What is Hydrocephalus (Water on the Brain)?
Hydrocephalus is sometimes known as “water on the brain,” but is more accurately described as a buildup of cerebrospinal fluid (CSF) that can cause pressure inside the head to increase. CSF normally flows through fluid-filled ventricles by way of openings that connect one ventricle to another. Eventually, the CSF reaches the surface of the brain and spinal cord, where it is absorbed into the bloodstream. To maintain normal pressure, the production, flow, and absorption of CSF must be kept in balance. Therefore, hydrocephalus may occur when there is:
- A blockage of CSF flow inside the head
- Problems with the body absorbing CSF
- An overproduction of CSF
How common is hydrocephalus in children?
Hydrocephalus is a relatively common condition that occurs in about one out of 500 births. At the Brain Care Institute of UPMC Children’s Hospital of Pittsburgh, our neurosurgeons have developed expertise in treating this condition by shunt insertion and, when appropriate, using minimally invasive endoscopic procedures.
What causes hydrocephalus (water on the brain)?
Hydrocephalus can be present at birth (congenital), or it can be acquired later in a child's life.
Causes of acquired hydrocephalus in children may include:
- Abnormal blood vessel formation inside the head
- Birth injury
- Bleeding inside the head
- Infection
- Prematurity
- Pseudotumor cerebri
- Trauma
- Tumors
Hydrocephalus Surgery Risk Factors
Hydrocephalus can affect a child’s brain and development. The extent of the problem depends on the severity of the hydrocephalus, and whether brain or other organ system problems exist.
Although the benefits of these surgeries usually outweigh the risks, potential complications can arise, including:
- Infection
- Shunt malfunction, resulting in underdrainage or overdrainage of the CSF
- Bleeding
- Fever
- Vomiting
- Irritability
- Redness
- Swelling along the area of the tubing
- Decreased alertness or lethargy
These complications require prompt medical evaluation. Following surgery, the family will receive instructions on how to care for the baby at home, and information about signs or symptoms requiring medical care.
What Are the Signs and Symptoms of Hydrocephalus?
The symptoms of hydrocephalus in children may resemble other conditions or medical problems, so patients and their families should always consult a physician for a diagnosis. Each child may experience symptoms differently, but the most common symptoms of hydrocephalus in infants include:
- A full or bulging fontanel (soft spot located on top of the head)
- A high-pitched cry
- An inability to look upward while the baby’s head is facing forward
- Developmental delays
- Increased irritability
- Increasing head circumference
- Poor feeding habits
- Projectile vomiting
- Seizures
- Sleepiness or lack of alertness
- Very noticeable scalp veins
In older children, headaches and visual changes may be seen.
How Do You Diagnose Hydrocephalus?
A doctor may diagnose hydrocephalus at birth through a series of tests and questions, including:
- A complete history of the child, including a prenatal/birth history and whether a family history of hydrocephalus or other medical problems exists
- A complete physical examination, including a detailed eye exam
- An assessment of developmental milestones as compared to siblings and other babies
Diagnostic tests are performed to establish the diagnosis of hydrocephalus, such as:
- Ultrasound: A diagnostic procedure that uses high frequency sound waves to give a detailed picture of the brain and its ventricles. This test can be performed before or after birth and can be used until the age when the child’s skull fuses
- Magnetic resonance imaging (MRI): A diagnostic procedure that uses an applied magnetic field to produce detailed, computer-generated images of the brain.
- Computed tomography scan (CT or CAT scan): A procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of any part of the body, including the brain.
The team at the Brain Care Institute at UPMC Children’s Hospital of Pittsburgh works hard to provide treatment, education, and guidance as each baby grows and develops. Our main goal for children with hydrocephalus is to determine the underlying cause of hydrocephalus, if present, and to promptly treat both the hydrocephalus and the reason for its development before irreversible changes in the brain occur.
A team of specialists will determine if medications or additional procedures should be used. The key to caring for hydrocephalus in infants is early detection and treatment, and prevention of infection through frequent medical evaluations.
How Do You Treat Hydrocephalus (Water on the Brain)?
The team at the Brain Care Institute at UPMC Children’s Hospital of Pittsburgh works hard to provide treatment, education, and guidance as each baby grows and develops. Our main goal for children with hydrocephalus is to determine the underlying cause of hydrocephalus, if present, and to promptly treat both the hydrocephalus and the reason for its development before irreversible changes in the brain occur.
A team of specialists will determine if medications or additional procedures should be used. The key to caring for hydrocephalus in infants is early detection and treatment, and prevention of infection through frequent medical evaluations.
For many children with hydrocephalus, surgery is needed. This may involve placing a shunt, which is a device used to help drain the extra CSF from the brain and redirect the extra fluid to another part of the body. A common type of shunt is the ventriculoperitoneal shunt. Insertion of the ventriculoperitoneal shunt is done under general anesthesia, which at Children’s is administered by pediatric anesthesiologists who specialize in treating children.
The shunt consists of three parts:
- A tube that is placed inside of the ventricular space
- A reservoir and valve to control the flow of CSF
- Tubing that is directed under the skin to the abdomen or, less commonly, to the heart or lung area
Some children with certain types of hydrocephalus can be treated successfully in a minimally invasive manner through endoscopic intraventricular surgery. An endoscope is used to create bypass channels for fluid to flow around an area of obstruction (as in an endoscopic third ventriculostomy or an endoscopic septostomy) or to directly treat an obstructing lesion, such as endoscopic cyst fenestration.
Research and Clinical Studies
As a nationally recognized research center, UPMC Children’s Hospital’s Brain Care Institute participates in the latest clinical studies, which involve human volunteers and are intended to add to our medical understanding.
