Hydrocephalus
Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles of the brain. The ventricles are fluid-containing cavities deep inside the brain. Hydrocephalus is caused by a mismatch of CSF production and absorption. This, in turn, causes an increase in pressure within the brain.
What’s in this section?
Signs and Symptoms
The signs and symptoms of hydrocephalus vary by age group.
For infants, the common symptoms of hydrocephalus are:
- Changes in the head
- Abnormally large head
- Quick increase in the size of the head
- Bulging or firm soft spot on the top of the head
- More noticeable scalp veins
- Vomitting
- Sleepiness
- Irritability
- Difficulty feeding
- Seizures
- Eyes fixed downward
- Muscle tone or strength deficits
- Poor responsiveness
For toddlers and children, the common symptoms of hydrocephalus are:
- Headache
- Vision problems, such as blurry or double vision
- Eyes fixed downward
- Abnormally large head
- Sleepiness
- Nausea or vomiting
- Difficulty with balance or coordination
- Loss of appetite
- Seizures
- Urinary incontinence
- Changes in personality, such as increased irritability
- Declines or delays in areas such as school or other functional skills
Potential Causes
The causes of hydrocephalus may or may not be known. In younger (newborn) patients, hydrocephalus can be caused by an abnormally developed central nervous system, bleeding within the ventricles or infections which cause brain tissue to swell. Hydrocephalus may be found following trauma to the brain as well as in those experiencing stroke, tumor or central nervous system infection.
Diagnosis
Diagnosis of hydrocephalus starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including detailed neurological exam , ultrasound , magnetic resonance imaging ( MRI ) and head computed tomography ( CT ).
Treatment Options
There are two different surgical procedures commonly performed to treat hydrocephalus:
- Shunting A shunt is a surgically implanted device used to help manage hydrocephalus. A shunt is used to drain the extra CSF from the ventricles inside the brain into the abdominal area or right atrium of the heart in order to relieve pressure on the brain. The surgery is performed in the operating room by a neurosurgeon. A catheter (tube) is placed into the ventricle in the brain using a navigation system, to make positioning of the catheter in the ventricle as safe and accurate as possible. This tubing exits through a hole made in the skull, known as a burr hole. It is attached to a reservoir or valve that is situated outside the child’s skull but under the skin. The valve is then connected to additional tubing under the child’s skin which is tunneled down to an appropriate drainage site.
The most common drainage site is the abdominal area known as the peritoneal space. Another safe site for drainage is the right atrium of the heart. The right atrium is used as a drainage site if the abdomen is compromised. This creates a continuous CSF drainage system. Once the shunt is placed, your child will typically require the shunt for their lifetime. - Endoscopic third ventriculocisternostomy (ETV) ETV allows CSF to bypass the obstruction causing the hydrocephalus and circulate from the ventricles to the space surrounding the brain so that it can be reabsorbed back into the vascular system. If your child has a high ETV success score (depending on your child’s age, cause of hydrocephalus and prior shunt), they may be offered an ETV as a means of treating the hydrocephalus. ETV involves making a burr hole in the skull, passing an endoscope into the ventricle and then making a hole in the floor of the ventricle. This allows CSF to (1) bypass the obstruction causing hydrocephalus, (2) be restored in its circulation from the ventricles to the space surrounding the brain and (3) be reabsorbed back into the vascular system.
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