One of the most common questions I hear from parents is: How do you treat hydrocephalus, and which procedure is right for my child?
When your child is diagnosed with hydrocephalus, it can feel overwhelming — but I always remind families that this condition is treatable. The goal is simple: to safely drain the excess fluid and protect your child’s developing brain.

Hydrocephalus happens when cerebrospinal fluid (CSF) builds up inside the brain’s ventricles. This can be due to a blockage, poor absorption, or rarely, overproduction. Left untreated, the extra fluid puts pressure on the brain and can affect your child’s growth, development, and quality of life.

Today, we mainly use two surgical treatments: the ventriculo-peritoneal (VP) shunt and the endoscopic third ventriculostomy (ETV).

A VP shunt is one of the most established ways to manage hydrocephalus. In this procedure, a small tube is placed inside the brain’s ventricle to drain the excess fluid into the abdomen, where it is safely absorbed by the body.
I often explain to parents: “A VP shunt is like creating a new pathway for the fluid to leave the brain safely.”
The system has three parts — a ventricular catheter in the brain, a valve to control flow, and a distal catheter that tunnels under the skin into the abdomen. Modern shunt systems can even be programmable, which allows us to adjust the drainage pressure later on, without a second surgery. This is especially helpful if we want to avoid repeated operations for growing children.

The second option is Endoscopic Third Ventriculostomy. Here, we use a small camera (an endoscope) to create a tiny opening at the base of the brain, allowing the trapped fluid to bypass the blockage and flow normally again. Unlike a shunt, ETV doesn’t leave any permanent implant in the body. Many parents find comfort in knowing that their child won’t need lifelong hardware.

So how do we choose? In my practice, age and cause of hydrocephalus guide our decision. For babies under two years, I usually recommend a VP shunt because their brain’s natural pathways are not fully developed yet: “In children less than two years, the Basal cisterns are not fully well developed, so a shunt gives us better results.”
In older children with obstructive hydrocephalus — such as aqueductal stenosis — an ETV can be an excellent first choice. It’s safe, effective, and avoids an implant altogether.

Every option has its pros and cons. VP shunts can sometimes get infected or blocked over time and may need to be revised. ETV, while avoiding hardware, isn’t suitable for every type of hydrocephalus and has a lower success rate in very young children.

My goal as a neurosurgeon is to choose the right procedure for each child — one that gives the best possible outcome, the lowest risk of complications, and the greatest chance to live a healthy life.

If you ever have questions about hydrocephalus treatment, I encourage you to talk to your doctor early. With good medical care, regular follow-up, and timely treatment, children with hydrocephalus can go on to reach their milestones and thrive.