Hydrocephalus (Patient Information)

Hydrocephalus is a condition that occurs when either the fluid in the brain (CSF-cerebral spinal fluid) is blocked from flowing through the normal channels in the body or when too much CSF is made in the brain (rare). CSF is made in small areas of the brain known as the ventricles. When the CSF cannot get out of the ventricles, it builds up and puts pressure on the brain. Pressure on the brain from the fluid buildup can cause injury to the brain.
What causes hydrocephalus?
Hydrocephalus can occur either before or after birth. Hydrocephalus before birth occurs when fluid channels in the brain are not formed correctly. In most cases, there is no known cause. Hydrocephalus can develop after birth when the baby has an intracranial hemorrhage or an infection.
What are the symptoms?
The symptoms may include a soft spot (fontanel) that feels full or bulging and an increasing head size.
How is it diagnosed?
Measuring the head size and comparing it with the usual rate of growth is one way to diagnose hydrocephalus. An ultrasound may also be performed so that the ventricles can be visualized. In some cases, the doctor may also perform a CT scan.
What is the treatment?
The doctor will determine what treatment is necessary depending on the severity of the hydrocephalus. Sometimes the baby will need only close monitoring for any changes. However, if the head is enlarging rapidly, several options are used:

1. Lumbar puncture (LP): excess fluid can be drained by placing a needle in the lower back. The needle is removed after the procedure. This is used on a temporary basis to relieve pressure in the baby's head.
2. Ventricular Tap: excess fluid can be drained from the ventricles by putting a needle in the soft spot. This is also used on a temporary basis to relieve the pressure.
3. Reservoir: a device that operates like a well is placed in the ventricle. This treatment is used to remove excess fluid until a permanent shunt can be placed.
4. Ventriculo-peritoneal shunt (VP shunt): a very soft plastic tube is placed in the ventricle to drain excess fluid. The tube and the fluid travel under the skin down into the belly. The fluid is then absorbed into the bloodstream. Families will be taught how to care for the VP shunt before discharge.

Future Expectations:
A few babies will outgrow the hydrocephalus; others will not and will need a shunt for the rest of their lives. The outcome of hydrocephalus depends on the cause, the part of the brain that is involved, and the severity of the problem. Early treatment and close follow-up will often improve the outcome. Your doctor will discuss future expectations with you.