Hydrocephalus is a pathological condition characterized by abnormal accumulation of cerebrospinal fluid within the ventricular system, leading to ventricular enlargement and increased intracranial pressure. It results from imbalance between CSF production, flow, and absorption and may occur at any age. Hydrocephalus may be classified as obstructive or communicating, each with distinct pathophysiological mechanisms and surgical implications.

Clinical manifestations depend on patient age, rate of progression, and underlying cause. In adults, symptoms commonly include headache, nausea, gait instability, cognitive impairment, and urinary dysfunction. In chronic forms such as normal pressure hydrocephalus, gait disturbance and cognitive decline may predominate. Acute hydrocephalus can lead to rapid neurological deterioration and requires urgent intervention.

Neurosurgical evaluation includes thorough neurological assessment and neuroimaging. Magnetic resonance imaging provides detailed visualization of ventricular anatomy, CSF pathways, and potential obstruction sites. Diagnostic evaluation focuses on identifying etiology and determining suitability for surgical intervention.

Surgical management aims to divert CSF and normalize intracranial pressure. Ventriculoperitoneal shunting is the most commonly performed procedure, providing continuous CSF diversion. Endoscopic third ventriculostomy offers an alternative in selected cases of obstructive hydrocephalus, restoring physiological CSF flow without implanted hardware.

Postoperative care includes monitoring for complications such as infection, shunt malfunction, overdrainage, or hemorrhage. Long-term follow-up is essential, as hydrocephalus often requires lifelong surveillance and potential revision procedures.

Hydrocephalus management demands precise diagnosis, careful surgical planning, and sustained neurosurgical follow-up to preserve neurological function and quality of life.