Adult Hydrocephalus

Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) accumulates in the ventricles of the brain, either through overproduction of CSF, an obstruction of the flow of CSF, or failure of the body to reabsorb CSF. Hydrocephalus is a complex neurological condition that affects 1 million Americans with an incidence of 40 per 100,000 people. When not present at birth or in childhood, hydrocephalus may develop in adults over the age of 40 years. Hydrocephalus can have many causes, including tumors, bacterial infections such as meningitis, hemorrhage, or bleeding within the brain, and traumatic injury. At times, no definitive cause is identified. There are many types of hydrocephalus that can affect adults, and different types of hydrocephalus can present with different kinds of symptoms.

What are symptoms of hydrocephalus?

  • Headache
  • Memory problems, particularly short-term memory
  • Seizures
  • Inability to perform simple tasks
  • Confusion
  • Imbalance
  • Frequent falls
  • Shuffling gait
  • Urinary incontinence (loss of bladder control)
  • Sleepiness

Who should be evaluated?

If you or your physician is concerned that you are showing symptoms of hydrocephalus, you should be evaluated closely. A patient who has previously undergone a shunt procedure which is the placement of a catheter system into the brain fluid space to drain excess cerebrospinal fluid (CSF) into another part of the body as a child is particularly at risk for redeveloping symptoms of hydrocephalus if the shunt stops working. Any patient who has had a shunt placed in the past and who has not been followed by a neurosurgeon in his/her adult years should be assessed to be sure the shunt is still functioning as effectively as possible.

Team approach through comprehensive evaluation

Given the broad spectrum of symptoms that may occur in hydrocephalus, a comprehensive evaluation is necessary and includes:

  • A thorough medical history
  • Detailed physical examination including baseline cognitive evaluation, motor assessment, balance assessment, and standardized gait assessment
  • An analytical review of the patient’s imaging to aide in diagnoses and to assist in determining whether additional imaging or testing is warranted to guide treatment
  • Procedural testing including a lumbar tap trial to determine whether the symptoms improve after a large volume of spinal fluid is removed, if indicated
  • Laboratory analysis of CSF to assist in diagnosis of any inflammatory, infectious, or neoplastic processes
  • Nuclear medicine shunt studies and cisternograms to evaluate the function of already present CSF devices, including ventricular and lumbar shunt systems
  • Preoperative evaluation and counseling
  • Postoperative evaluation and follow-up

What is a Lumbar Tap Trial (LTT)?

A lumbar tap trial is a test commonly used to diagnose certain types of hydrocephalus. It consists of a spinal tap performed in the office with local anesthesia where the pressure within the spinal fluid space is measured by inserting a small needle into the back. A large volume of spinal fluid is removed and sent for laboratory studies to make sure there are not any other abnormalities. Cognitive and motor tests and standardized gait measures are performed before the spinal tap to establish the patient’s baseline. These same tests are repeated later that afternoon and again the next day.

This trial may be recommended by your physician if you are displaying symptoms of hydrocephalus. The LTT is useful to confirm the diagnosis of hydrocephalus and to further assess if any surgical treatment could alleviate some of your symptoms.

LTT consists of two days of testing:

Day 1—Initial Evaluation:

  • Physical Therapy evaluation
  • Cognitive Evaluation
  • Lumbar Tap Trial

Re-evaluation later the same day

  • Physical Therapy evaluation
  • Cognitive Evaluation

Day 2—Final Evaluation:

  • Physical Therapy evaluation
  • Cognitive Evaluation

The information obtained from this testing will be used to determine your further medical treatment.

Specific instructions prior to your lumbar tap trial:

  • Should you have questions, please call our office at 716.218.1000.
  • It is ok to eat breakfast before the test.
  • Bring a relative or friend with you on the day of the procedure to provide you with transportation home, because we do not recommend you drive afterward.
  • If you are ill, please call our office to reschedule the procedure.
  • If you are currently on NSAIDS (Ibuprofen, Aleve, etc.), Coumadin (Warfarin) or Plavix (Clopidogrel), you must be off these medications seven days before the lumbar tap trial.
  • If you are currently on aspirin, this must be stopped three days before the lumbar tap trial.
  • If you are currently on Lovenox, this needs to be stopped 24 hours before the lumbar tap trial.

Instructions after your lumbar tap trial:

  • After the procedure, you should rest at home in a comfortable position. Lay flat if you experience a headache.
  • You may resume physical therapy and driving the day after the procedure.
  • Use ice over the puncture site for 20 minutes every hour as needed for post-puncture pain for two days. Do not use heat for 48 hours.
  • If you develop any of the following symptoms: fever, nausea, vomiting, or continuous headache or if increased pain is not relieved with ice or medication please call our office for further instruction.

Our Goals

The Adult Hydrocephalus Center at UBNS has a primary focus of providing state-of-the-art care for our patients in the evaluation, diagnosis, and medical and surgical treatment of hydrocephalus. The multidisciplinary approach is important given the common symptoms associated with adult-onset hydrocephalus, such as difficulty walking or memory trouble. These symptoms can be caused by a variety of other medical conditions, not specifically hydrocephalus. By a thorough medical history and physical examination, other causes of these symptoms may be identified and treated, thus protecting patients from unnecessary invasive tests or unindicated surgical treatment. Through this multidisciplinary approach, patients who are found to have hydrocephalus are afforded the best chance of reducing their symptoms and improving their quality of life. Furthermore, by identifying and treating hydrocephalus, the adverse consequences of this untreated condition such as recurrent falls are minimized.

Surgical Treatment

Two surgical procedures effective in treating hydrocephalus are cerebrospinal fluid (CSF) shunting or endoscopic third ventriculostomy (ETV).

Cerebrospinal Fluid Shunting
The treatment of hydrocephalus generally focuses on diverting CSF buildup away from the head by way of surgically placed tubes called shunts. Though effective, shunts require open surgery with incisions in both the scalp and abdomen. Shunts are occasionally associated with serious complications, including infection, over-drainage, and shunt malfunction. For these reasons, patients with shunts need to be regularly seen by a specialized physician to ensure proper shunt function.

Endoscopic Third Ventriculostomy (ETV)
A modern, minimally invasive alternative to the shunt is the ETV. In this procedure, an endoscope is introduced through a small hole in the skull into the third ventricle of the brain where a perforation is made in a membrane to restore normal flow of CSF. The entire procedure is performed using video guidance, and no device or hardware is implanted in the body. Therefore, if successful, no revisions or replacements are necessary, and subsequent hospitalizations are markedly reduced. Though not all patients with hydrocephalus are eligible, approximately 70 to 80% of properly selected patients are successfully treated by ETV.

Contact us for an appointment
If you are concerned that you or your loved one is suffering from hydrocephalus and would like to proceed with an evaluation at the UBNS Adult Hydrocephalus Center, please call (716) 218-1000 for an appointment. We would be more than happy to set up your visit or answer any questions that you may have regarding the process.

Meet Our Physicians

Kevin J. Gibbons


Clinical Team

Minimally Invasive Brain Endoscopy

Spine & Skull Base Disorders

Veetai Li


Clinical Team

Pediatric Neurosurgery

Minimally Invasive Brain Endoscopy

Jonathan P. Riley


Clinical Team

Comprehensive Movement Disorders

WNY Locations

  • Dunkirk

  • John R. Oishei Children’s Hospital

  • Erie County Medical Center

  • Buffalo General Medical Center

  • Roswell Park Comprehensive Cancer Center

  • Gates Vascular Institute

  • Summit Park Office Complex

  • Oishei Children’s Outpatient Center

  • Brook Bridge Medical Complex

  • Conventus Building

  • Comprehensive Neuroscience Center

Surgical Locations:  Sisters of Charity Hospital, Niagara Falls Memorial Medical Center, Millard Fillmore Suburban Hospital, Mercy Hospital of Buffalo, Buffalo General Medical Center, Gates Vascular Institute, Kenmore Mercy Hospital

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