Hydrocephalus: Treatment, Current Research, and Challenges

Hydrocephalus is a complex neurological condition characterized by derangements in cerebrospinal fluid (CSF) dynamics including disrupted CSF flow/absorption and/or excess CSF production that leads to ventricular enlargement and presents both diagnostic and therapeutic challenges. Its origins span from congenital anomalies to acquired cases following hemorrhage, infection, or tumors. Hydrocephalus is suspected in the setting of appropriate clinical signs/symptoms, and the diagnosis is confirmed with brain imaging and, in rare cases, invasive intracranial pressure monitoring. Surgical intervention is the mainstay of modern hydrocephalus management, with CSF diversion via an implanted shunt being the most common management strategy. However, for a subset of patients, endoscopic third ventriculostomy can also effectively manage hydrocephalus without the need for an implanted device. This article highlights both genetic and acquired forms of hydrocephalus, reviews the surgical interventions for managing hydrocephalus and commercially available shunt technologies, discusses the shortcomings of current management strategies, and explores the ongoing development of next-generation shunt technology including smart shunts and antifouling catheter coatings that aim to reduce shunt malfunction rates. Additionally, we review current bench research investigating the cellular/molecular mechanisms involved in hydrocephalus induction including studies on ventricular lining disruption and the role of aquaporins in hydrocephalus.