Advancing Hydrocephalus Management: Pathogenesis Insights, Therapeutic Innovations, and Emerging Challenges

Hydrocephalus is a prevalent neurological disorder, particularly impactful in older adults, characterized by high incidence and numerous complications that impose a significant burden on healthcare systems. This review aims to provide a comprehensive description of hydrocephalus pathogenesis, focusing on cellular and molecular insights derived from animal models. We also present the latest advances in hydrocephalus research and highlight potential therapeutic targets. Lastly, the review advocates the integration of findings from both animal and human studies to achieve better outcomes and examines the potential of emerging technologies. We wish to raise public attention about this disease in an aging society. Current animal models for hydrocephalus involve acquired hydrocephalus models and genetic/congenital hydrocephalus models. Studies from animals have shown that the main mechanisms of models can be broadly classified into nine types. A variety of drug-targeted therapy methods and non-surgical treatment methods have been used in clinical practice. But current treatment approaches primarily focus on symptomatic relief and intracranial pressure control rather than addressing the underlying pathological mechanisms. We call for the development of more accurate and representative animal models to achieve better outcomes and examine the potential of emerging technologies, such as artificial intelligence and neuroimaging. In summary, this review synthesizes recent findings in hydrocephalus research, identifies promising therapeutic targets and interventions, and critically evaluates the limitations of current research paradigms, aiming to align preclinical studies with clinical endpoints. Continued studies and multidisciplinary collaboration are essential to develop effective interventions and facilitate new treatments into bedside.