Hydrocephalus in children

Our brains receive protection and nourishment from a special fluid, starting when we’re in the womb. But when too much of this fluid builds up, it can harm brain function and lead to other complications.

Fortunately, our experienced pediatric neurosurgeons can provide relief from this condition, called hydrocephalus. We help many children every year, with options for surgery that take a light approach and an intensive care unit for recovery. We help safeguard physical and mental development, making hydrocephalus just a small part of your child’s life.

Read about Gracie, who regained her balance after hydrocephalus treatment at Advocate Children's Hospital.

What is hydrocephalus?

Hydrocephalus involves cerebrospinal fluid (CSF), the clear liquid that bathes the brain and spinal cord. This fluid is continuously produced in spaces inside the brain called ventricles connected by narrow passageways. Normally, the fluid flows around the brain and spine eventually getting absorbed and sent to the kidneys and liver for removal.

If the fluid’s flow gets blocked, the ventricles swell and push on surrounding brain tissue. This pressure can damage the tissue and affect the way the brain works.

What causes hydrocephalus?

Hydrocephalus in children is often congenital, meaning it’s present at birth. Less frequently a child may develop or acquire the condition later on.

Causes of hydrocephalus include:

• Aqueductal stenosis, when one of the passageways between ventricles does not fully form or later closes
• Bleeding in the ventricles from head injuries, problems with clotting, blood vessel rupture or being born too soon
• Brain tumors pushing on the ventricles or passageways
• Chiari malformations, when parts of the brain get pushed out of place
• Cyst forming between the brain or spinal cord and one of the protective coverings (membranes)
• Dandy-Walker syndrome, a condition in which the brain doesn’t develop in a typical way
• Encephaloceles, when some of the brain and its protective membrane stick out because the skull doesn’t form properly
• Infections such as meningitis scarring the path that CSF takes
• Spina bifida, in which the spinal covering doesn’t completely close

Hydrocephalus symptoms

Hydrocephalus symptoms can vary widely and depend on a child’s age since the bones of the skull don’t fuse together right away.

Signs of hydrocephalus in infants

• Unusually large head at birth or head that grows rapidly in size
• Extreme sleepiness
• Frequent or severe vomiting
• Trouble looking up when the head is facing forward
• Seizures

Signs of hydrocephalus in older children

• Severe headaches
• Blurred or double vision
• Trouble looking up
• Problems with balance, coordination, standing or walking
• Loss of bladder control
• Extreme tiredness
• Personality changes or irritability for no apparent reason
• Delays in reaching developmental milestones
• Trouble remembering and focusing

Hydrocephalus diagnosis

Hydrocephalus is sometimes apparent on an ultrasound while a baby is still in the womb. For infants and older children, we provide a complete neurological examination. We use scans such as ultrasound, computed tomography (CT) or MRI to look for swollen or damaged tissue or cracks in the skull. Special devices can also help us evaluate pressure inside the brain.

Learn more about what to expect during a neurological examination.

Is there a cure for hydrocephalus?

While treatments typically don’t cure hydrocephalus, they’re very effective and help many children live normal lives with few limitations.

Hydrocephalus treatment

Our neurosurgery program offers the full range of minimally invasive, endoscopic treatments for hydrocephalus. During these surgeries, your child receives general anesthesia. Once they’re under, a surgeon makes small incisions in the scalp. A tube-like scope with a fiber optic camera allows the surgeon to see inside the brain and work to relieve pressure. Hydrocephalus treatments include:

Endoscopic third ventriculostomy

While it’s not appropriate for every child, we always consider this option before others. We don’t need to implant any devices in your baby's body with a ventriculostomy, and it requires fewer incisions with less chance of complications.

During the surgery, the surgeon creates a new passageway from one of the brain's ventricles. This hydrocephalus treatment allows cerebrospinal fluid to flow toward the surface of the brain and get absorbed by the body.

Shunts for cerebrospinal fluid

If surgeons can’t create a new passageway, they may recommend placing a shunt. These devices consist of flexible tubing and a valve and send away excess cerebrospinal fluid. Most commonly, surgeons run the tubing to the peritoneal cavity, the space containing organs such as the stomach and liver. There, the fluid gets absorbed by the bloodstream.

Ventriculo-peritoneal (VP) shunts are both flexible and sturdy. While children with these shunts can’t play contact sports, they don’t otherwise need to take any special precautions. Once hair on the scalp grows back after surgery, people won’t realize your child has a shunt. While shunts are designed to accommodate a child’s growth, occasionally surgeons need to adjust them.

Follow-up care for hydrocephalus

After surgery, our neurosurgeons regularly check your child’s health and brain growth. They also make sure any shunts placed remain effective, as your child may occasionally need extra care. They help you recognize the signs that it’s time to come in to see us.

We work to ensure your child continues to thrive, and that often requires a team. We partner with your child’s pediatrician, who can provide day-to-day care and arrange other needed services. Your child may need to see a physical or occupational therapist. A pediatric neuropsychologist can also watch your child’s development and coordinate school needs.