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Hydrocephalus is a condition where fluid builds up within the brain, and it is one of the most common neurosurgical problems worldwide, particularly in children. While modern treatment allows many children in high-income countries to grow up healthy and active, the story is quite different in underprivileged populations. In many parts of the world, delayed diagnosis, lack of access to imaging, and limited neurosurgical services mean that hydrocephalus remains a life-threatening condition for a number of newborns. 

Early detection is crucial. In newborns, hydrocephalus can progress quickly because the brain is developing so rapidly. If fluid pressure builds up, it can cause permanent brain injury. Simple signs, such as a rapidly growing head, a bulging soft spot, or a baby becoming unusually sleepy or irritable, can often be recognised without advanced equipment. Yet in under-resourced settings, families may struggle to reach healthcare facilities, and basic growth monitoring is not always done. As a result, diagnosis is often delayed until the condition is severe.  Delayed diagnosis and treatment can contribute to delayed development and cognitive and physical disability. 

Imaging modalities, like ultrasound, CT or MRI scans, is used to confirm the diagnosis. While ultrasound is relatively inexpensive and safe, many low- and middle-income countries lack the equipment or trained staff to perform and interpret these scans. This creates a major barrier to timely treatment. Access to CT or MRI scan is often more expensive and difficult.  

Management, too, highlights the global gap. The mainstay of treatment is surgery, either a ventriculoperitoneal (VP) shunt or, in selected cases, an endoscopic third ventriculostomy (ETV). In high-income countries, these procedures are routine. But in resource-limited regions, there may be very few neurosurgeons, and access to sterile operating theatres, shunt supplies, and long-term follow-up can be scarce. Shunt malfunctions and infections, which require urgent attention, can be fatal if families cannot return quickly to a hospital with adequately trained staff. 

The causes of hydrocephalus also vary across regions. In affluent nations, congenital malformations or premature birth-related bleeding are common. In many low-resource settings, however, untreated neonatal infections, such as meningitis, play a significant role. This highlights the need not just for surgical care but also for better maternal health and antenatal care, infection prevention, and access to antibiotics.  

Despite these challenges, progress is being made. Global health initiatives are training more neurosurgeons in Africa, Asia, and Latin America. Low-cost shunt systems and innovative techniques such as ETV combined with choroid plexus cauterization are being used with success in parts of sub-Saharan Africa, reducing dependence on lifelong shunts. Community-based programmes that teach families to monitor head growth and recognise warning signs have also shown promise in improving early diagnosis. 

For families in underprivileged populations, a diagnosis of hydrocephalus is not just a medical challenge but often a social and financial one. Long travel distances, high treatment costs, and stigma can all create barriers to care. Tackling hydrocephalus globally therefore requires more than surgical solutions: it demands investment in maternal-child health, infection prevention, affordable technology, and equitable healthcare systems.