What is Obstructive Hydrocephalus?
Hydrocephalus (hydro=water, cephalus=head) is an abnormal increase of fluid in the brain. This fluid is called cerebral spinal fluid or CSF. These are two types of hydrocephalus, communicating and obstructive. Communicating hydrocephalus is caused by either an overproduction of CSF in the brain of trouble reabsorbing it. Obstructive hydrocephalus is caused by a blockage of CSF flow within the ventricles or CSF pathways. When this happens, you will have signs and symptoms of increased intracranial pressure. These symptoms may vary with age, but often include:

• Headache
• Blurred or double vision
• Sleepiness
• An infant’s head size increases
• Vomiting
• Irritability
• Decrease in appetite
• An infant may have "sunset eyes," eyes which do not look up

The site of blockage often lies within the narrow passage between the third and fourth ventricles. It can also be where the CSF exits the fourth ventricle. Because of the blockage, the ventricles no longer provide free passage of CSF through them into the subarachnoid space where it is reabsorbed. Obstructive hydrocephalus can be caused by tumors, cysts, or congenital defects, such as, aqueductal stenosis.

Treatment for Obstructive Hydrocephalus
There are two methods of treatment for obstructive hydrocephalus. The first method is to insert a VP (ventriculo-peritoneal) shunt into the ventricle to drain excess CSF from the brain to the abdomen. This is a useful treatment in all cases; however, the shunt can malfunction or become infected. The second method is a third ventriculostomy. It is successful 50-70% of the time. A small incision is made in the scalp and a small hole in the skull. Through this hole a small camera (endoscope) is inserted to view the ventricles and the blockage (obstruction). A hole is created in the floor of the third ventricle, usually larger than the laser. The hole is then increased (dilated) using a catheter with an inflatable balloon. This creates a detour around the blockage to allow the CSF to circulate and be reabsorbed. The operation will take about two hours. Usually, only a small amount of hair will be shaved for surgery. In some cases, a temporary tube (ventriculostomy) will be left in the ventricle to monitor intracranial pressure (ICP) for two or three days. This helps evaluate the success of the third ventriculostomy.

Before Surgery
Before surgery, your child will have a pre-surgical work-up. This includes a health history, physical exam, and blood tests. You will also talk with people in anesthesia and admissions. You will need to sign a consent form that says you understand what the neurosurgeon explained to you about the procedure, and the risks and benefits of the surgery. The night before and the morning of surgery, your child’s hair must be washed with an antibacterial soap (e.g., Hibiclens®). You will be given the soap during your clinic visit. The patient may not eat of drink anything after midnight the night before the surgery.

After Surgery
Your child may have a mild headache after surgery. Acetaminophen (Tylenol®) or Ibuprofen may be used for discomfort. If your child receives a ventriculostomy, he or she will spend two or three days in the intensive care unit. If your child does not want to receive a ventriculostomy, he or she will return to the general care floor following surgery. Once the patient is eating and drinking, and there are no complications, the IV (intravenous) line will be removed and your child will be able to go home. You will need to sponge bathe your child until the dressing is removed. Please keep the dressing clean and dry. You will have a follow-up appointment in the neurosurgery clinic in 7-10 days. The head dressing and staples will be removed at that time. At home, your child may resume his/her regular activities.

When to Call the Neurosurgeon or Nurse Practitioner
Please contact your neurosurgeon or nurse practitioner if any of the following signs and symptoms occur:

• Redness, pain, swelling or drainage at the incision site
• Fever greater than 101.5 ° F -- within the first six months of surgery
• Irritability or excessive sleepiness
• Nausea and vomiting
• Recurring headaches
• Blurred or double vision
• Loss of appetite
• Sudden or gradual change in personality
• Rubbing of the head
• Listlessness
• Weakness
• Balance or coordination problems
• Sunset eyes

If you notice any of these signs or have any questions, call your neurosurgeon or nurse practitioner.

Neurosurgery (Dr. Iskandar’s) office: (608) 263-9651, 8:00 am-4:30 pm, Monday-Friday
Bonnie Ohm, Nurse Practitioner: (608) 265-2194

If Bonnie is not available, call the office and ask to speak with one of the other nurse practitioners.

After hours, weekends and holidays, the office phone number will connect you with a paging operator. Ask for the neurosurgeon on call. Give the operator your name and phone number with the area code. The doctor will call you back.

Copyright © 1998. University of Wisconsin Hospitals and Clinics Authority, Madison WI. All rights reserved. Written by Bonnie Ohm, RN, MS, CPNP. Reviewed by Bermans J. Iskandar, MD. Produced by the Department of Nursing. UWH #5259.