The most common, and typically the only available treatment for normal pressure hydrocephalus (NPH) is the surgical implantation of a shunt. In the past five to ten years new diagnostic techniques, better shunt design and recognition of prognostic factors have improved patient selection and outcomes for NPH treatment. Although the insertion of a shunt is a relatively simple neurosurgical procedure that is typically completed in less than one hour, the decision to undergo shunt surgery is more complex.
A shunt is a flexible tube placed into the ventricular system of the brain that diverts the flow of cerebrospinal fluid (CSF) into another region of the body, most often the abdominal cavity, where it can be absorbed. A valve within the shunt maintains CSF at normal levels and pressure within the ventricles.
Endoscopic Third Ventriculostomy (ETV)
A surgical procedure called endoscopic third ventriculostomy (ETV) may be considered as an alternative to a shunt for people diagnosed with aqueductal stenosis, a narrowing of the aqueduct of Sylvius located in the brain. In this procedure, the neurosurgeon uses a special endoscope to create an alternative CSF passageway that bypasses the obstruction at the cerebral aqueduct.
Determination of aqueductal stenosis can be made by MRI, and success of ETV in adults is variable, and some people who undergo the procedure later require shunt surgery to treat their symptoms. Clinical trials are currently exploring ETV as a treatment for NPH.