Which treatment options are used for aqueductal stenosis?

• A. Radiation therapy
• B. Antibiotics
• C. Antihypertensive
• D. CSF diversion (shunt) or aqueductoplasty/third ventriculostomy

Answer: (D)

Obstructive hydrocephalus from aqueductal stenosis is treated by methods that restore or bypass the flow of cerebrospinal fluid. The goal is to relieve increased intracranial pressure by either diverting CSF away from the obstructed system or by creating a new pathway for CSF to reach the subarachnoid space.

CSF diversion with a shunt (such as ventriculoperitoneal or ventriculoatrial) lowers pressure by draining excess CSF from the ventricles to another body cavity, effectively bypassing the blockage. Endoscopic options, like an aqueductoplasty (to widen the narrowed aqueduct) or an endoscopic third ventriculostomy (ETV), bypass or reconstruct the flow: aqueductoplasty attempts to restore patency of the aqueduct, while ETV creates a new route by perforating the floor of the third ventricle so CSF can flow directly into the basal cisterns.

Radiation therapy, antibiotics, or antihypertensives do not address the blocked CSF pathways or reduce hydrocephalus, so they’re not used as primary treatments for aqueductal stenosis.