What is hydrocephalus?
Pediatric hydrocephalus is the accumulation of spinal fluid inside the brain, also known as "water on the brain." This can be a very dangerous condition, as the normal production and recycling of spinal fluid throughout the neurological system is disrupted.
Inside the brain are the fluid-filled ventricles. CSF flows through the ventricles by way of channels that connect one ventricle to another. Eventually, the CSF is absorbed into the bloodstream. In order to maintain normal pressure inside the skull the production, flow and absorption of CSF must be kept in balance.
Hydrocephalus is typically a symptom of some other problem. Your pediatric neurologist and neurosurgeon will want to determine the cause of the hydrocephalus and treat the underlying cause. The prognosis for successful treatment of hydrocephalus is excellent, if the underlying cause can be properly treated.
Some hydrocephalus conditions occur during pregnancy and others after birth. In addition, a small number can be transmitted genetically.
How is hydrocephalus diagnosed?
Typically hydrocephalus is discovered by the child’s parents or pediatrician when the child’s head begins to rapidly swell and enlarge. Depending on your child’s age (before six months), your pediatrician will probably order a series of X-rays and possibly a CT scan and refer you to a pediatric neurologist and/or neurosurgeon. Sometimes an ultrasound of the brain is also performed.
If your child is older than six months, an MRI may be ordered, as a better diagnosis can be made at that time through MRI.
- Your doctor will conduct a thorough physical and will ask for a detailed family and patient history.
- Your doctor may order further imaging of the brain and/or spine through ultrasound, CT, MRI or X-rays.
- Depending on the results of the imaging studies, your doctor will have to make a determination about the course of treatment. Often other factors come in to play including:
- Eye exams
- Changes in level of activity or school performance.
- Repeated imaging studies to look for changes in the brain
Treatment for hydrocephalus in children
The Johns Hopkins difference involves multiple specialties in reviewing the cases of children with hydrocephalus. Neurosurgeons, neurologists, pediatric ophthalmologists, radiologists, among others, join together to develop the treatment plan. The team will decide when and if surgery is the best option.
Shunts in the treatment of hydrocephalus
Most often, hydrocephalus is treated surgically with the placement of a shunt to bypass the blockage that is causing the buildup, or to create a better flow of CSF. A shunt is a tiny silicone tube that allows for fluid to flow through it in one direction. A valve system regulates the flow and creates a reservoir of CSF that can be tested often to make sure the shunt is working properly and there are no signs of infection.
Alternatives to shunts
- Endoscopic Third Ventriculostomy: Certain types of hydrocephalus can be treated by making a tiny hole in the ventricles to recreate a normal flow. This alternative to shunting is an endoscopic approach that bypasses the blockage and creates a detour for the flow of CSF. Our pediatric neurosurgeons are fellowship trained to perform these endoscopic procedures. The benefits of an endoscopic approach include the elimination of placing foreign materials in the brain; which results in fewer infections and less risk of over-drainage of CSF.
Follow-up care is extremely important in tracking the progress of a child’s recovery. Your pediatric neurosurgeon will schedule follow-up appointments to make sure your child is making a full recovery.