Hydrocephalus Surgery

Hydrocephalus surgery; It is a surgical intervention performed to reduce intracranial pressure, which increases as a result of excessive accumulation of cerebrospinal fluid (CSF) in the ventricles (ventricles) in the brain, and to protect brain tissue.

This operation aims to prevent permanent damage caused by hydrocephalus by providing controlled drainage of accumulated fluid or surgical rearrangement of fluid flow pathways.

What is Hydrocephalus Surgery?

Hydrocephalus surgery is a neurosurgical procedure in which the condition known as “water accumulation in the brain” is resolved mechanically or endoscopically.

Cerebrospinal fluid is produced, circulated and absorbed under normal conditions; However, any blockage or malabsorption in this cycle causes the brain to become depressed.

By restoring the balance of cerebrospinal fluid, surgical intervention allows for the improvement of symptoms such as headaches, gait disturbance, vision loss, and cognitive decline.

In Which Situations Is Hydrocephalus Surgery Performed?

Not every case of hydrocephalus may require surgery; However, in progressive cases, surgery is inevitable. Key indications include:

• Obstructive Hydrocephalus: Closure of the circulatory pathway of fluid due to a tumor, cyst or congenital stenosis.
• Communicative Hydrocephalus: Although there is no obstacle in the circulation of the fluid, there is a problem in the absorption centers.
• Normal Pressure Hydrocephalus (NPH): Conditions in which the pressure of the cerebrospinal fluid causes enlargement of the brain tissue even though it is within normal limits, especially in the elderly.
• Head Trauma and Bleeding: Clots blocking fluid pathways after cerebral hemorrhage.

What are the Hydrocephalus Surgery Methods?

In modern neurosurgery, hydrocephalus treatment is carried out with two main methods depending on the patient’s age, type of disease and anatomical structure.

Shunt Surgery (Ventriculoperitonal Shunt)

Shunt surgery is the most commonly used classical method in the treatment of hydrocephalus worldwide.

• System: It is a thin, flexible system of silicone tubes with one end in the ventricle of the brain and the other end usually in the abdominal cavity (peritoneum).
• Valve Mechanism: A valve in the middle of the system automatically opens when the intracranial pressure rises, transferring excess fluid to the abdominal cavity and allowing it to be absorbed there.
• Programmable Shunts: Today, thanks to the valves that can be pressure-adjusted with the help of magnets from the outside, the amount of drainage can be updated without surgery according to the patient’s needs.

Endoscopic Third Ventriculostomy (ETV)

ETV is a “closed” and modern surgical method applied without the need for shunt insertion, especially in cases of occlusive hydrocephalus.

• Application: The brain is entered with an endoscope (camera) through a small hole opened in the skull.
• Lead Opening: A small hole is made in the floor of the third ventricle in the brain with micro-surgical instruments.
• Advantage: In this way, the cerebrospinal fluid returns to its natural circulatory pathways, bypassing the blockage. Since there is no foreign body (shunt) left in the body, there is no risk of shunt infection or mechanical failure.

According to Assoc. Prof. Dr. Erdinç Özek; “In the treatment of hydrocephalus, the era of ‘shunt for every patient’ is now over. Especially in cases of occlusive hydrocephalus with appropriate anatomical structure, our primary goal should be to save the patient from lifelong shunt dependence with the endoscopic (ETV) method. However, in malabsorption cases, the shunt is still the most reliable and life-saving companion.”

How is Hydrocephalus Surgery Performed?

Although hydrocephalus surgery involves different technical stages depending on the method chosen, it is performed under general anesthesia and in sterile operating room conditions.

• Preparation Phase: A small part of the patient’s scalp is shaved and the operation area is disinfected.
• Incision and Access: In shunt surgery, small incisions are made in the scalp, neck, and abdomen. In the endoscopic method, a burr hole of approximately 1-2 cm is made only in the skull.
• Placement and Control: As the shunt is inserted, the tip of the catheter is precisely guided into the brain ventricles. After the valve adjustments are made, the system is checked during surgery to see if it is working.
• Closure: The incisions are closed with aesthetic sutures and the operation is usually completed in 30 to 60 minutes.

What are the Risks of Hydrocephalus Surgery?

As with any surgical procedure, there are certain risks in hydrocephalus surgeries. However, developing technology and “programmable valve” systems have minimized these risks.

• Shunt Infection: It is one of the most sensitive issues after surgery. To reduce this risk, special antibiotic-coated shunts may be preferred.
• Blockage and Mechanical Failure: The end of the shunt can become blocked by protein deposits or a blood clot; In this case, revision surgery may be required.
• Over or Under Drainage: It is a condition in which cerebrospinal fluid is drained more or less than necessary. With programmable valves, this problem can be solved without surgery, by adjusting it externally.
• Subdural Hematoma: These are hemorrhages that may develop due to the stretching of the vessels with a sudden decrease in intracranial pressure.

Recovery Process After Hydrocephalus Surgery

The postoperative period is the stage for the brain to adapt to the new pressure balance and requires close monitoring.

• Hospital Stay: Generally, patients are kept under observation in the hospital for 1 or 2 nights after the operation.
• First 24 Hours: The patient’s consciousness, gait and visual functions are closely monitored.
• Seam Care: The incision sites heal within 7-10 days. Keeping the areas dry and clean is vital during this process.
• Long-Term Follow-up: It is recommended that patients with shunts go for periodic neurosurgical check-ups for life. Especially in children, the shunt length may need to be checked depending on the growth process.

According to Assoc. Prof. Dr. Erdinç Özek; “A patient who has had shunt surgery or their relatives should have ‘shunt awareness’. Even months or years after surgery, when symptoms such as headache, gushing vomiting or imbalance begin, the first question that comes to mind should be ‘is the shunt blocked?’ This awareness turns into a life-saving reflex in emergencies.”

Clinical Experience Note (Anonymous Case): “Normal Pressure Hydrocephalus” was detected in a 72-year-old patient who presented with the complaint of forgetfulness and gait disturbance (walking by dragging his steps). The patient was fitted with a programmable shunt. On the 2nd day of the operation, it was observed that the patient’s walking distance increased and the problem of incontinence (urinary incontinence) improved. This case is an important example that hydrocephalus in advanced age can be treated with the right intervention without being confused with dementia.

Frequently Asked Questions

Can I have an MRI after shunt surgery?

Yes, but if your shunt is of the “programmable” type, it is essential that the valve pressure adjustment is checked again by your doctor after the MRI and corrected if necessary.

Why isn’t endoscopic (ETV) surgery performed on everyone?

For the ETV method to be successful, the absorption pathways of the liquid must be clear. If the problem is the inability to absorb fluid (communicating hydrocephalus), endoscopy is not a solution; In this case, the shunt is mandatory.

Is a shunt for life?

Shunt systems are designed to remain in the body for years without any problems. However, it does not need to be replaced unless an infection or mechanical problem develops.

Source and Expert Knowledge: This article has been prepared based on Assoc. Prof. Dr. Erdinç Özek’s current clinical achievements in the field of hydrocephalus pathophysiology, shunt technologies and neuroendoscopy in 2026 and international neurosurgery guidelines. Assoc. Prof. Dr. Erdinç Özek is an expert who applies advanced surgical techniques in both pediatric and adult hydrocephalus surgery.