Both medication and surgery are possible treatments for Hydrocephalus. Medical therapy may be palliative (ease symptoms, but not cure) and will help most patients. However, if the hydrocephalus is severe, then medication will probably not be effective long term and surgery may be required.
There are several different medications that may be prescribed. Medications that decrease CSF production in the brain are a key component of this treatment. Acetazolamide or methazolamide are carbonic anhydrase inhibitors that decrease CSF production and can be palliative for hydrocephalus. Omeprazole and prednisone are also known to decrease CSF production. Diuretics like furosemide help pull fluid from the brain as well as decreasing CSF production. Often, a combination of these medications may be used. If helpful, medical treatment may be continued long term, but special attention should be paid to possible medication side effects.
Surgery is recommended for patients with severe hydrocephalus. Placement of a ventriculoperitoneal shunt allows for continuous drainage of CSF, and is the treatment of choice in people. In general, the earlier a shunt is placed, the better the long term prognosis is for neurological recovery. The goal of CSF shunting is to halt disease progression and improve the neurologic status of the patient.
A shunt has several components: the ventricular catheter (placed in the ventricles of the brain where the CSF is held), the peritoneal catheter (drains into the abdominal cavity), and the valve in between. The valve prevents fluid from flowing backwards and prevents over-shunting of CSF. Some shunts may also have a port that can be used to collect CSF intermittently (when needed).
Shunt surgery is considered to have a high success rate, but there is also a significant rate of complications after surgery - about 30%. Possible complications include infection of the shunt, which can ultimately lead to meningitis (infection of the coverings around the brain and spinal cord) or peritonitis (inflammation/infection of the abdominal cavity); obstruction of the shunt; or migration (movement) of the shunt. When these complications occur, they may be treated medically, but often, the shunt must be replaced.
In humans, causes for shunt failure include mechanical failure of the shunt, infection, and functional failure from over or under drainage. Mechanical failure and infections are most likely to occur within the first 6 months after shunt surgery.
It is important to schedule regular examinations with your pets neurologist to watch for signs of improvement or deterioration. Rapid deterioration of the patients neurologic status (i.e., mentation, respiration, postural reaction deficits) is suggestive of elevated intracranial pressure and shunt malfunction.
Depending on the severity of the underlying disease process, the prognosis of patients that have undergone ventriculoperitoneal shunting is guarded to fair. In severe cases of hydrocephalus, neurologic improvement may be minimal. A realistic expectation is improvement of clinical signs but not complete resolution of neurologic deficits.
"Baby Love" did not gain sight or become a "normal" dog after the shunt was installed. But she was better in many aspects and her quality of life was greatly improved. Dr. Ducote and her staff were always up front about risks and possibilities as well as giving me a realistic idea of what to expect in the way of progress. Ask your neurologist lots of questions and make sure you are aware of what to expect. As mentioned above the shunt is not a reversal of this condition or cure it is however the best treatment for the symptoms of severe Hydrocephalus.