Remote Assessment: Distinguishing the Type Is the Foundation
The most critical step in hydrocephalus is determining the correct type, because a method applied to the wrong type fails. For this reason an international assessment begins with a remote review of your MRI images. You can request an online preliminary assessment by sharing your existing MRI and reports via WhatsApp; if normal-pressure hydrocephalus (NPH) is suspected, a short walking video is also very valuable. In this opinion, the type of hydrocephalus, the suitability of a shunt versus ETV, and whether traveling to Turkey is meaningful for your situation are discussed honestly.
Types of Hydrocephalus and Why They Matter
There are three main types, and the treatment method changes entirely according to the type. In obstructive hydrocephalus there is an obstacle to CSF flow (aqueductal stenosis, tumor, bleeding); in the communicating type flow is free but absorption is impaired; and NPH is a treatable condition seen in the elderly that progresses with the triad of gait disturbance, urinary incontinence and dementia. Symptoms differ by age: in infants, a rapidly enlarging head circumference and the 'setting sun' sign; in adults, a morning-predominant headache, visual disturbance and balance problems; in the elderly, a 'magnetic gait' in which the feet feel stuck to the floor. The first aim of the remote assessment is to clarify this type distinction with the MRI and history at hand, because the choice of the right method depends on it.
Ventriculo-Peritoneal (VP) Shunt
The VP shunt is a permanent drainage system that transfers excess CSF to the abdominal cavity through a valve and tubes, where it is absorbed naturally. It is preferred in communicating hydrocephalus, in NPH and in many infant/child cases, or where ETV is not suitable. Its advantage is that it can be applied across a wide range of patients and rapidly returns pressure to normal; in NPH a significant proportion of patients are reported to have meaningful improvement in gait and cognitive function. Its disadvantage is lifelong dependence on the system and the increasing chance over time of complications such as infection, blockage or disconnection; a shunt revision is performed when needed. For a patient coming from across a border, how shunt follow-up will be continued in their home country is planned from the outset.
Endoscopic Third Ventriculostomy (ETV)
ETV endoscopically creates a small opening (stoma) in the floor of the third ventricle, allowing CSF to bypass the obstruction and engaging the body's own absorption mechanism. For it to succeed, the obstruction must be below the third ventricle and the absorption mechanism must be intact; its main indication is obstructive hydrocephalus such as aqueductal stenosis. Its greatest advantage is that it leaves no foreign body in the body, so the risk of shunt infection is almost zero, and it offers a permanent solution when successful; the procedure usually takes 30-60 minutes and a 1-2 day stay is sufficient. Its disadvantage is that it is not suitable for every type (not preferred in the communicating type or NPH) and that the chance of success is low in small infants. Suitability is estimated before surgery with tools such as the ETV Success Score (ETVSS) and shared with you in the remote assessment.
The Treatment Journey in Turkey and Programmable Valves
Once it is clear after the remote opinion which method is suitable, the date and estimated length of stay are planned before your arrival. In communicating hydrocephalus and NPH a shunt generally comes to the fore, in suitable obstructive cases ETV; in infants under one year a shunt is mostly preferred. If a shunt is chosen, the valve type also matters: programmable valves can be adjusted from outside with a magnet without surgery and are particularly valuable in NPH—a practical advantage for international patients who may need fine-tuning after returning home. In NPH a 'tap test' can be performed before the decision to shunt. No method guarantees 100% success; our aim is to choose the right method for the right type and to ensure treatment can be followed up after Turkey.