Hydrocephalus is an incurable and unpredictable disease. However, it can be controlled to relieve pain and disorders. Two medical therapies exist but they are only short-term treatments, which means pain and disorders will be relieved only temporarily. These two treatments are able to only control communicating hydrocephalus.
- Drugs such as acetazolamide (carbonic hydrase inhibitors) and furosemide (loop diuretic) may temporarily control communicating hydrocephalus by decreasing CSF production. It helps to alleviate pain and disorders due to hydrocephalus. Another drug, isosorbide (osmotic diuretic), could increase CSF reabsorption. However, its effectiveness is questionable.
- A lumbar puncture will drain the CSF excess that filled the lumbar subarachnoid spaces. It is a medical procedure that needs to be performed by your physician. While you are lying down on your side with you knee pulled up, under local anesthesia, your physician will insert a hollow needle in the lower part of your spine (between the two bones of your spinal base). This needle will allow the CSF in excess to pass by and will reduce the intracranial pressure. This procedure usually takes around 30 to 45 minutes to be completed. It needs to be repeated if the hydrocephalus proves to be permanent. Indeed, when the needle is removed, the CSF does not have any more an exit and will remain in excess.
Although drugs and lumbar puncture may temporarily control communicating hydrocephalus, surgery is the only truly effective long term therapy or obstructive hydrocephalus treatment. Indeed, two therapies create another pathway to drain excess CSF. One therapy is endoscopic and the other one implant a device.
- Endoscopic third ventriculo-cisternostomy
This operation is only performed in obstructive hydrocephalus and enables excess CSF which is blocked within the ventricles to be evacuated into the areas where it is reabsorbed naturally: the interpeduncular cistern, which is connected directly to the third ventricle. The procedure of placing the cerebral ventricles in communication with the cerebral cisterns in the sub-arachnoid spaces is called ventriculo-cisternostomy. This type of intrathecal shunt is performed by stereotactic or endoscopic (+++) perforation of the third ventricle floor.
- CSF shunting
These have been performed for decades and still represent the most important advance made until now in the treatment of hydrocephalus when endoscopic treatment is not indicated or possible. A CSF shunt involves establishing an alternative pathway for the movement of CSF in order to bypass an obstruction of the natural pathways.
The shunt is positioned to enable the CSF to be drained from the cerebral ventricles or lumbar sub-arachnoid spaces into another absorption site, the peritoneal cavity or the right atrium of the heart, through a system of small tubes known as catheters. A regulatory device, the valve which may be more or less sophisticated, is inserted between a said “proximal" catheter and a “distal" catheter. This drainage enables the excess CSF within the brain to be evacuated and, thereby, the pressure within the cranium to be reduced.