treated, surgical treatment for the hydrocephalus itself is typically required. Most often, patients undergo ventricular shunt surgery. Some patients may be candidates for endoscopic third ventriculostomy or even endoscopic third ventriculostomy with choroid plexus cauterization. […] If a patients symptoms improve with spinal fluid drainage, shunt surgery, which is usually brief and safe, is recommended. The goal of placing a shunt is to divert CSF into a region of the body where it can be absorbed, such as the peritoneal cavity or a vein just above the heart. […] In some cases of noncommunicating hydrocephalus, the blockage can be bypassed using endoscopic surgery. […] For some infants, endoscopic third ventriculostomy can be performed with the addition of choroid plexus cauterization.

• #2 Management of Normal Pressure Hydrocephalus | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0915/p1071.html

  Ventriculoperitoneal shunting remains the most common therapy for NPH. This procedure involves the use of general anesthesia. A catheter is placed into one lateral ventricle and attached to a cap and valve positioned below the scalp. Tubing is tunneled subcutaneously from the valve to the abdomen, where it is deposited into the sterile peritoneal cavity for continuous drainage. […] In NPH, success rates of this procedure vary from 33 percent to more than 90 percent. This wide range in outcome probably reflects variations in patient selection. The most serious complications of shunt placement include subdural and intracerebral hematomas. […] Examination of the results of multiple studies yields a wide variation in patient response to CSF diversion. According to one review, 59 percent of patients with NPH reported improvement after shunting with a persistent improvement in only 29 percent. In another study, at one year following ventriculoperitoneal shunting in their cohort of 25 patients, 72 percent of patients had improvement in activities of daily living, a 58 percent improvement in urinary incontinence, and a 57 percent improvement in ambulation.

• #2 Hydrocephalus – A Shunting Alternative Treatment for Hydrocephalus | Advanced Neurosurgery Associates

  https://ana-neurosurgery.com/hydrocephalus-awareness-month-a-shunting-alternative/

  As with many such procedures, advanced technology has greatly improved the success rate of ETV neurosurgery. […] In studies with carefully selected patients, ETVs have had a high level of success. […] Recovery after ETV surgery is relatively quick due to the use of minimally invasive surgery techniques. However, patients need to be diligent in monitoring their recovery in case any complications arise. […] Possible risks after ETV surgery include the hole closing, infection, bleeding, or the brain being unable to absorb the cerebrospinal fluid. […] All candidates for whom ETV is an option must be individually evaluated by experienced neurosurgeons in order to determine their viability for this procedure.

• #2 Innovative medical trial for treatment of hydrocephalus to lead to safer outcomes for patients | VCU Healthic_closeGroup

  https://www.vcuhealth.org/news/innovative-medical-trial-for-treatment-of–hydrocephalus-to-lead-to-safer-outcomes-for-patients/

  Innovative medical trial for the treatment of normal pressure hydrocephalus intended to lead to safer outcomes for patients at VCU Health. […] VCU Health’s Neurosurgery Department is involved in a groundbreaking clinical study that is intended to enable patients suffering from symptoms of normal pressure hydrocephalus (NPH) to recover quicker and with fewer complications. […] Unlike Alzheimer’s disease, the symptoms of NPH can often be effectively treated with surgery, though the procedure is invasive and carries certain risks. […] Used for decades, the standard treatment for NPH involves the surgical implantation of a ventricular peritoneal (VP) shunt into the ventricle of the brain. […] A new, investigational device has been designed to make the procedure for draining the fluid buildup much easier and potentially safer for patients.

• #2 Hydrocephalus treatment: Stories: Neuroscience: Key Areas: Research Impact: Indiana University

  https://research.impact.iu.edu/key-areas/neuroscience/stories/blazer-yost-hydrocephalus.html

  IUPUIs Bonnie Blazer-Yost and colleagues are hoping to change that by creating a treatment that could eliminate the need for invasive surgery. […] Currently, the only effective treatment involves brain surgery and the placement of a shunt to divert the fluid from the brain to other parts of the body. […] We are working to identify a safe drug treatment instead. […] Blazer-Yost and her team of researchers are currently testing antagonists of TRVP4, an electrolyte channel, and seeing promising results. […] A drug option would make a huge impact on their treatment of the disease. […] We have shown that our treatment is working to decrease the excess cerebrospinal fluid in our animal models, now we want to look at whether it reverses the effects happening in other areas of the brain like vision and also to determine if the treatments are effective in a range of other animal models, Blazer-Yost said.

• #2 Hydrocephalus and Mobility Challenges | Loh Medical

  https://www.lohmedical.com/en/solutions/hydrocephalus-and-mobility-challenges

  The primary treatment for hydrocephalus is surgical intervention, which involves the placement of a shunt system to drain excess CSF from the brain to another part of the body. This can alleviate pressure on the brain and improve mobility-related symptoms. […] Physical therapy can help individuals with hydrocephalus improve their strength, balance, and coordination. This can improve overall mobility and decrease the risk of falls or other injuries. […] Occupational therapists can help individuals with hydrocephalus adapt to their mobility limitations by teaching them new ways to perform daily tasks and recommending assistive devices or home modifications to improve safety and independence. […] Depending on the severity of the mobility limitations, individuals with hydrocephalus may benefit from using assistive devices such as canes, walkers, or wheelchairs. These devices can provide additional support, stability, and confidence, particularly in situations where balance or strength may be compromised. […] Cognitive rehabilitation can help individuals with hydrocephalus address cognitive impairments that may impact their mobility. Techniques may include memory aids, time management strategies, or problem-solving exercises to improve cognitive function and daily living skills.

• #2 Recovery & Support for Normal Pressure Hydrocephalus | NYU Langone Health

  https://nyulangone.org/conditions/normal-pressure-hydrocephalus/support

  Recovery from normal pressure hydrocephalus is possible with shunt surgery, but improvement varies from person to person. […] Walking problems, mild dementia, and bladder control issues usually show some improvement within days after surgery. […] However, it may take weeks or months to achieve the maximum benefit of the surgery. […] Many people find physical therapy helpful after surgery to improve their balance and ability to walk. […] Working with a physical therapist, many people see improvement with their walking within a few weeks of shunt surgery. […] The experts at Rusk Rehabilitation treat the cognitive challenges associated with normal pressure hydrocephalus through cognitive therapy. […] People may also benefit from working with an occupational therapist to address issues of safety, balance, coordination, and improved functioning in the home after surgery.

• #2 Hydrocephalus Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/hydrocephalus

  Although shunting is a relatively straightforward procedure, complications can arise, which underscores the importance of selecting a neurosurgeon experienced in treating this condition. […] Patients treated at Columbia have access to world-renowned neurosurgeons experienced in treating hydrocephalus. […] Patients who are surgically treated for hydrocephalus will need long-term follow-up to optimize shunt function and minimize complications. Shunt valves may need to be reprogrammed over time to ensure patients are getting the best clinical benefit.

• #2 What is Hydrocephalus? Symptoms, Causes, and Treatments

  https://www.hydroassoc.org/about-hydrocephalus/

  This surgery, primarily performed in infants, involves the addition of choroid plexus cauterization (CPC) to the ETV. The choroid plexus is a network of vessels in the ventricles of the brain where cerebrospinal fluid is produced. […] It is important to understand that living with a shunt or ETV requires being well-informed and vigilant about potential complications. […] It is possible for a shunt to malfunction, fail, or become infected, which would then require a shunt revision (brain surgery). Likewise, an ETV can close unexpectedly and put an individual in an emergency situation. […] Yes, hydrocephalus is treatable with early detection and appropriate intervention.

• #2 Hydrocephalus Treatment and Recovery

  https://kamranaghayev.com/hydrocephalus-treatment/

  ETV offers an alternative surgical solution, creating an artificial window to allow the CSF to bypass the blockage. […] Both shunting and ETV provide effective means to treat hydrocephalus. […] Following hydrocephalus surgery, patients usually experience a significant improvement in their symptoms. […] Regular follow-up appointments with the neurosurgeon are critical to monitor the patients progress, manage any post-operative complications, and make necessary adjustments to the treatment plan. […] In some cases, despite successful surgery, patients might continue to experience persistent symptoms, or additional surgeries might be necessary.

• #2 Hydrocephalus | USF Health

  https://health.usf.edu/care/neurosurgery/services-specialties/hydrocephalus

  Normal pressure hydrocephalus (NPH) is an increase in the volume of cerebrospinal fluid (CSF) that normally fills the ventricles of the brain and surrounds the brain and spinal cord. […] Treatment is a flexible tube (shunt) surgically placed into the ventricles of the brain that slowly drains CSF from the ventricles into the abdomen where it is usually absorbed. Programmable valves permit for fine-tuning the rate of CSF drainage. These adjustments are made noninvasively in the office using a magnet. […] According to the Hydrocephalus Association, 80% of patients who are accurately diagnosed with NPH and evaluated for shunt responsiveness will demonstrate improvement, but it may take weeks or months to appreciate the full benefit.

• #2 New Insights by Mass General on the molecular mechanism of hydrocephalus could lead to the first-ever non-surgical treatment

  https://www.massgeneral.org/news/press-release/new-insights-by-mass-general-on-the-molecular-mechanism-of-hydrocephalus%20could-lead-to-the-first-ever-non-surgical-treatment

  By deciphering the unique cellular and molecular biology that occurs within the brain after infection or severe hemorrhage, the MGH-led research team has taken a major step toward nonsurgical, pharmacologic treatment for humans. […] MGH researchers are continuing to explore how rapamycin and other repurposed drugs which quell the inflammation seen in acquired hydrocephalus could be turned into an effective drug treatment for patients. […] What has me most excited is that this noninvasive therapy could provide a way to help young patients who don’t have access to neurosurgeons or shunts, emphasizes Kahle. No longer would a diagnosis of hydrocephalus be fatal for these children.

• #3 What is Hydrocephalus? Symptoms, Causes, and Treatments

  https://www.hydroassoc.org/about-hydrocephalus/

  Hydrocephalus is treatable with early detection and appropriate intervention. While brain surgery is currently the only form of treatment, many people find success in managing their hydrocephalus with one of the three following surgical options: […] The most common treatment for hydrocephalus is a medical device called a shunt. This is a flexible tube that is placed in the ventricular system of the brain that diverts the flow of CSF to another part of the body, most often the abdominal cavity, or heart, where it can be absorbed. The shunt system has a valve that maintains CSF at normal pressure within the ventricles. […] With this procedure, an endoscope (a small tube with a camera) is used to puncture a hole in the membrane on the floor of the third ventricle. This opens a natural pathway that allows CSF to flow out of the ventricles and around the brain, bypassing a blockage.

• #3 Get Hydrocephalus Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/hydrocephalus-treatment

  The only treatment for hydrocephalus is brain surgery. We know this may sound scary. But you can rest assured you’ll get the best and most experienced care from our neurology providers. […] There are two types of brain surgery used to treat this serious condition: […] This is the most common way to treat hydrocephalus. Our surgical team will place a flexible tube called a shunt in your brain. It will drain built-up spinal fluid to another area of your body so it can be absorbed. […] Your surgical team will make a small hole in a very thin portion of a fluid cavity in your brain called the third ventricle. They do this with an endoscope a thin, lighted tube with a video camera on one end. This treatment doesn’t damage any nerves and creates an open path for spinal fluid to flow normally in and around your brain, which relieves pressure and swelling.

• #3 Hydrocephalus – Wikipedia

  https://en.wikipedia.org/wiki/Hydrocephalus

  Hydrocephalus is typically treated through surgery. One option is the placement of a shunt system. A procedure called an endoscopic third ventriculostomy has gained popularity in recent decades, and is an option in certain populations. Outcomes are variable, but many people with shunts live normal lives. However, there are many potential complications, including infection or breakage. There is a high risk of shunt failure in children especially. However, without treatment, permanent disability or death may occur. […] Hydrocephalus is treated through surgery by creating a way for the excess fluid to drain away. An external ventricular drain (EVD), also known as an extraventricular drain or ventriculostomy, provides relief in the short term. In the long term, some people will need any of the various types of cerebral shunts. It involves the placement of a ventricular catheter (a tube made of silastic) into the cerebral ventricles. This creates a way to bypass the flow obstruction/malfunctioning arachnoidal granulations. The excess fluid drains into other body cavities where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculoperitoneal shunt). Other shunts drain the fluid into the right atrium (ventriculoatrial shunt), pleural cavity (ventriculopleural shunt), and gallbladder.

• #3 Hydrocephalus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560875/

  Ventriculoperitoneal (VP) shunt is the most common type of shunt. It usually drains CSF from the lateral ventricle to the peritoneal cavity; in children, it has the advantage that the distal peritoneal part may be left long and will not require changing during the growth of the child. […] There are alternatives to shunting that may be considered. Endoscopic third ventriculostomy (ETV) opens the floor of the third ventricle to permit the CSF in the third ventricle to enter the prepontine basal cistern. […] Acute hydrocephalus is a medical emergency. For those cases where a shunt cannot be placed urgently, an anterior fontanelle ventricular tap may be performed in infants. In adults and children, placement of external ventricular drain is the most common procedure performed in these cases. […] Acetazolamide, a carbonic anhydrase inhibitor, decreases CSF secretion by the choroid plexus and hence used in the treatment of hydrocephalus. It is mostly used in pseudotumor cerebri.

• #3 Treatment of Hydrocephalus | QLI

  https://qliomaha.com/blog/treatment-of-hydrocephalus/

  The procedure is conducted under general anesthesia procedure without complications to put a shunt in place generally only takes about 90 minutes open to close, so it is a relatively rapid process. […] Hospital recovery after implantation of a shunt is typically a two to three day process. […] The failure rate for shunts after placement is typically around 10 to 20% failure rate within the first year and around 5% thereafter. […] The craniectomy process, if the brain tissue itself is swelling, which is now squeezing off those narrow passageways, relieving that pressure can remove the need for having a shunt put in place. […] A craniectomy often will serve that purpose if the obstruction is secondary to brain tissue swelling. […] The only way to do it is taken off, palm sized piece of the skull or more to allow the brain to swell.

• #3 Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4743412/

  Most patients are managed by shunting using a silicone tube and valve system, where CSF is diverted from the cerebral ventricles to another body site. […] Treatment by shunting is associated with frequent complications, particularly obstruction and infection in young infants, which add to morbidity and mortality. […] Surgical alternatives to ventriculo-peritoneal shunting, such as endoscopic third ventriculostomy (ETV), have become popular. […] In controlled trials, ETV has reasonable efficacy in pediatric hydrocephalus particularly for aqueduct stenosis. […] ETV requires more robust evidence for routine use in adult normal pressure hydrocephalus (NPH). […] Lumboperitoneal shunting also shows some promise in NPH. […] For more than six decades, researchers have been trying to develop nonsurgical means for management of hydrocephalus.

• #3 Pediatric Hydrocephalus Treatments – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/services/hydrocephalus/treatment.html

  Endoscopic third ventriculostomy (ETV) restores the natural flow of cerebrospinal fluid by creating an opening in one of the ventricles through which CSF is able to flow to the base of the brain. […] After the free flow of CSF has been restored, in some cases the ETV may be improved further with a procedure called a choroid plexus coagulation (CPC). […] If all goes as expected, that will be the last brain surgery the patient ever needs to treat his or her hydrocephalus. […] An alternative procedure for treatment of hydrocephalus, also performed at Packard Childrens, requires the installation of a piece of synthetic tubing known as a ventricular peritoneal shunt, which drains excess CSF from the brain to the abdomen. […] Packard Childrens surgeons successfully treat hydrocephalus with both ETV/CPC and shunt procedures, but a growing percentage of patients are being treated with ETV/CPC. […] Whichever procedure is most appropriate for a child with hydrocephalus, Packard Childrens doctors are equipped to give them the best available care.

• #3 Hydrocephaly: Medical Treatment | IntechOpen

  https://www.intechopen.com/chapters/59236

  Treatment of hydrocephaly depends on its cause. Medical treatment is used to delay surgical procedures in hydrocephaly. Medical treatment is not effective in long-term treatment of chronic hydrocephaly but can be resumed to balance CSF dynamics (production or absorption) during this interim period. Medications include decreasing CSF secretion by the choroid plexus (acetazolamide), increasing CSF reabsorption (isosorbide, furosemide), or osmotic diuretics which increase water excretion and are used to reduce intracranial pressure. […] In expert opinion, acetazolamide is the most suitable drug alone or in combination with furosemide for treatment of hydrocephaly. […] The major three mechanisms of medical treatment of patients with hydrocephaly are based on (i) reducing CSF production, (ii) decreasing brain water content, and (iii) increasing CSF. About two-thirds of CSF is formed at the choroid plexus, and the other third is formed in the brain and spinal cord. Carbonic anhydrase inhibitors are effective drugs still used to decrease the rate of CSF production in the choroid plexus. Loop diuretic agents, such as furosemide, have also been used to reduce CSF formation.

• #3 Hydrocephalus Medication: Carbonic anhydrase inhibitors, Loop diuretics

  https://emedicine.medscape.com/article/1135286-medication

  Acetazolamide (ACZ) and furosemide (FUR) treat posthemorrhagic hydrocephalus in neonates. Both are diuretics that also appear to decrease secretion of CSF at the level of the choroid plexus. ACZ can be used alone or in conjunction with FUR. The combination enhances efficacy of ACZ in decreasing CSF secretion by the choroid plexus. If ACZ is used alone, it appears to lower risk of nephrocalcinosis significantly. […] Medication as treatment for hydrocephalus is controversial. It should be used only as a temporary measure for posthemorrhagic hydrocephalus in neonates, or when shunting is not possible. Medications should not be used in patients with functional shunts. Medication is not effective in long-term treatment of chronic hydrocephalus, and it may induce metabolic consequences. […] If seizures occur, antiepileptic drugs are recommended. […] Used as adjunctive therapy with ACZ in temporary treatment of posthemorrhagic hydrocephalus in neonates.

• #3 Minimally invasive treatment of hydrocephalus | CereVasc

  https://cerevasc.com/treatment-of-hydrocephalus/

  The eShunt System comprises an endovascularly implantable CSF shunt and associated delivery componentry designed to avoid the need for invasive surgery, general anesthesia, extended hospitalization, and post-procedure pain management. […] The innovative nature of the eShunt System highlights a significant opportunity to dramatically simplify the treatment of communicating hydrocephalus by potentially eliminating the need for open surgical VPS placement and fits the definition of disruptive technology in the same way that endovascular coiling and stenting revolutionized the microsurgical clipping of cerebral aneurysms. […] Other significant potential advantages of the eShunt System include elimination of the common problem of over drainage of CSF, typically caused by a siphoning effect of certain VPS devices, as well a significant reduction or elimination of post-procedure pain and infection. […] With an intended reduction in procedure morbidity and the use of local anesthesia, the eShunt System has the potential to expand the use of CSF shunts in patients with co-morbidities in whom general anesthesia and invasive surgery are currently contra-indicated.

• #3 Hydrocephalus | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/hydrocephalus

  Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC): This procedure can be used as the primary treatment for most infants with hydrocephalus. It combines ETV with CPC, which reduces the tissue in the ventricles (called choroid plexus) that pulsates with every heartbeat, creating pressure waves inside the brains ventricles, and also produces some of the cerebrospinal fluid. ETV/CPC is thought to work by reducing the rate of cerebrospinal fluid production and the strength of the pulsations, in addition to providing a new pathway for the fluid to escape. This surgery was pioneered by Benjamin Warf, MD, neurosurgeon at Boston Children’s Hospital and director of Neonatal and Congenital Anomaly Neurosurgery. […] While there is no cure for hydrocephalus, the treatments have an excellent success rate, especially with early diagnosis.

• #3 Treatment of Normal Pressure Hydrocephalus – Barrow Neurological Institute

  https://www.barrowneuro.org/for-physicians-researchers/education/grand-rounds-publications-media/barrow-quarterly/volume-19-no-2-2003/treatment-normal-pressure-hydrocephalus-2/

  The treatment of normal pressure hydrocephalus (NPH) is complicated by the lack of certain diagnostic criteria. The risks associated with treating NPH are also higher than for other forms of hydrocephalus. Possible forms of treatment include ventricular shunts, lumbar shunts, and endoscopic third ventriculostomy. […] The quality of life of carefully selected patients with normal pressure hydrocephalus (NPH) can be improved significantly by shunting. […] The use of endoscopic third ventriculostomy (ETV) has only recently been advocated. […] The ideal valve for use with ventriculoperitoneal (VP) shunting is likely to differ among patients. […] The most recent technological advance to improve the risk-benefit ratio associated with the management of NPH is the development of programmable valve mechanisms.

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