Obstructive (Non-Communicating) Hydrocephalus
Obstructive hydrocephalus is the accumulation of cerebrospinal fluid (CSF) and raised intracranial pressure caused by a blockage along the CSF flow pathway within the ventricular system. The obstruction (such as aqueductal stenosis, a tumor or a cyst) enlarges the ventricles upstream of the block.
Përditësimi i fundit: 2026-06-07
Definition
Obstructive (non-communicating) hydrocephalus develops because of a physical blockage along the circulation pathway of cerebrospinal fluid within the ventricular system. After being produced in the ventricles, CSF flows through narrow passages — particularly the aqueduct of Sylvius connecting the third and fourth ventricles — to reach the subarachnoid space. A block along this route raises pressure and enlarges the ventricles upstream of the obstruction.
Causes
Common causes include aqueductal stenosis, tumors and cysts compressing the CSF pathway, and congenital malformations such as Chiari and Dandy-Walker. Congenital malformations predominate in children, while obstruction after tumor, hemorrhage and infection is more frequent in adults. The location of the obstruction determines the pattern of ventricular enlargement.
Symptoms
Symptoms reflect raised intracranial pressure: headache that is often worse in the morning, nausea and vomiting, blurred and double vision, balance and gait disturbance, and cognitive slowing. Acute obstruction can develop over hours to days and become life-threatening. In infants with open fontanelles, rapid head growth, a tense fontanelle and downward deviation of the eyes (sunset eyes) may be seen.
Diagnosis
In emergencies, brain CT is the first choice; it shows ventricular enlargement upstream of the obstruction, transependymal CSF seepage and any mass or hemorrhage. Brain MRI defines the cause of the obstruction in more detail, and phase-contrast (cine) MRI can assess CSF flow dynamically and help predict the success of endoscopic treatment. Lumbar puncture is avoided in obstructive cases because of the risk of herniation.
Treatment
In acute symptomatic cases, a temporary external ventricular drain can control pressure. Endoscopic third ventriculostomy (ETV) is often a suitable option in obstructive hydrocephalus; an opening is made in the floor of the third ventricle so CSF bypasses the obstruction, potentially avoiding an implanted shunt. A ventriculoperitoneal (VP) shunt is used when ETV is not suitable. In tumor-related cases, removing the tumor may relieve the obstruction.
Prognosis
Untreated hydrocephalus can lead to brain injury, visual loss and, in severe cases, death. With early diagnosis and appropriate treatment, most patients can lead a functional life. The success of ETV depends on patient age, the cause of obstruction and anatomy. Shunted patients require regular follow-up because problems such as blockage and infection can occur. Outcomes vary by patient and cannot be guaranteed.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:426-479.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:525-531.
- Kulkarni AV, Drake JM, Mallucci CL, et al. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155(2):254-259.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.