Hydrocephalus Treatment

Hydrocephalus is a serious, sometimes life-threatening condition in which cerebrospinal fluid (CSF) builds up in the brain. Pediatric neurosurgeons at Children’s Hospital Los Angeles specialize in treating this condition with therapies that help more children make a full recovery.

Hydrocephalus Treatment: Why Choose Us?

Your child receives care from specialized pediatric neurosurgeons. Many of our experts completed advanced training through fellowships. We deliver care that’s precise, personalized and reflects the latest science in hydrocephalus treatment.

Highlights of our program include:

• Early hydrocephalus care: Some children show signs of hydrocephalus before they are born (congenital hydrocephalus). We provide specialized monitoring to assess complication risks through our Fetal and Neonatal Institute. In severe cases, we may recommend delivering your baby early so that we can provide treatment.
• Endoscopic third ventriculostomy (ETV): This treatment is an alternative to implantable shunts placed in the brain to drain excess CSF. We are experienced with all forms of hydrocephalus treatment, and work with families to decide on the optimal individualized treatment strategy.  With ETV, we use minimally invasive techniques to create a safe pathway within the brain for excess fluid to escape. Endoscopic third ventriculostomy can in many cases help avoid the use of shunt devices.
• Research: Children’s Hospital is a member of consortia including the Hydrocephalus Clinical Research Network. We contribute to multi-center studies that aim to improve hydrocephalus care and outcomes, advancing the standard of care. We continue to develop advanced imaging methods that allow safer and better treatment of hydrocephalus, and we are involved in national clinical trials that explore new hydrocephalus treatments.

What Causes Hydrocephalus?

The human brain has a complex system of physiology, including blood flow and circulating clear fluid. The clear, circulating liquid in the brain, called cerebrospinal fluid or CSF, is produced constantly from the brain’s inner fluid chambers (ventricles), and flows through and around the brain and nearby spinal cord. In a healthy brain, CSF flows freely, cushioning the organ. The CSF needs to be reabsorbed as new fluid is produced.

In certain cases, the CSF cannot be reabsorbed, either because of blockages in the pathways of flow, problems with the cells responsible for absorption, or from other causes. Certain problems with CSF reabsorption can be acquired through life, and others can come about even before children are born. When more fluid is produced than can be reincorporated back into the body, excess fluid builds up in the brain, and can cause increased pressure that interferes with normal brain function. This leads to swelling and pressure on the brain’s delicate tissue. The name of this condition, hydrocephalus, derives from the Greek words “hydro” (water) and “cephalus” (head).

According to the National Institute of Neurological Disorders and Stroke, hydrocephalus is believed to affect approximately one to two in every 1,000 children born in the U.S. It is also estimated that nearly 1 million Americans live with hydrocephalus. The majority of cases are diagnosed before birth, at the time of delivery, or in early childhood.

Congenital and Acquired Hydrocephalus

Congenital hydrocephalus typically develops before, during or shortly after birth. When a condition present at birth causes hydrocephalus later in childhood or adulthood, that is also a type of congenital hydrocephalus. Potential causes of congenital hydrocephalus include:

• Structural blockages, such as aqueductal stenosis or cysts
• Bleeding in the brain (hemorrhage)
• Complications of prematurity
• Certain infections during pregnancy
• Conditions affecting spine and brain development, such as neural tube defects (spina bifida) or encephalocele
• Genetic mutations (changes) or syndromes that affect brain structure

Acquired hydrocephalus develops after birth and may affect people of any age. Potential causes of acquired hydrocephalus include:

• Bleeding in the brain after birth
• Brain tumor
• Head trauma, including traumatic brain injury
• Meningitis, inflammation in the brain’s protective membrane

Symptoms of Hydrocephalus

Hydrocephalus symptoms vary by age. Some examples of typical symptoms are provided below.

Hydrocephalus signs and symptoms in infants

Common signs of hydrocephalus in infants include:

• Bulging fontanelle (soft spot) on top of a baby’s head
• Downward-looking eyes
• Large or rapidly growing heads
• Prominent scalp veins

Infants may have symptoms such as:

• Irritability
• Poor feeding
• Seizures
• Sleepiness
• Vomiting

Hydrocephalus symptoms in children

Common symptoms of hydrocephalus in older babies and children include:

• Headache
• Nausea or vomiting
• Vision problems

Your child may experience additional symptoms such as:

• Balance, coordination or movement problems
• Changes in personality, memory or concentration
• Developmental delays, including slower or lost progress walking or talking
• High-pitched cry
• Loss of bladder control
• Sleepiness or difficulty waking up

Hydrocephalus Treatments We Offer

At Children’s Hospital, options for hydrocephalus treatment include:

• Brain shunt surgery: Doctors place a shunt to divert excess CSF from the brain and direct it to another part of the body (usually the belly). The shunt system is fully internal, and is not in contact with the outside of the body. By normalizing the pressure in the brain, shunts can allow babies to grow and develop along their optimal trajectory.
• Endoscopic third ventriculostomy (ETV): In this surgical procedure, doctors create a small opening in the third ventricle, providing a pathway for CSF to escape when the natural pathways for CSF flow are blocked. The procedure helps to restore normal flow of CSF out of the brain, and relies on the normal absorption mechanisms of CSF in the brain to bring the fluid back to the body’s circulation.
• Ongoing monitoring: We monitor your child regularly to ensure that, after treatment, no further fluid buildup occurs. If your child has been treated for hydrocephalus, we make sure that the brain’s ventricles continue to drain properly.

Best-in-Class Pediatric Neurosurgery

Hydrocephalus treatment is one of the many services available through our renowned Neurosurgery Program. Our program consistently ranks among the nation’s top programs, according to U.S. News & World Report. Find out more about how our commitment to clinical excellence can help your child. Read more about our Neurosurgery Program.