In patients with acute hydrocephalus, caused by an obstructive tumor or by intracranial bleeding, symptoms have usually started very recently, within hours or days.
These cases are emergency neurosurgeries, which is why they require monitoring in the Intensive Care Unit (ICU) and, frequently, respiratory support. The placement of an external ventricular drain or ventriculoperitoneal shunt relieves intracranial pressure and is usually the first step in treating a tumor process or intracranial hemorrhage.
Subacute or chronic hydrocephalus
Patients with by subacute or chronic hydrocephalus may show a gradual increase in ICP and milder symptoms, due to the action of intracranial pressure compensatory mechanisms. They are usually scheduled for ventriculoperitoneal shunt (VPS) implant surgery, if an obstructive cause is ruled out.
In cases when obstructive hydrocephalus (arachnoid cysts or membranes, slow growing tumors ...) is strongly suspected, primary treatment of the obstructive cause is possible through tumor resection, or open or endoscopic fenestration of the arachnoid cyst or membrane.
Normal pressure hydrocephalus
Patients suffering from normal pressure hydrocephalus, more often exhibit symptoms related to cognitive deterioration, difficulty walking, and/or changes in control of sphincters. In these patients, the etiological diagnosis is essential when choosing the most appropriate treatment. Placement of an external ventricular drain or ventriculoperitoneal shunt is usually the most common treatment. Different types of ventriculoperitoneal shunt valves can be used, with fixed flow pressure opening, or programmable.