Hydrocephalus in Children

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Duke pediatric neurologists and neurosurgeons offer several proven treatments to care for your child’s hydrocephalus, sometimes called “water on the brain,” including advanced minimally invasive procedures. We aim to keep your child comfortable and your family informed throughout diagnosis and treatment. Ultimately, our goals are to relieve pressure on the brain, prevent damage to brain tissue, and improve your child’s quality of life.

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Tests

For the best results, it’s important to detect congenital hydrocephalus as early as possible, even before birth. Likewise for acquired hydrocephalus, which is usually the result of bleeding in or around the brain due to injury, a tumor, or infection. Once we are able to determine the cause of your child’s hydrocephalus (be it a blockage, slow absorption, or excess fluid), we’ll be able to create a custom treatment plan for your child.

Head Size and Growth
A pediatric neurologist or neurosurgeon may examine your baby’s head to see if it is larger than normal or is growing too quickly, or if the fontanel (better known as a “soft spot”) is closing too soon.

Ultrasound
This test uses sound waves to create images of the brain. This painless test is usually used for babies in utero and very young infants, because other imaging options require babies to lie still for a while.

CT (Computed Tomography)
Using X-rays and measurements, CT scans create images of the brain from many different angles. For this 30-to-60-minute test, your child will be asked to lie still on a bed and should not feel pain.

MRI (Magnetic Resonance Imaging)
This test uses magnets and radio waves to create a high-quality image of the brain to show how much cerebrospinal fluid is present. For this 30-to-60-minute test, your child will be asked to lie still on a bed. While MRI is typically painless, some children may require sedation or even general anesthesia to complete this procedure.

Fast-Brain MRI
For young children who may have trouble lying still for a traditional MRI, this much-quicker 15-to-30-minute test can be done simultaneously with a CT scan.

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Treatments

Shunts

The most common treatment for hydrocephalus, a shunt is a device consisting of two long, flexible tubes (catheters) and a valve joining them. Shunts are surgically inserted. One end of the shunt is placed into the part of your child’s brain where there is too much fluid. The excess fluid is diverted from the brain to another area in the body, likely the abdomen, where it can be reabsorbed. Typically, a shunt will be needed for life and may need to be replaced one or more times, but some children improve enough that the shunt can be removed permanently.

Although shunts are widely used to control hydrocephalus, they are not perfect. The device can malfunction, become blocked, or introduce infection. It’s important to see your doctor regularly to make sure the shunt is working properly.

ETV/CPC

ETV (endoscopic third ventriculostomy) and CPC (choroid plexus cauterization) are often performed together to improve outcomes, and this newer option is not yet widely available. When possible, ETV/CPC is preferred to shunting because it is less invasive, is better tolerated, and has fewer risks.

ETV: In this minimally invasive procedure for obstructive hydrocephalus (that is, caused by a blockage), neurosurgeons use a small, thin tube called an endoscope to make a hole in the third ventricle of the brain, creating a new pathway where fluid can be drained and reabsorbed into the bloodstream.
CPC: Neurosurgeons use a small, electrified wire to burn some of the choroid plexus, which is tissue that produces cerebrospinal fluid. This reduces the amount of fluid the choroid plexus creates.

Temporary External Drain

To quickly drain excess cerebrospinal fluid, surgeons can tap into your child’s brain or spine to remove the fluid directly. This is useful for short-term or emergency relief of pressure on the brain, but it is typically followed up by a different surgery for longer-term management.

Ventricular Reservoir

Used most often in premature infants, ventricular reservoirs have two main parts. A catheter is surgically placed into a brain ventricle where there is too much fluid. An attached bag sits between the scalp and skull and collects fluid, which can be removed with a needle as needed. Typically, this method is used only until an infant is able to receive a shunt or no longer needs to have fluid drained.

Medication

For older children, a neurologist may prescribe medications that limit cerebrospinal fluid production.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Why Choose Duke

Team Approach
Pediatric neurologists, neurosurgeons, neuropsychologists, mental health professionals, and others work together to diagnose and treat your child, address any underlying brain issues, and monitor neurodevelopmental concerns.

Certified Children’s Surgery Center
As defined by the American College of Surgeons, Duke Children’s Hospital is one of only a limited number of Level I Children’s Surgery Centers in the country, and the only one in North Carolina. This designation recognizes our commitment to providing the highest-quality surgical care to our youngest patients.

Family-to-Family Counseling
We have families who are happy to share their experiences with their own children’s diagnosis and treatment for hydrocephalus. We believe making these kinds of connections can keep you from feeling isolated and help you know what to expect.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.

Related Treatments and Conditions

Patient Resources

Hydrocephalus Association

Reviewed: 10/03/2019