How is hydrocephalus formed, and how should it be treated?

Patient's question:

All symptoms Hydrocephalus due to traffic accident: discovered due to a fall

Doctor's answer:

Analysis of the Condition: Hydrocephalus is a general term referring to an excessive accumulation of cerebrospinal fluid (CSF), leading to increased intracranial pressure and expansion of the normal space occupied by CSF, which in turn causes secondary intracranial hypertension and ventricular enlargement. The majority of cases are caused by obstructions in the CSF circulation pathway, while overproduction is less common. It most often occurs in infants under two years old and can be classified into two types: communicating hydrocephalus, where CSF absorption on the brain surface is obstructed, and non-communicating hydrocephalus, where CSF circulation within the ventricular system is blocked. There are many causes of hydrocephalus, with the most common being the following:
1) Congenital malformations: such as narrowing of the mesencephalic aqueduct, diaphragm formation or atresia, foramen of Monro atresia (obstruction of the fourth ventricle's median aperture or lateral foramina), vascular malformations, spina bifida, and tonsillar herniation of the cerebellar tonsils.
2) Infections: intrauterine infections in fetuses, such as viral, protozoal, and syphilitic meningitis that are not promptly controlled, leading to fibrotic proliferation obstructing CSF circulation pathways, or intracranial inflammation in fetuses that may cause adhesions and occlusions in cisterns, subarachnoid spaces, and arachnoid granulations.
3) Hemorrhage: fibrosis resulting from intracranial hemorrhage or poor absorption of intracranial hemorrhage due to childbirth.
4) Tumors: any part of the CSF circulation pathway may be obstructed, more commonly near the fourth ventricle or by choroid plexus papillomas.
5) Others: certain hereditary metabolic disorders, perinatal asphyxia, and severe vitamin A deficiency.
Guidelines for Treatment: Non-surgical treatment is suitable for early or mild cases with slow progression. The methods include:
(1) Use of diuretics or dehydration agents, such as acetazolamide, hydrochlorothiazide, furosemide, and mannitol.
(2) Repeated lumbar puncture or anterior fontanelle tapping to drain CSF.
Surgical Treatment: Surgical intervention is recommended for progressive hydrocephalus with significantly enlarged heads and cerebral cortex thickness exceeding 1 cm. The surgery can be categorized as follows:
1. Procedures to reduce CSF secretion: such as choroid plexus resection followed by cauterization, which is now rarely used.
2. Surgical correction of ventricular obstruction: such as mesencephalic aqueduct formation or dilation, median foramen, and resection of intracranial space-occupying lesions.
3. CSF shunt surgery: The goal is to establish a CSF circulation pathway and relieve CSF accumulation, applicable to both communicating and non-communicating hydrocephalus. Common shunt procedures include lateral ventricle-cerebellomedullary cistern shunts, third ventriculostomy, lateral ventricle-abdominal cavity, superior sagittal sinus, right atrium, or external jugular vein shunts.
Patients Not Suitable for Surgical Treatment: Those with severe hydrocephalus, intellectual disability, blindness, paralysis, and significant cerebral atrophy with cerebral cortex thickness less than 1 cm are generally not candidates for surgery.
Traditional Chinese Medicine Treatment: Acupuncture therapy for hydrocephalus has not been documented in ancient medical texts. However, modern reports first appeared in 1959, describing a case where a child was cured by acupuncture at points such as Weizhong and Hegu. Subsequently, from the 1970s, the acupuncture community began to focus on treating this condition. In the past decade, there has been an increasing number of clinical studies with larger sample sizes, not only experimenting with various acupoint stimulation methods (e.g., combining acupuncture with moxibustion using mugwort sticks, herbal thread cauterization, and topical application of Chinese herbal medicine) but also conducting in-depth exploration of clinical syndrome differentiation and treatment patterns. Preliminary findings suggest that acupuncture is more effective for patients with kidney yang deficiency, while it is less effective for those with spleen-kidney yin deficiency. From a Western medical perspective, acupuncture has been found to be highly effective in treating communicating hydrocephalus with stable long-term outcomes, whereas it yields lower efficacy and poorer prognosis in obstructive hydrocephalus.