Hydrocephalus is a broad term that is usually understood as an excess amount of cerebrospinal fluid (CSF) accumulation resulting in the expansion of the cerebral ventricular system. The CSF is produced by the choroid plexus, mainly in the lateral ventricles, and it flows between the third and fourth ventricles and eventually to the subarachnoid space (SAS). It is critical in brain protection, removal of toxic waste metabolites and is important for proper neuronal function. Hydrocephalus is a neurological pathology linked to high morbidity associated with neurocognitive and motor impairment. It is classified as either communicating or non-communicating and has numerous causes, including, but not limited to, congenital, hemorrhage, bacterial infection, tumor, or brain injury. Treatment typically is surgical with shunt placement for example the endoscopic third ventriculostomy (ETV) technique. In addition, some modified forms of treatment couple ETV with choroid plexus cauterization (CPC) due to the function of the choroid plexus in producing CSF. Still, there is mixed data on the impact with a suggestion of a time-dependent benefit. However, these surgical interventions have high failure risks and complications that require re-intervention, further increasing morbidity and mortality risk. To date, there are few non-surgical treatment strategies, but many have proved limited benefit and many patients still require surgical treatment. This analysis lays out the typical treatment strategies and explores new, innovative interventions, especially highlighting the studies which showed the importance of brain parenchymal tissue playing an active role in the pathogenesis of hydrocephalus. If the latter has merit, the surgical interventions can have more success with a synergistic non-interventional treatment.

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