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Hydrocephalus

Pediatric hydrocephalus is a condition where the cerebrospinal fluid being constantly produced cannot be absorbed at a fast enough rate. When the fluid isn't absorbed, it increases pressure in the brain. This can be a temporary, long term, or permanent condition. The symptoms can range from subtle to life threatening. There are many causes and multiple treatment options.

UVA Health Children’s has the pediatric neurosurgical expertise and experience to guide, inform, and treat children with hydrocephalus.

What Causes Hydrocephalus?

Anything that impedes the circulation or absorption of cererbrospinal fluid (CSF) can cause hydrocephalus. Some of the more common pediatric causes are:

  • Congenital malformation
  • Bleeding or infection in the CSF pathways
  • A mass blocking the pathways

To correctly treat hydrocephalus, pediatric neurosurgeons need to understand the cause.

Symptoms of Hydrocephalus

In congenital hydrocephalus, we often see symptoms, like an unusually large head, on ultrasound before birth. We’ll also be on close lookout if your child has any conditions associated with hydrocephalus. Symptoms include:

  • Unusually large head (macrocephaly)
  • Prominent scalp veins
  • Bulging soft spot (fontanel)
  • Irritability
  • Vomiting

For acquired hydrocephalus, your child may experience:

  • Headache
  • Blurred/double vision
  • Personality changes
  • Dizziness and balance problems
  • Changes in how they walk
  • Inability to concentrate/school performance worsening
  • Nausea, vomiting, or unwilling to eat

Treatment for Hydrocephalus

Timely treatment for hydrocephalus is important. Treatment can immediately relieve pressure and pain. It can also prevent future issues. 

Shunt Surgery

A shunt is a hollow tube. The shunt lets fluid drain from your child’s head. The excess spinal fluid travels through the shunt to a new location where it’s absorbed.

Most of the time, the absorption location is your child’s abdomen. We’ll talk to you about the shunting options that make the most sense for your child.

Types of Shunts:

  • Ventriculoperitoneal (VP) shunts: drain from the brain into the abdomen.
  • Ventriculoarterial (VA) shunts: drain fluid from the brain into the heart.
  • Ventriculo-pleural (V-pleural) shunt: drain fluid to the chest cavity.
  • Ventriculo-subgaleal (VSG) shunt: used for premature babies. This temporary shunt often is converted into a permanent shunt type when your child is bigger.

We’ll educate you about signs that your child’s shunt isn’t functioning well. If you see these signs, your child will need medical evaluation.

Shunt Valve Types

The valve provides appropriate resistance and one way flow.

  • Fixed Valve: The amount of resistance allowed is fixed.
  • Programmable/adjustable valve: The resistance can be changed. Programmable valves are also sometimes called magnetically adjustable valves. They use a magnet to adjust the valve.

Any magnetic field close to your child could change the valve settings. We’ll go over what this means in terms of phone, tablet, or other connected-device use.

We’ll talk to you about all of your options and help determine the best fit for your child.

Endoscopic Third Ventriculostomy (ETV)

ETV is an alternative to a shunt. This minimally invasive procedure involves making a small hole in the ventricle of the brain. This allows CSF “trapped” within the fluid chambers inside the brain to enter the fluid space that surrounds the brain, where normal CSF absorption occurs.

This isn’t a treatment for all causes of hydrocephalus. It tends to work best in obstructive hydrocephalus and older children.  

ETV & Shunt Malfunction

Hydrocephalus is usually a lifelong condition. But as your child grows, his or her shunt may need to be repaired or replaced. ETV procedures also sometimes need to be repeated.

When this happens, your child will have hydrocephalus symptoms again. Headaches are often the first sign that pressure is building up again.

At UVA Health Children’s, we’ll schedule follow-up visits with your child’s neurosurgery team. By regularly meeting, we’ll work to stay ahead of any problems. As your child grows into adulthood, we’ll help find an adult neurosurgery team to continue with follow-up.

Pediatric Neurology