Fluid can build up in your brain and cause the pressure inside your head to increase. This is called hydrocephalus. Shunt surgery and endoscopic third ventriculostomy (ETV) are common treatments for hydrocephalus.
What is hydrocephalus?
The brain and spinal cord are surrounded by a clear fluid called cerebrospinal fluid (CSF). The CSF supports and protects the brain and the spinal cord.
Some brain tumours block the normal circulation of the CSF. Because the fluid can’t drain away, it builds up inside the brain and increases the pressure inside the head (intracranial pressure).
This increased pressure can cause symptoms, such as headaches and feeling sick. It can also damage the brain if left untreated.
Treatment for hydrocephalus
Treatment for hydrocephalus is usually surgery. There are 2 main types of surgery that you can have:
- shunt surgery
- endoscopic third ventriculostomy (ETV)
You might have surgery for hydrocephalus at the same time you have surgery to remove your tumour. Or you may have a separate operation.
A shunt is a thin tube that drains away the extra CSF from the ventricles of the brain, to other parts of the body, where it is absorbed.
Shunts are usually plastic and small, about 0.3cm (3mm) across. They have valves so that fluid can flow down from the brain but not back the other way. Shunts are also called ventricular catheters.
You have shunt surgery under a general anaesthetic. This means that you will be asleep and won’t feel anything. A specialist team of doctors does your surgery. They are called neurosurgeons.
The most common type shunt is the ventriculoperitoneal shunt. This is a tube from the brain ventricles into the abdomen (tummy). Other types of shunts drain the fluid into the chest.
You can’t see the shunt from outside the body. Some people have a shunt for a short period of time and then it’s removed. Others have them for much longer.
Possible problems with shunts
The most common problems with shunts are blockage and infection. Shunts that drain into the tummy can also cause a hole in the bowel (perforation), but this is rare.
Doctors don’t know for sure why some shunts become blocked. A blockage may cause symptoms of increased pressure inside the head. Symptoms include:
- feeling or being sick
- neck stiffness
A shunt blockage can be serious. You usually need an urgent operation to replace it.
Shunt infections are more common in the first few weeks after having shunt surgery. If your shunt is infected, you might have:
- high temperature (fever)
- a reddening of the skin over the path of the shunt (a red area tracking down your neck and chest for example), but this is rare
You usually have antibiotics if this happens.
Endoscopic third ventriculostomy (ETV)
ETV involves making a tiny hole inside your brain to allow the extra CSF to drain into another part of the brain, where it is absorbed.
You usually have an ETV under general anaesthetic. This means that you will be asleep and won’t feel anything.
Your surgeon carefully makes a small hole into the skull. They put an endoscope through the hole and into the ventricles. The ventricles are spaces inside the brain filled with CSF.
An endoscope is a long tube with a light and a camera at one end. This allows your doctor to see inside the brain and make the tiny hole inside the ventricles.
Possible problems with ETV
ETV is a safe procedure and complications are usually rare. Possible problems of ETV include:
- bleeding in the brain
- damage to other parts of the brain
- a hole in the membranes that cover the brain (meninges) which may cause the CSF to leak
It can be upsetting to learn that you have hydrocephalus and need to have brain surgery. Talk to your doctor or cancer nurse specialist about what to expect during an operation to treat hydrocephalus. Ask them about the side effects you might have and the support that will be available to you.