How Billy Joel's surgery may help him and others with the normal pressure hydrocephalus brain disorder

Billy Joel revealed this week he had surgery to treat a disorder that was causing fluid to build up in his brain, impacting his balance and creating a rocking sensation he likened to “being on a boat.”

The condition, which he announced in 2025, is called normal pressure hydrocephalus, or NPH. It also impacted his hearing and vision, he has said, forcing him to cancel more than a dozen concerts through this summer.

Over a million Americans — many of them people over 60 — live with hydrocephalus, though it is estimated that more than 80% of cases go unrecognized and untreated, according to the Hydrocephalus Association.

Joel, 77, spoke about his health on his SiriusXM channel. In a clip of that discussion, Joel did not say where or when he had his surgery, but in March 2025 he announced he was postponing concerts to recover from an unspecified surgery. In May of that year, he canceled upcoming concerts and announced a diagnosis of NPH.

What is NPH?

NPH is a condition in which naturally occurring cerebrospinal fluid builds up in the ventricles, or cavities, of the brain. Doctors look for a combination of symptoms sometimes known as the Hakim triad, named for Dr. Salomon Hakim, who defined the condition more than half a century ago: walking problems, dementia-like and urinary problems, according to the Hydrocephalus Association.

The excess fluid is thought to cause "stretching of some of the fibers that coarse around the central cavity" of the brain, impeding those functions, said Dr. Charles Matouk, chief of neurovascular surgery at Yale Medicine. 

In some cases, the buildup can be traced to a head injury or tumor, but the cause is often unknown.

“It’s been subject to a lot of research, but we don’t know what causes it,” said Dr. Michael Egnor, a pediatric neurosurgeon at Stony Brook Children's Hospital.

Diagnosis can be challenging because some NPH symptoms are found in other conditions like Parkinson’s or Alzheimer’s disease, according to the association. Diagnosis may involve imaging, neuropsychological or other tests.

What is the treatment?

The standard treatment — validated by a landmark 2025 study led by Johns Hopkins School of Medicine researchers and others — is implantation of a pencil-sized shunt, or flexible tube, in the brain, to drain excess fluid, usually into the abdomen.

"If you remove some fluid, there’s less pressure exerted, less deformation of the fibers" of the brain, Matouk said. 

Implantation is an inpatient procedure that takes about an hour and is done under general anesthesia. Most patients leave the hospital within a couple days.

Common complications include infection, obstruction of the shunt, or "over-shunting," a condition which can require additional surgery, Matouk said. 

As Joel discussed in his podcast, the details of implantation are not for the faint of heart: Doctors told him they would “drill a hole through your skull and we install a shunt in your brain.” His response, at first: “No, I think I’ll pass.”

It is “kind of a frightening thing to go to a doctor’s office and get your head drilled,” Egnor conceded. But, he said, “most patients I deal with are in a situation where they’re losing their ability to walk and to control their bladder. With such a difficult prognosis … most are happy to undergo surgery.”

What is the prognosis?

“Most people are helped by shunts,” Egnor said. “Many people are helped a lot, some just a bit, a few are not helped at all. Sometimes, people are helped initially, but over a period of months or years, the benefit of the shunt wears off.”

Matouk, who is developing minimally invasive shunt implantation techniques, also said  results can be variable. Some of his patients are disappointed to learn the shunts restore basic functionality but don't allow them to return to activities like skiing or tennis.

"We're going to make things better, not normal," he said he tells patients. 

A representative for Joel declined to comment, but an Instagram post Thursday by the Joel Foundation noted his diagnosis "has given us new appreciation for the extraordinary relationship between music and the brain. Remarkably, some people with neurological disease or brain injury who struggle to speak can still sing familiar words and melodies — because music can engage neural pathways differently from ordinary speech."  

Joel, speaking on SiriusXM, said he had benefited from the brain shunt. “Memory got better, balance got a little better, my ability to function was a little better.”

He said he was doing physical therapy, and, as if to soothe fans’ worries, added: “Don’t worry about me. I’m not going anywhere. I’m here, I’m still here.”

By Nicholas Spangler

nicholas.spangler@newsday.comspanglernewsday

Nicholas Spangler is a general assignment reporter and has worked at Newsday since 2010.