Adult Hydrocephalus Program
At Swedish Issaquah, we bring together the region’s top doctors and specialists to provide expert diagnosis and treatment of hydrocephalus in adults. We have one of the few programs in the United States dedicated to diagnosing and treating adults with Normal Pressure Hydrocephalus.
Types of hydrocephalus we treat include:
- Normal-pressure hydrocephalus. Usually seen in people over the age of 55 and is typically caused by head trauma, bleeding in the brain or infections. In NPH, there is an increase in ventricle size and a mild increase in intracranial pressure.
- Arrested hydrocephalus. When hydrocephalus is caused by the narrowing of the pathway that carries CSF, known as aqueductal stenosis, it is called arrested hydrocephalus. About 10 percent of adults who have hydrocephalus have arrested hydrocephalus.
If you are experiencing symptoms of hydrocephalus, your doctor will refer you to a neurologist who will review your medical history and conduct a physical exam. Next, your doctor will order tests to determine if you have hydrocephalus as well as the severity of it. Tests may include:
- Computed tomography (CT) scan. This is an imaging test to identify if the ventricles are enlarged or if there are any blockages.
- Cerebrospinal fluid (CSF) flow study. This is used to evaluate how CSF is traveling through the brain.
- Magnetic resonance imaging (MRI). This is an imaging test to look for aqueductal stenosis and to measure the volume of CSF.
The results of this initial evaluation can indicate if you have arrested hydrocephalus or normal-pressure hydrocephalus (NPH).
If the results of this initial evaluation will suggest you might have NPH, the team will ask you to perform an additional series of tests, including gait and balance testing and cognitive testing. The results of these tests are your baseline or starting point.
Additional tests for diagnosing normal-pressure hydrocephalus include gait and balance testing, cognitive testing, physical therapy evaluation and lumbar puncture.
Early diagnosis and treatment of all types of hydrocephalus are important for the best outcomes.
Treating NPH consists of implanting a shunt (small tube or catheter) into chambers in your brain called ventricles. When normal pressure hydrocephalus (NPH) is properly identified, treatment is successful more than 80 percent of the time.
There are three approaches to treating arrested hydrocephalus:
- Monitoring. If patients with arrested hydrocephalus are not experiencing symptoms, they may not need immediate treatment. However, because their condition could change suddenly, they will benefit from being monitored regularly by a specialist. If these patients develop symptoms, they may require treatment at some point.
- Endoscopic third ventriculostomy. ETV is often used in patients with aqueductal stenosis, which is a narrowing or blockage of the cerebral aqueduct that keeps the cerebrospinal fluid from flowing properly through the ventricles. During this procedure, the surgeon makes a hole in the bottom front part of the third ventricle to allow spinal fluid to circulate and be re-absorbed despite the blockage at the level of the cerebral aqueduct.
- Implanting a shunt. This procedure consists of implanting a small tube into chambers in your brain called ventricles. The shunt allows the CSF to drain into your abdomen, where it is absorbed.