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When a brain tumour blocks the flow of fluid, pressure builds inside the skull. It is treatable — often with a shunt or a keyhole procedure — while the tumour behind it is treated too.
Your brain floats in a clear liquid called cerebrospinal fluid (CSF). This fluid is made deep inside the brain, flows through narrow channels and around the brain and spinal cord, and is then reabsorbed into the bloodstream. It is a constant, gentle circulation that keeps the pressure inside your skull steady.
A brain tumour can interrupt this flow. If a tumour sits on or near one of the narrow channels, it can act like a dam — fluid keeps being made, but it cannot drain away. The fluid backs up, the fluid-filled spaces (the ventricles) swell, and the pressure inside the skull rises. This build-up is called hydrocephalus. In brain tumours it is nearly always the obstructive type, meaning something is physically blocking the flow.
The important message is this: hydrocephalus is treatable, and treating it usually makes a person feel much better quickly. Relieving the pressure is often the first step, done alongside — not instead of — treating the brain tumour that is causing it. It is not the same thing as the tumour itself; it is a pressure problem the tumour has created.
Your brain makes and reabsorbs roughly 500 ml of cerebrospinal fluid every day — but only about 150 ml is present in and around the brain at any one time, because it is constantly being renewed. According to the European Association of Neuro-Oncology (EANO), tumour-related hydrocephalus is most often obstructive — caused by a tumour blocking the CSF pathways, especially in the posterior fossa or around the third ventricle. Relieving that blockage, with a shunt or an endoscopic third ventriculostomy, is a well-established way to control the raised pressure.
Most brain tumours do not cause hydrocephalus. It happens mainly when a tumour sits close to the fluid pathways. The tumours most likely to block CSF flow include:
Because rising pressure is the real danger, knowing the warning signs matters. Seek urgent medical review for any of these — especially if they are new, persistent and getting worse:
Emergency red flag: a sudden severe headache, rapidly worsening drowsiness, or repeated vomiting can mean pressure is rising fast — treat this as an emergency and get urgent care. If you have a scan showing a brain tumour and these symptoms appear, speak to a CION neuro-oncologist without delay.
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The only reliable way to confirm hydrocephalus is brain imaging. A scan shows whether the fluid spaces are enlarged, where the blockage is, and how much pressure is likely building. This is why imaging is central to CION's diagnostic pathway.
An MRI is the most detailed test. It shows the size of the ventricles, the exact point where CSF flow is blocked, and the tumour causing it. Special sequences can even show fluid movement, helping the team decide whether an endoscopic procedure is possible. MRI guides the whole plan.
A CT scan is faster and is often used in an emergency — for example, when someone arrives drowsy or vomiting. It quickly shows enlarged ventricles and rising pressure, so urgent action can be taken. CT is also used to check a shunt is working after it is placed.
Alongside imaging, the team examines eye movements, balance, alertness and reflexes — the physical signs of raised pressure. In babies, head size is measured. Putting the scan and the examination together tells the team how urgently the pressure needs to be relieved.
There is more than one way to relieve the pressure. The right choice depends on where the blockage sits, how urgent the situation is, and the tumour behind it. At CION, all of these neurosurgical procedures are coordinated with accredited neurosurgical partners, while the imaging, molecular testing, tumour treatment and follow-up care are delivered by CION. Here are the main options you may hear about.
A VP shunt is the most common permanent solution. A thin, soft tube drains excess cerebrospinal fluid from a ventricle inside the brain, runs under the skin down the neck and chest, and empties into the abdomen (the peritoneal cavity), where the fluid is safely reabsorbed. A small valve controls how much drains, keeping the pressure normal. The tube is not usually visible and stays in place long-term. A shunt reliably relieves the headache, drowsiness, nausea and vision problems of raised pressure. It is the right choice when the blockage cannot be bypassed internally, or when drainage is needed on an ongoing basis. This procedure is delivered through CION's coordinated neurosurgical partners.
An ETV is a keyhole procedure that can treat obstructive hydrocephalus without leaving a permanent shunt in the body. Using a tiny camera passed into the ventricles, the surgeon makes a small opening in the floor of the third ventricle, allowing trapped fluid to bypass the blockage and drain naturally. When it works, there is no long-term tube — a real advantage. ETV suits certain blockages, particularly when a tumour obstructs the flow between the ventricles. It is not right for every case, and a shunt is sometimes still needed. The decision between ETV and a shunt depends on the exact site and cause of the blockage and is made by the neurosurgical team.
When pressure is rising dangerously and needs relief straight away, an external ventricular drain may be placed. This is a temporary tube that drains fluid from a ventricle out to a collection bag at the bedside, allowing the team to control pressure hour by hour and measure it directly. It is often used as a bridge — buying time to treat the tumour or plan a permanent solution such as a shunt or ETV. It is not a long-term device and is removed once the situation stabilises.
Sometimes the best way to relieve hydrocephalus is to treat the tumour that is blocking the flow. If brain tumour surgery can safely remove or reduce the tumour, the fluid channel may reopen and drainage returns on its own — sometimes without needing a permanent shunt. Radiation therapy or systemic treatment can also shrink certain tumours over time, easing the obstruction. This is why the pressure problem and the tumour are always considered together, not separately.
Corticosteroids (steroid medicines) are often used to reduce swelling around a tumour, which can ease pressure and improve symptoms while a definitive plan is made. Anti-sickness medicine, careful monitoring and, where needed, seizure medicine are all part of supportive care. These do not replace drainage when a true blockage exists, but they help control symptoms and stabilise the situation. CION delivers this supportive and medical care directly, as part of a coordinated plan.
Not every enlarged ventricle needs a procedure straight away. If the pressure is mild, the person feels well, and the tumour is being actively treated, the team may choose close monitoring with repeat scans and regular review. This avoids an unnecessary operation while keeping a careful watch for any change. If symptoms develop or the scan worsens, a shunt or ETV can be arranged promptly. The plan is always tailored to how you are actually doing — not to the scan alone.
Important: the right approach depends on a careful review of your scans and diagnosis. This page explains the options — your brain tumour treatment team will recommend the one that fits your situation. Call 18002028726 to talk it through.
A shunt is designed to work quietly in the background for years. Most people return to normal life and are not limited by it. The tube is under the skin and not usually noticeable. After placement, the relief from headache, drowsiness and nausea is often felt quite quickly.
Shunts can occasionally have problems — most commonly a blockage, infection, or draining too much or too little. This is called a shunt malfunction. The warning signs are simple to remember: the original symptoms come back. A returning morning headache, new drowsiness, vomiting or vision changes should always be checked promptly. A scan looks at the fluid spaces, and the shunt can be revised if needed. Regular follow-up catches most problems early.
The single most important thing to know: if you have a shunt and old symptoms return, contact your team quickly rather than waiting. Shunt problems are usually straightforward to fix when caught early. CION coordinates shunt reviews and any revision with the neurosurgical partners who placed it, while managing your tumour care throughout.
A shunt does not have to be forever. When the tumour blocking the fluid pathway is successfully treated — for example by surgery that reopens the channel — the normal circulation of cerebrospinal fluid can sometimes return, and in selected cases the shunt is no longer needed. This is one reason the pressure problem and the tumour are always planned together at CION's multidisciplinary tumour board, following NCCN and EANO guidance.
Decisions about hydrocephalus and shunts are important, and it is completely reasonable to seek a second opinion — particularly in these situations:
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Start Your Story. Book Free Consultation.Hydrocephalus means a build-up of cerebrospinal fluid (CSF) inside the brain. Normally this fluid flows through narrow channels and is reabsorbed. A brain tumour can block one of these channels or interfere with reabsorption, so fluid backs up and pressure rises inside the skull. In tumours, this is usually obstructive hydrocephalus — the tumour physically blocks the flow. It is common with tumours near the back of the brain, the ventricles, or the fluid pathways. The pressure causes headache, nausea, drowsiness and vision changes, and needs prompt attention. It is treatable — often with a shunt or an endoscopic procedure, alongside treating the tumour itself.
A ventriculoperitoneal (VP) shunt is a thin, soft tube placed to drain excess cerebrospinal fluid away from the brain. One end sits in a fluid-filled space inside the brain (a ventricle); the tube runs under the skin, down the neck and chest, to the abdomen (peritoneal cavity), where the fluid is safely reabsorbed. A small valve controls how much fluid drains, keeping pressure normal. The shunt stays in place long-term and is not usually visible. It relieves the headache, drowsiness and vision problems caused by raised pressure. At CION, shunt placement is coordinated with accredited neurosurgical partners, while CION manages your imaging, tumour treatment and follow-up care.
No. Most brain tumours do not cause hydrocephalus. It happens mainly when a tumour sits on or near the fluid pathways — for example tumours in the back of the brain (posterior fossa), inside or beside the ventricles, or near the third ventricle. Tumours far from these channels rarely cause it. Hydrocephalus is more common in children with certain tumours and in adults with tumours blocking CSF flow. The only way to know if it is present is imaging — an MRI or CT scan shows enlarged fluid spaces. If your scan does not show hydrocephalus, a shunt is not needed. Your team will tell you clearly whether it applies to your tumour.
The classic warning signs of raised pressure include a headache that is worse in the morning or on lying down, nausea and vomiting, drowsiness or confusion, blurred or double vision, and problems with balance. In babies, the head may enlarge and the soft spot may bulge. These symptoms can come on over days or, if severe, quite quickly. Sudden severe headache, worsening drowsiness or repeated vomiting is a medical emergency — seek urgent care. Because these overlap with the tumour itself, imaging is used to confirm whether hydrocephalus is the cause. When it is, relieving the pressure often improves how a person feels within hours.
A VP shunt is usually meant to stay in place long-term, though some people need it only until the tumour is treated. Shunts can occasionally block, become infected, or drain too much or too little — this is called shunt malfunction. Warning signs are a return of the original symptoms: headache, vomiting, drowsiness or vision changes. A malfunction needs prompt review; a scan checks the fluid spaces and the shunt is revised if needed. Regular follow-up catches problems early. If you have a shunt and old symptoms return, contact your team quickly rather than waiting. CION coordinates shunt reviews with the neurosurgical partners who placed it.
An endoscopic third ventriculostomy (ETV) is a keyhole procedure that can treat obstructive hydrocephalus without a permanent shunt. Using a small camera passed into the ventricles, the surgeon makes a tiny opening that lets trapped fluid bypass the blockage and drain naturally. When it works, there is no long-term tube in the body — an advantage over a shunt. ETV suits certain blockages, particularly when a tumour obstructs the flow between ventricles. It is not right for every case, and sometimes a shunt is still needed. The choice between ETV and a shunt depends on the exact cause and site of the blockage, decided by the neurosurgical team.
The shunt or ETV procedure itself is coordinated with CION's accredited neurosurgical partners — CION's panel is led by medical and radiation oncologists, not neurosurgeons. What CION delivers directly is the care around it: advanced imaging and diagnosis, molecular testing on the tumour sample, radiation therapy and systemic treatment for the tumour causing the hydrocephalus, steroid and seizure management to control pressure and symptoms, and rehabilitation. Every case is reviewed at a multidisciplinary tumour board. This means one coordinated team plans your whole journey — from relieving the pressure to treating the tumour behind it.
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