Diagnosis and treatment of adult hydrocephalus

Abstract

Despite a long history, adult-type hydrocephalus is still challenging when it comes to the decision of when and whether shunt treatment should be performed in the individual case. Modern technical achievements in the design of shunt valves, which allow a noninvasive pressure and fl ow adjustment, have not substantially improved the overall outcome and treatment-related risks over the past decades. In adult-type hydrocephalus, we are fronting a chronic illness where symptoms occur insidiously, at fi rst glance appearing mild and fl uctuating, hard to capture or to measure. Also, the origin and pathology is often not clearly understood, like in idiopathic normal-pressure hydrocephalus (NPH), or assigned an unknown period of pathology, such as long-standing overt ventriculomegaly (LOVA) and idiopathic aqueductal stenosis, both of which have a possible relationship to childhood or being preterm. In those hydrocephalic patients who survive infancy and childhood, the majority of cases with spina bifi da and its associated problems, when becoming an adult, are almost a forgotten population, lost in the space between pediatric and adult neurosurgeons.