Dr. Richard Anthony Rammo, MD

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.

To determine if spinal cord stimulation may benefit someone, they will first undergo a trial period. During this period, a temporary electrode lead is placed subcutaneously above the spinal cord, and it is connected to an external stimulator that they will carry with them. The procedure is typically completed within an hour, and patients may return home the same day. After a few days or weeks, the trial stimulator will be assessed for effectiveness. If the trial is unsuccessful, patients may undergo a second trial period, or the leads will be removed, and other treatment options will be considered. If, instead, a patient's pain is relieved during the trial, they will undergo surgery for implantation of a permanent stimulator and leads.

The components of a spinal cord stimulation system include the stimulator, the leads, and the wire that connects the two. Implantation of permanent leads may be percutaneous (through the skin) or involve a surgical incision. The spinal cord stimulator is implanted subcutaneously in the abdomen or buttock. The stimulator is battery-powered and may be rechargeable. If the battery is not rechargeable, it will last around 2-5 years, and a patient will need surgery to replace it.Their doctor will program the neurostimulator following the procedure.

After spinal cord stimulator surgery, patients may be released from the hospital the same day or the next one. In the weeks following the operation, patients will need to work with their doctors to find the optimal settings for their neurostimulator. Activities such as driving, twisting, bending, raising one's arms, sleeping on one's stomach, or lifting heavy objects should be limited.