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What is Hydrocephalus?

Madi celebrating her 3rd Birthday - 2 days after her 14th revision.  She is always smiling and bring joy to her family and friends.  April 27, 2000.

Hydrocephalus - often referred to as 'water on the brain' is an abnormal and excessive accumulation of cerebral spinal fluid (CSF) within the brain's cavities called ventricles. Hydrocephalus is a lifelong illness, except in rare cases. Currently the condition cannot be cured, but can be treated by surgically implanting a tube, called a 'shunt', in the brain. This shunt channels fluid from the brain to another part of the body, where the fluid is absorbed into the bloodstream.

Hydrocephalus can be congenital—meaning the problem was present at birth—or acquired—meaning it developed after birth.

Congenital Causes include:

  • Acueductal Obstruction of the passageway between the 3rd and 4th ventricle.
  • Spina Bifida
  • Arachnoid Cysts
  • Dandy-Walker Malformation—where a portion of the cerebellum fails to develop.

Acquired Causes include:

  • Intraventricular Hemorrhage—most frequently affects premature infants.
  • Meningitis which can scar the delicate membranes that line the CSF pathway.
  • Head Trauma
  • Tumors

Diagnostic Tests for Hydrocephalus

Ultrasonography is a technique that uses high-frequency sound waves to outline structures within the head—used when the baby's fontanel is open.

Computerized Tomography (CT Scan) uses an x-ray beam that is passed through the patients body and pictures of the internal structures, in this case the brain, are made by computer.

Magnetic Resonance Imaging (MRI) uses radio signals and a very powerful magnet to scan the patient's body, and the signals are then formed into pictures by a computer.

Treatment for Hydrocephalus consists of a surgical procedure in which a flexible tube called a shunt is placed into the child's CSF system. The shunt diverts the flow of CSF from the ventricles to another region of the body.

Shunt Placement include:

  • Ventriculoperitoneal (V-P) Shunt which diverts CSF from the ventricles into the peritoneal cavity, the space in the abdomen where our digestive organs are.
  • Ventriculoatrial (V-A) Shunt which diverts CSF from the ventricles into the right atrium of the heart.

Complications include:

  • Obstruction or blockage of the shunt by tissue from the choroid plexus or ventricles, blood cells, bacteria, loops of bowel or fat tissue.
  • Infections usually caused by the child's own bacterial organisms.
  • Disengagement of the shunts components or mechanical malfunction of the shunt.

Symptoms of Shunt Malfunction

Infants:

  • Enlargement of baby's head
  • Fontanel is full and tense when baby is upright and quiet
  • Prominent scalp veins
  • Swelling or redness along the shunt tract
  • Fever
  • Vomiting
  • Irritability
  • Sleepiness
  • Downward deviation of the eyes
  • Seizures

Toddlers:

  • Head Enlargement
  • Fever
  • Vomiting
  • Headache
  • Irritability and/or sleepiness
  • Swelling or redness along the shunt tract
  • A loss of previous abilities (sensory or motor function)
  • Seizures

Children and Adults:

  • All of the above
  • Vision problems
  • Personality change
  • Loss of coordination or balance
  • Difficulty in waking up or staying awake
  • Decline in academic performance

Hydrocephalus Facts

  • Hydrocephalus is a common birth defect that afflicts more than 10,000 babies every year.
  • It occurs in 70% to 90% of children with spina bifida.
  • CSF shunting procedures account for approximately $100 million of national health care expenditures in the United States.
  • Normal pressure hydrocephalus affects adults and can cause dementia, difficulty walking and urinary incontinence.
  • A brain injury occurs every 15 seconds in this country. Such injuries can lead to the onset of hydrocephalus.
  • There are approximately 200-300 children and adults affected by hydrocephalus in Vermont and Northern New York.
  • Fletcher Allen Health Care neurosurgeons treat 20-30 new babies for hydrocephalus each year.