Hydrocephalus
What is hydrocephalus?
Hydrocephalus is a buildup of fluid in the brain, or more precisely, cerebrospinal fluid in the ventricular system, which causes potentially damaging increased pressure in the head. Most children who have it are born with it. It occurs in one or two per 1,000 live births.
The ventricular system in the brain is made up of four chambers that hold most of the cerebrospinal fluid that is in the head. The two upper chambers are called the left and right lateral ventricles. They connect to the third chamber or ventricle, which drains into the fourth.
Cerebrospinal fluid is a water-like substance that acts to cushion the brain within the skull. It also filters waste from tissue in and around the brain.
The cerebrospinal fluid is made in the walls of the ventricles. The fluid flows from the upper ventricles down to the lower ventricles and then over the surface of the brain and around the spinal cord. The cerebrospinal fluid is absorbed over the surface of the brain into the blood stream.
What is the cause of hydrocephalus?
Hydrocephalus occurs when the body makes more cerebrospinal fluid than the brain absorbs. A child may be born with this, but it can happen to a person at any age. Older children or adults with an abnormal growth in the head (tumor) or a head injury can develop hydrocephalus. 
Hydrocephalus has two base causes: the bloodstream is not fully absorbing the fluid due to a damaged filter in the brain and / or the flow of fluid within the ventricles is blocked.
Any significant block in the ventricular system will cause hydrocephalus since cerebrospinal fluid is made there. This blockage can occur due to a buildup of debris that blocks the flow of fluid or can be from a smaller than normal opening in the ventricular system.
This narrow opening in the ventricular system may happen during the baby's growth in the womb. The debris which collects and creates a blockage can be from an infection or from bleeding (hemorrhage) after birth. A tumor in the head may also block the flow of cerebrospinal fluid.
This buildup of fluid causes increased pressure in the head. If untreated, over time it can cause damage to the brain.
What are the symptoms of hydrocephalus?
Your infant's doctor may order a screening for hydrocephalus if your infant's head is growing more quickly than others his age. Headaches and vomiting are signs of increased intercrainial pressure which can result from hydrocephalus.
What are the treatment options?
The most common treatment for hydro is inserting a ventricular shunt. A shunt is a tube that drains the CSF from the ventricles to another space in the body, which then absorbs the fluid.
A second type of treatment for hydrocephalus is endoscopic third ventriculostomy (ETV). This procedure has proven more effective at managing hydrocephalus caused by the ventricular system. It is not used for children who have a damaged filter in the brain that does not allow cerebrospinal fluid absorption into the blood stream.
Should my child and I do anything to prepare for the surgery?
Whether your child is getting a shunt or is having endoscopic third ventriculostomy, to help us prepare for a successful surgery, please share with us your child's full medical history.
What happens during the surgery?
Prior to surgery, your child's surgeon will choose the most appropriate surgery, either the shunt or endoscopic third ventriculostomy. The neurosurgeon will discuss the procedure in detail with you before your child's scheduled surgery date, but a brief description of these follows.
Shunt -- The first step in the shunting procedure is placing a ventricular catheter through the skull into the ventricular system. A ventricular catheter is a tube with tiny holes. This catheter is connected to a pressure valve that serves to regulate the amount of spinal fluid drainage.
Another long, thin tube called a distal catheter is attached to the valve. This is the tube that drains the cerebral spinal fluid. The distal catheter and valve are located underneath your child's skin.
Endoscopic Third Ventriculostomy (ETV) -- For this procedure, the surgeon makes a small hole in the bottom of the third ventricle so that cerebral spinal fluid bypasses the obstruction and flows into the natural pathways.
Both of these surgeries are performed under general anesthesia and will be scheduled for at least one hour and a half.
What should we expect after the procedure?
Your child will go to the Postanesthesia Care Unit (PACU) after surgery and the surgeon will update you on how well the surgery went. When you receive a call from the PACU, you may join your child.
Your child will spend two or three nights with us, and we will take care of special dietary needs (general anesthesia may cause an upset stomach). When your child is eating and drinking well, has been up walking around successfully and has his or her pain under control, he or she will be discharged home.
Our discharge criteria are that the child is able to take good oral nutrition, have good pain control on oral meds, and have had a bowel movement.
Before you leave, make sure that a follow-up appointment with the Pediatric Nurse Practitioner (PNP) is scheduled for seven to 10 days after surgery and a follow-up appointment with the surgeon is scheduled for six to eight weeks after surgery.
Please refer to any of the following sections if you have concerns once you and your child get home.
Pain -- If your child is under four years of age, please administer regular children's Tylenol" as directed for his or her pain. Children older than four years may be sent home with a prescription for Tylenol" with codeine.
Diet -- Once your child is home, he or she will be on a regular diet. There are some restrictions immediately following surgery, but since your child will be spending several nights with us, we will restrict the diet as needed during that time.
Wound care -- You should wash your child's incision each day with a mild shampoo (see home care instructions for a child with cranial incision lines).
Activity -- Your child may resume regular activities gradually upon returning home.
Medication -- No medications are prescribed routinely following hydrocephalus surgery. If your child complains of pain at the site of the incision, please give him or her Tylenol".
Bathing -- The wounds should be washed daily with a mild soap or shampoo and rinsed with clear water. A shower is fine if your child typically takes showers. Please do not let the wound soak in water such as a bath tub or swimming pool until the skin is completely healed.
Seven to 10 days after surgery your child will have a follow up appointment with the Neurosurgery Department for a wound check. Your child will then return to the Neurosurgery clinic in about 6 weeks for another follow up with a head CT. A repeat head CT gives a picture of the size of your child’s ventricles for future comparison.
The MRI also gives pictures of the size of your child's ventricles for future comparison. If your child becomes ill, this helps in determining whether or not hydrocephalus is causing problems.
Your child may return to school or daycare three to five days after surgery, depending on how he or she feels. Observe him / her for any signs of hydrocephalus; these would typically be the same symptoms that prompted the surgery. (See Shunt Malfunction for signs of hydrocephalus.)
When should I call the doctor?
Our office hours are 8 am to 4:40 pm, Monday through Friday. Please call 513-636-4726.
Rev. 5/09
