Pathophysiology and Classification of hydrocephalus

Abstract

Hydrocephalus is one of the oldest neurologic pathologies recorded in human history, with multiple descriptions by Galen and Hippocrates. Despite the passage of more than two millennia from these early accounts, hydrocephalus remains a common, enigmatic, and challenging entity to treat. Most modern surgical management strategies for obstructive and non-obstructive hydrocephalus have followed evolving cerebrospinal fluid (CSF) shunting strategies. However, recent advances in our understanding of hydrodynamic dysfunctions underlying hydrocephalus have spurred intervention strategies that focus on restoring normal physiologic CSF circulation rather than on external drainage. Neuroendoscopy, a vital tool in the minimally invasive paradigm, affords maximum access to the ventricular system. An imbalance in this CSF production and absorption, leading to net accumulation of fluid and an enlargement of the brain ventricles, leads to hydrocephalus. The balance between production and absorption of CSF is critically important. The resulting pressure of the fluid against the brain tissue causing signs and symptoms of raised pressure is what constitutes hydrocephalus.