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The usual treatment for Normal Pressure Hydrocephalus (NPH)

Hydrocephalus is a condition wherein there is an interruption to the normal flow, absorption, and production of the brain's CSF (Cerebrospinal Fluid), which is the medium that carries all the nutrients needed by the brain to remain healthy and fully-functional. If there's an interruption or overproduction of CSF - such as in hydrocephalus - it will build up inside the brain that is shown through the swelling of a child's or adult's skull.

Hydrocephalus of one kind or another is especially prevalent at the two extremes of the life cycle -- in the very young and the very old -- but can occur at any age. In infancy, hydrocephalus can be caused by malformed brain-tissue. In contrast, adults with hydrocephalus were usually born with normal brain anatomy, but acquired a blockage due to a tumor, injury, bleed or infection. However, many cases of hydrocephalus in adults occur without a history of these preceding illnesses.

The enlargement of the ventricles creates problems. The enlarged ventricle presses on the nearby brain tissue and also interferes with normal blood flow to the brain tissue immediately surrounding the enlarged ventricle. As a result, that tissue cannot function normally. The area of brain first affected is usually the area which controls the act of walking. This leads to disturbances in gait: walking becomes unsteady, the stance is wider, the stride is shorter, the movement is shuffling, and the feet act as if they are attached to the ground by magnets. The person has problems starting the walking, stopping the walking, and changing directions while walking. There may also be difficulty in sitting down and getting up.

CT and MRI scans are sensitive tools in detecting hydrocephalus, particularly when it's striking enough not be confused with ventricular enlargement due to gradual loss of surrounding brain tissue from aging. The main treatment of hydrocephalus is for a surgeon to insert a tube (shunt) into one of the swollen lateral ventricles and provide an alternative pathway for the backed-up CSF to drain. Once the shunt equipment is in place, a piece of hardware about the size of a large button sits outside the hole made in the skull (but inside the skin of the scalp) and redirects the excess CSF through another tube into either a jugular vein in the neck or into the abdominal cavity (peritoneum). Thus, the patient can receive either a "VJ" shunt or a "VP" shunt, with the letters designating the locations of the two ends of the shunt.


The usual treatment for NPH is the insertion of a V-P shunt (ventriculo-peritoneal shunt). This shunt consists of a narrow tube which is passed through the skull and inserted into one of the lateral ventricles of the brain. The other end of the tube is then passed under the skin down to the abdomen and into the peritoneal cavity. This shunt allows the excess cerebrospinal fluid to leave the ventricle and be carried to the abdominal cavity. The removal of fluid allows the ventricles to return to their normal size. Because of the passageways between ventricles, all the ventricles are affected.

The insertion of the V-P shunt usually has remarkable effects in those cases where the symptoms are limited to disturbances of gait. But when dementia and incontinence are also present, the insertion of the shunt may not yield such favorable outcomes.

Pediatric Nurses