INNOVATIVE APPROACHES AND TECHNOLOGICAL ADVANCES IN THE MANAGEMENT OF HYDROCEPHALUS

Jędrzej Sztajura; Małgorzata Gola; Igor Andjelić; Piotr Paździora; Anna Zioła-Paździora; Maciej Wojtacha

doi:10.31435/ijitss.4(48).2025.4490

Authors

Jędrzej Sztajura Students’ Scientific Club, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0009-8975-731X
Małgorzata Gola Students’ Scientific Club, Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0002-4945-7856
Igor Andjelić Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0005-7687-9909
Piotr Paździora Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0001-3598-3217
Anna Zioła-Paździora Department of Pediatric Surgery, Upper Silesian Children’s Health Centre, Katowice, Poland
Maciej Wojtacha Department of Neurosurgery, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4490

Keywords:

Hydrocephalus, Cerebrospinal Fluid, Ventriculoperitoneal Shunt, Endoscopic Third Ventriculostomy, Neuroinnovation, Neurosurgery

Abstract

Introduction and Purpose: Hydrocephalus is a neurological disorder caused by abnormal accumulation of cerebrospinal fluid (CSF) within the brain ventricles, leading to increased intracranial pressure and neurological impairment. Despite advances in neurosurgery and neuroimaging, optimal management remains a major challenge. This review aims to summarize current therapeutic strategies for hydrocephalus and highlight recent and emerging innovations to improve outcomes and patient quality of life.

Materials and Methods: A comprehensive literature search was conducted using PubMed, BioMed Central, Scopus, and Google Scholar. Keywords included: hydrocephalus, NPH, VP shunting, LP shunting, and endoscopic third ventriculostomy (ETV). Reference lists of selected papers were also reviewed.

Conclusion: Over the past century, hydrocephalus treatment has progressed from simple drainage to valve-regulated shunts and endoscopic procedures. However, no curative therapy exists, and CSF diversion remains the mainstay. Progress has been incremental due to heterogeneous etiologies, biological complexity, technical constraints, and lack of pharmacological options. Current approaches primarily include ventriculoperitoneal shunting and ETV, selected according to etiology and patient profile. Future directions involve hybrid surgical techniques (ETV with stenting), smart and biocompatible implants, molecular modulation of aquaporins and glial function, gene and stem-cell therapies, and prenatal neuroendoscopic repair demonstrated in experimental models. The next generation of therapy will likely unite mechanical precision with biological insight, shifting from simple drainage toward restoration of CSF physiology and brain health. Integrating surgical, molecular, and etiological perspectives is essential to move beyond symptomatic management.

References

Patel, S.K., Tari, R., Mangano, F.T. (2021). Pediatric Hydrocephalus and the Primary Care Provider. Pediatr Clin North Am. Aug;68(4):793-809. doi: 10.1016/j.pcl.2021.04.006. PMID: 34247710

Dewan, M.C., Rattani, A., Mekary, R., Glancz, L.J., Yunusa, I., Baticulon, R.E., Fieggen, G., Wellons, J.C., Park, K.B., Warf, B.C. (2018). Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. Apr 27;130(4):1065-1079. doi: 10.3171/2017.10.JNS17439. PMID: 29701543.

Tamber, M.S. (2021). Insights into the epidemiology of infant hydrocephalus. Childs Nerv Syst. Nov;37(11):3305-3311. doi: 10.1007/s00381-021-05157-0. Epub 2021 Apr 11. PMID: 33839901.

Schulz, L.N., Redwan, A., Edwards, S., Hamilton, M.G., Isaacs, A.M. (2025). Hydrocephalus Pathophysiology and Epidemiology. Neurosurg Clin N Am. Apr;36(2):113-126. doi: 10.1016/j.nec.2024.11.001. Epub 2025 Feb 5. PMID: 40054966.

Isaacs, A.M., Riva-Cambrin, J., Yavin, D., Hockley, A., Pringsheim, T.M., Jette, N., Lethebe, B.C., Lowerison, M., Dronyk, J., Hamilton, M.G. (2018). Age-specific global epidemiology of hydrocephalus: Systematic review, metanalysis and global birth surveillance. PLoS One. Oct 1;13(10):e0204926. doi: 10.1371/journal.pone.0204926.

Bir, S.C., Patra, D.P., Maiti, T.K., Sun, H., Guthikonda, B., Notarianni, C., Nanda, A. (2016). Epidemiology of adult-onset hydrocephalus: institutional experience with 2001 patients. Neurosurg Focus. Sep;41(3):E5. doi: 10.3171/2016.7.FOCUS16188. PMID: 27581317.

Karimy, J.K., Reeves, B.C., Damisah, E., Duy, P.Q., Antwi, P., David, W., Wang, K., Schiff, S.J., Limbrick, D.D. Jr., Alper, S.L., Warf, B.C., Nedergaard, M., Simard, J.M., Kahle, K.T. (2020). Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol. May;16(5):285-296. doi: 10.1038/s41582-020-0321-y.

Udayakumaran, S., Pattisapu, J.V. (2021). Controversies in Hydrocephalus: QUO VADIS. Neurol India. Nov-Dec;69(Supplement):S575-S582. doi: 10.4103/0028-3886.332269. PMID: 35103016.

Pérez-Alfayate, R., Cabezas-Camarero, S., Castaño-Montoya, J.P., Arévalo-Saenz, A.A., Carrascosa-Granada, A., Alonso-Lera, P., Grasso, G. (2025). Communicating hydrocephalus in glioblastoma presenting as chronic hydrocephalus: systematic review and meta-analysis. Acta Neurochir (Wien). Jan 16;167(1):19. doi: 10.1007/s00701-024-06414-2. PMID: 39820650; PMCID: PMC11739179.

Mirkhaef, S.A., Harbaugh, L., Nagra, G. (2024). Hydrocephalus: A Review of Etiology-Driven Treatment Strategies. Cureus. Sep 3;16(9):e68516. doi: 10.7759/cureus.68516. PMID: 39364470; PMCID: PMC11448269.

Greenberg, A.B.W., Mekbib, K.Y., Mehta, N.H., Kiziltug, E., Duy, P.Q., Smith, H.R., Junkkari, A., Leinonen, V., Hyman, B.T., Chan, D., Curry, W.T. Jr., Arnold, S.E., Barker Ii, F.G., Frosch, M.P., Kahle, K.T. (2024). Utility of cortical tissue analysis in normal pressure hydrocephalus. Cereb Cortex. Jan 31;34(2):bhae001. doi: 10.1093/cercor/bhae001. PMID: 38275188; PMCID: PMC10839843.

Kelbert, J., Nosova, K., Kern, A., Russell, R., Pico, A., Mamaril-Davis, J., Hussein, A., Murthy, G., Barbagli, G., Bina, R.W. (2025). Idiopathic Normal Pressure Hydrocephalus and Shunt Complications per Valve Type: A Meta-Analysis of Proportions. World Neurosurg. Feb;194:123450. doi: 10.1016/j.wneu.2024.11.033.

Hydrocephalus, National Institute of Neurological Disorders and Stroke, https://www.ninds.nih.gov/health-information/disorders/hydrocephalus (accessed: 11.11.2025)

Koleva, M., De Jesus O. (2023). Hydrocephalus. StatPearls [Internet].

Kawazoe, M., Koga, S., Sekiya, H., Josephs, K., Graff-Radford, N., Dickson, D. (2025). Disproportionately Enlarged Subarachnoid-Space Hydrocephalus on MRI in Pathologically Confirmed Progressive Supranuclear Palsy. Neur Clin Pract. 15(2):e200431. doi:10.1212/cpj.0000000000200431 - Pubmed)

Hochstetler, A., Raskin, J., Blazer-Yost, B.L. (2022). Hydrocephalus: historical analysis and considerations for treatment. Eur J Med Res. Sep 1;27(1):168. doi: 10.1186/s40001-022-00798-6. PMID: 36050779; PMCID: PMC9434947.

Pindrik, J., Schulz, L., Drapeau, A. (2022). Diagnosis and Surgical Management of Neonatal Hydrocephalus. Semin Pediatr Neurol. Jul;42:100969. doi: 10.1016/j.spen.2022.100969.

Williams, M.A., Malm, J. (2016). Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus. Continuum (Minneap Minn). Apr;22(2 Dementia):579-99. doi: 10.1212/CON.0000000000000305. PMID: 27042909; PMCID: PMC5390935.

Dinçer, A., Özek, M.M. (2011). Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst. Oct;27(10):1543-62. doi: 10.1007/s00381-011-1559-x.

Ros, B., Iglesias, S., Martín, Á., Carrasco, A., Ibáñez, G., Arráez, M.A. (2018). Shunt overdrainage syndrome: review of the literature. Neurosurg Rev. Oct;41(4):969-981. doi: 10.1007/s10143-017-0849-5. Epub 2017 Mar 29. PMID: 28352945.

Kashyap, S., Ghanchi, H., Minasian, T., Dong, F., Miulli, D. (2017). Abdominal pseudocyst as a complication of ventriculoperitoneal shunt placement: Review of the literature and a proposed algorithm for treatment using 4 illustrative cases. Surg Neurol Int. May 10;8:78. doi: 10.4103/2152-7806.206007. PMID: 28584681; PMCID: PMC5445654.

Pyykkö, O.T., Nerg, O., Niskasaari, H.M., Niskasaari, T., Koivisto, A.M., Hiltunen, M., Pihlajamäki, J., Rauramaa, T., Kojoukhova, M., Alafuzoff, I., Soininen, H., Jääskeläinen, J.E., Leinonen, V. (2018). Incidence, Comorbidities, and Mortality in Idiopathic Normal Pressure Hydrocephalus. World Neurosurg. Apr;112:e624-e631. doi: 10.1016/j.wneu.2018.01.107.

Vanhala, V., Junkkari, A., Korhonen, V.E., Kurki, M.I., Hiltunen, M., Rauramaa, T., Nerg, O., Koivisto, A.M., Remes, A.M., Perälä, J., Suvisaari, J., Lehto, S.M., Viinamäki, H., Soininen, H., Jääskeläinen, J.E., Leinonen, V. (2019). Prevalence of Schizophrenia in Idiopathic Normal Pressure Hydrocephalus. Neurosurgery. Apr 01;84(4):883-889. doi: 10.1093/neuros/nyy147

Del Bigio, M.R., Di Curzio, D.L. (2016). Nonsurgical therapy for hydrocephalus: a comprehensive and critical review. Fluids Barriers CNS. Feb 5;13:3. doi: 10.1186/s12987-016-0025-2. PMID: 26846184; PMCID: PMC4743412.

Beangklang, R., Sitthinamsuwan, B., Tansirisithikul, C., Nunta-Aree, S. (2024). Hydrocephalus following Brain Tumor Surgery: Factors Correlating with Occurrence of Postoperative Hydrocephalus and Predictive Scoring Model. Asian J Neurosurg. Feb 26;19(1):44-51. doi: 10.1055/s-0044-1779345. PMID: 38751388; PMCID: PMC11093642.

Abdel-Latif, A.M., Greenfield, J.P. (2017). Hydrocephalus and Ventriculomegaly. In: Jeffrey P. Greenfield, Caroline B. Long, eds. Common Neurosurgical Conditions in the Pediatric Practice. 1st ed. New York: Springer Science+Business Media, p.163-176.

Tschirgi, R.D., Frost, R.W., Taylor, J.L. (1954). Inhibition of cerebrospinal fluid formation by a carbonic anhydrase inhibitor, 2-acetylamino-1,3,4-thiadiazole-5-sulfonamide (diamox) Proc Soc Exp Biol Med. 87:373–376. doi: 10.3181/00379727-87-21386.

Domer, F.R. (1969). Effects of diuretics on cerebrospinal fluid formation and potassium movement. Exp Neurol. 24:54–64. doi: 10.1016/0014-4886(69)90005-3

Cantore, G., Guidetti, B., Virno, M. (1964). Oral glycerol for the reduction of intracranial pressure. J Neurosurg. 21:278–283. doi: 10.3171/jns.1964.21.4.0278.

Diringer, M.N., Edwards, D.F., Zazulia, A.R. (1998). Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke. 29:1352–1357. doi: 10.1161/01.STR.29.7.1352.

Yang, C., Li, Y. (2022). Review of the Prevention and Treatment of Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. Dec;168:134-138. doi: 10.1016/j.wneu.2022.08.089.

Goel, A., Sharma, R., Elfeky, M., et al. Ventriculoperitoneal shunt. Reference article, Radiopaedia.org (accessed: 11.11.2025)

Bradley, W., Scalzo, D., Queralt, J., Nitz, W., Atkinson, D., Wong, P. (1996). Normal-Pressure Hydrocephalus: Evaluation with Cerebrospinal Fluid Flow Measurements at MR Imaging. Radiology. 198(2):523-9.

Manley, G., Hemphill, C., Stiver, S. (2009). Intracranial Pressure and Brain Monitoring XIII. ISBN: 9783211855782

Yang, T.H., Chang, C.S., Sung, W.W., Liu, J.T. (2019). Lumboperitoneal Shunt: A New Modified Surgical Technique and a Comparison of the Complications with Ventriculoperitoneal Shunt in a Single Center. Medicina (Kaunas). Sep 26;55(10):643. doi: 10.3390/medicina55100643. PMID: 31561485; PMCID: PMC6843463.

Elfeky, M., Iqbal, S. (2025). Lumboperitoneal shunt. Reference article, Radiopaedia.org (Accessed on 17 Jun) https://doi.org/10.53347/rID-71217

Gaillard, F., Ibrahim, D., Hacking, C., et al. (2025). Third ventriculostomy. Reference article, Radiopaedia.org (Accessed on 17 Jun) https://doi.org/10.53347/rID-2166

Yadav, Y.R., Parihar, V., Pande, S., Namdev, H., Agarwal, M. (2012). Endoscopic third ventriculostomy. J Neurosci Rural Pract. May;3(2):163-73. doi: 10.4103/0976-3147.98222. PMID: 22865970; PMCID: PMC3409989.

Jensen, T.S.R., Tefre, S., Holst, A.V., Hansen, T.S., Juhler, M. (2021). Endoskopisk behandling af hydrocefalus. Ugeskr Læger 183:V03210290.

Santangelo, G., Pieters, T.A., Jalal, M.I., Rahmani, R., Silberstein, H.J., Stone, J.J. (2023). Treatment of hydrocephalus in an ovine model with an intraparenchymal stent. J Neurosurg Pediatr. Jun 30;32(4):437-446. doi: 10.3171/2023.5.PEDS22545. PMID: 37410601.