Hydrocephalus Program

Hydrocephalus, or water on the brain, is fluid buildup deep within the brain that causes increased pressure in the skull.

Houston Methodist’s Hydrocephalus Program experts include neurologists, physical therapists, neuropsychologists, urologists, orthopedists and ophthalmologists who manage all hydrocephalus types and offer the most advanced techniques to provide the best possible care — from various shunts to minimally invasive endoscopic procedures. We tailor treatments based on each patient’s specific needs.

Hydrocephalus Types and Causes
Communicating – occurs when cerebrospinal fluid (CSF) flow is blocked after it exits the ventricles. Causes include:
o An infection
o A cranial cavity bleed
o Raised venous pressure in the venous sinuses
Noncommunicating – also called obstructive hydrocephalus, occurs when CSF flow is blocked along at least one passage connecting the ventricles. Causes include:
o Brain tumors
o Vascular malformations
o Congenital malformations
o Aqueductal stenosis – narrowing of the aqueduct of Sylvius, which blocks CSF cerebrospinal fluid flow in the ventricular system
o Colloid cysts – contain gelatinous material in the brain
o Pituitary gland masses
o Dandy Walker malformation ¬– a rare congenital malformation involving the cerebellum and fourth ventricle
o Chiari malformation – a condition present at birth in which brain tissue extends into the spinal canal
o Myelomeningocele – a spine and spinal cord defect
o Bleeding or infection
Normal pressure hydrocephalus (NPH) – CSF drainage gradually becomes blocked and fluid slowly builds up
Idiopathic intracranial hypertension (IIH) – an abnormal increase in CSF pressure for unknown reasons, but is not hydrocephalus

Hydrocephalus symptoms vary, depending on age and disease progression. They can include:
Difficulty waking or staying awake
Coordination or balance loss
Bladder control loss or frequent urination urges
Impaired vision
Decline in memory, concentration or reasoning skills
Difficulty walking – a shuffling gait or the feeling of the feet being stuck
Slower than normal movements

Neurological exam to judge:
o Muscle condition
Muscle strength and tone
o Sensories
Vision and eye movement
o Movement
o Psychiatric condition
Mental status
Brain imaging
o Ultrasound
o Magnetic resonance imaging (MRI)
o Computerized tomography (CT) scan
Lumbar puncture or lumbar drain trial – used for NPH patients to evaluate for symptom improvement and determine whether permanent CSF diversion will benefit the patient

Shunt – a surgical drainage system insertion involving a tube with a valve, which allows fluid from the brain to flow properly
Endoscopic third ventriculostomy – a surgical procedure using a small video camera to see inside the brain and make a hole in the bottom of a ventricle or between ventricles to allow CSF to flow out of the brain
Diuretic therapies ¬ treatments that decrease CSF production, which can be used alone or with surgical therapies. Some IIH patients respond well to diuretics alone

Neurological Institute