The nervous system contains a fluid called cerebrospinal fluid. Fresh cerebrospinal fluid is made continuously by the brain every day. It circulates around the brain and spinal cord, carrying nutrients, washing away impurities and cushioning these delicate structures.

Cerebrospinal fluid flows through the ventricles, which are open areas within the brain, by way of channels that connect one ventricle to another. Eventually, the fluid is absorbed into the bloodstream.

In order to maintain normal pressure inside the skull the production, flow and absorption of cerebrospinal fluid must be kept in balance.

Most problems arise from an obstruction of cerebrospinal fluid flow or poor absorption. Hydrocephalus is the accumulation of too much cerebrospinal fluid inside the ventricles when the normal production and absorption of cerebrospinal fluid is disrupted.

What causes hydrocephalus in children?

Hydrocephalus is typically a symptom of some other problem, and a pediatric neurologist and neurosurgeon can to determine the cause. Sometimes hydrocephalus develops during pregnancy and in other cases, after birth.

Several conditions can result in blocked cerebrospinal fluid flow:

• Inborn irregularities of the nervous system, such as

  • Chiari malformation

  • Neural tube defects, such as spina bifida

  • Dandy-Walker syndrome (a congenital brain malformation involving the cerebellum and the fluid-filled spaces around it)

• Arachnoid cysts

• Infection, such as meningitis

• Intraventricular hemorrhage, which can affect premature babies

• Tumor in the back of the brain (posterior fossa)

• Head injury

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. In some instances, a prenatal sonogram or MRI scan can identify hydrocephalus in a growing fetus.

If hydrocephalus is suspected in your child, your doctor will conduct a thorough physical and ask for a detailed family and patient history. Imaging studies, such as MRI scans,are essential to diagnosis and will sometimes need to be repeated so your child’s doctor can note any progression of the hydrocephalus.

Treating Hydrocephalus in Children

A team approach, including practitioners from multiple specialties, is best for deciding on a course of treatment for the child with hydrocephalus. Neurosurgeons, neurologists, pediatric ophthalmologists, radiologists and others may be called upon to develop the treatment plan.

In most cases, hydrocephalus can be treated, but your child may require ongoing monitoring throughout his or her life.

Shunts for Treating Hydrocephalus

The most common hydrocephalus treatment is a shunt, a small piece of silicone tubing placed surgically inside the body to bypass a blockage or otherwise create a better flow of cerebrospinal fluid.

The shunt allows for fluid to flow through it in one direction. A valve system regulates the flow and creates a reservoir of cerebrospinal fluid that can be tested often to make sure the shunt is working properly and there are no signs of infection.

Endoscopic Third Ventriculostomy

Certain types of hydrocephalus in selected patients can be treated by this alternative to shunting. The surgeon uses an endoscopic approach and makes a tiny hole in the affected ventricle to bypass the blockage and restore a more normal flow of cerebrospinal fluid.

After Surgery

Follow-up care is extremely important in tracking the progress of your child’s recovery. Your pediatric neurosurgeon will schedule follow-up appointments to make sure your child’s recovery continues.