Pediatric Hydrocephalus is a condition in which the clear fluid that normally protects the brain builds up excessive pressure within the brain. This clear brain fluid is known as Cerebral Spinal Fluid (CSF), and its function is to provide buoyancy for the brain and to protect it from shock, as well as to provide nutrition and to carry away waste. CSF is produced within the brain and circulates around the brain and spinal cord, around the meninges (the outer covering of the brain and spinal cord), and within the brain’s open cavities (called ventricles). Normally, there is an equilibrium between CSF produced and the CSF being absorbed. However, in hydrocephalus, more CSF is produced than absorbed, allowing abnormally high pressure to build up within the brain.

Hydrocephalus can have a rapid or a gradual onset. It can be present during fetal development, after birth, or into childhood depending upon the root cause. Rapid onset hydrocephalus is a medical emergency generally caused by traumatic injury or infection. Gradual onset hydrocephalus, on the other hand, is usually first detected by measuring an infant’s head circumference. An unusually large head or unusually rapid head growth may be an indication that brain fluid is building up within the brain’s interior, causing outward pressure against the skull. The bones within an infant and child’s skull are not fused and may expand if the brain expands. Other symptoms in infants include sleepiness, “sunsetting” (a downward gaze of the eyes), vomiting, irritability, and seizures. In older children, symptoms include nausea, balance issues, poor coordination, trouble walking, slowing of development, lethargy, drowsiness, or changes in cognition. A physician may also see a swelling of the ocular nerve in older children.

In order to diagnose hydrocephalus, a neurologist will typically order a CT scan or an MRI. In a very young baby with a large fontanelle (soft spot in the skull), an ultrasound may be used to make a diagnosis. Unfortunately, without treatment, a child’s brain will undergo further damage due to increasing pressure and can ultimately lead to death. 

Long-term rehabilitation for hydrocephalus includes caring for an implanted shunt and physical, cognitive, and behavioral therapy for any brain damage resulting from abnormal brain pressure.

Conventional Treatment

The treatment for hydrocephalus is generally to determine the cause (e.g. a tumor or blockage) and remove it, if possible. If the cause is not a blockage or if the blockage is inoperable, then a pediatric neurosurgeon may insert a semi-permanent shunt to drain excess fluid from the brain to another part of the body. The end of the tube is then implanted in a body cavity which can reabsorb the CSF, generally the abdomen, but sometimes near the lungs or heart. The pressure level of the shunt is able to be controlled via a mechanism near the head.

In some cases, an ETV procedure (endoscopic third ventriculostomy), using a small endoscopic camera is inserted into the brain and a shuntless bypass is created for the flow of the CSF. Although shunts and ETV procedures are effective, at some point, they fail and must be replaced so as to prevent pressure from building in the brain.

Long-term rehabilitation for hydrocephalus includes care of the shunt and physical, cognitive, and behavioral therapy for any brain damage resulting from abnormal brain pressure.