Hydrocephalus
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- Children’s Hydrocephalus Support Group
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- Hydrocephalus Research
- Neurosurgery Team
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- What is hydrocephalus?
- Who gets hydrocephalus?
- What is your experience with hydrocephalus?
- What surgery do you use to treat hydrocephalus?
What is hydrocephalus?
Hydrocephalus (pronounced hi-dro SEF-a-lus) means water (hydro) in the head (cephalous). It is sometimes called water on the brain. The water is actually cerebrospinal fluid.
Simply put, there is too much CSF in the areas of the brain, called ventricles, which store and circulate CSF.
Hydrocephalus can also involve extra fluid in spaces between the brain and the skull called the subarachnoid spaces.
When a child’s CSF cannot flow or be reabsorbed correctly, it builds up, causing hydrocephalus. It is rarely because of extra CSF production.
A hydrocephalus MRI scan and a normal MRI scan
What are the symptoms?
Symptoms of hydrocephalus can vary by age.
Symptoms in infants
Head Growth
Head growth is followed in infancy and in a baby with hydrocephalus the head growth is larger than normal and crosses growth lines on a growth chart.
Bulging fontanelle
The fontanelle is the soft, flat spot on the top of a baby’s head that is present at birth and lasts for months.
There is also one in the back of the skull that is smaller and closes in the first few months after birth. A bulging fontanelle is full and either soft or firm.
Splayed sutures
An infant has several sutures — fibrous joints between the flat bone plates — in his skull. The bones slowly grow together and join (fuse) at about 2 -3 years of age.
With hydrocephalus, the increased pressure inside the baby’s head causes the sutures to widen abnormally (splay) to make room for the extra fluid.
Sunsetting eyes
A baby with sunsetting eyes appears to be looking down all the time. The white part of the eye is visible above the colored part and the colored part of the eye is partially covered by the lower eyelid.
The eyes look like a setting sun, often creating a surprised look on the child’s face.
Other symptoms in infants:
- Poor feeding
- High-pitched cry
- Sleepiness
- Delayed development
Symptoms in children
In children with hydrocephalus, we usually see:
- Headache
- Nausea and vomiting
- Low energy and sleepiness
- Less ability to understand (lowered cognition), memory problems
- Vision changes
Who gets hydrocephalus?
Hydrocephalus occurs in one of 1,000 live births. Hydrocephalus can be present at birth (congenital).
Hydrocephalus can also develop anytime after birth or in childhood and is called acquired hydrocephalus. It can develop because of bleeding inside a brain ventricle (intraventricular hemorrhage), a head injury, brain infection, brain tumors and numerous other reasons.
What is your experience with hydrocephalus?
Our team has a great deal of experience treating hydrocephalus. It is a very common problem among children with other neurosurgical disorders. We do about 200 surgeries a year for hydrocephalus.
We follow all our patients for a number of years because many need several operations for their hydrocephalus during childhood.
What surgery do you use to treat hydrocephalus?
Shunts
The most common surgery for treating hydrocephalus is putting in a shunt. A shunt is a small tube called a catheter that drains excess CSF from a ventricle in the brain to another area in the body.
We place one end of the shunt in the ventricle inside your child’s brain where the extra CSF is causing problems. A small valve in the tube controls the pressure in your child’s head by controlling the amount of fluid running through it.
It also makes sure the fluid flows in only one direction, away from the brain.
The catheter tubing continues on to an area where the body can reabsorb the fluid. The most common area is the stomach area (abdomen). This is called a ventricular to peritoneal shunt.
The catheter can be positioned to drain into other areas, such as the heart or chest. When the body reabsorbs the fluid, it either reuses it or passes it through the kidneys.
Our neurosurgeons can choose from many different types of shunts and valves. Sometimes we place a valve that can have its pressure changed by a small magnetic device, if needed. These valves must always be reset immediately after an MRI by one of our neurosurgery nurse practitioners. Your child’s neurosurgeon will make the best choice of catheter and valve.
Endoscopy
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Endoscopy can be used to do minimally invasive brain surgery to treat some cases of hydrocephalus.
One complex type of hydrocephalus is called multiloculated hydrocephalus. This happens when there is scarring in the four small cavities in the brain called ventricles which produce CSF. The scarring is caused by infection and/or bleeding and it creates multiple, small compartments of CSF that do not connect with each other.
In the past, multilocuated hydrocephalus was treated by placing a separate shunt in each compartment. However, using an endoscope, small holes in these separate compartments may be made so that they connect with each other and only a single shunt is needed.
Endoscopic third ventriculostomy
A child’s surgeon may suggest doing this operation, also called an ETV, rather than putting in a shunt. The decision is based on the child’s particular anatomy and age.
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During an ETV, the neurosurgeon makes a small hole in your child’s skull.
Then he uses an endoscope, a wand-like instrument with a light and camera attached to reach the floor of the third ventricle of your child’s brain.
Next, the neurosurgeon uses the endoscope to make a hole in the floor of the ventricle. The extra fluid can now drain out and be reabsorbed.
An ETV avoids putting in any permanent hardware such as a shunt in your child’s body.