Hydrocephalus in Children

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 (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.
   

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. 

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.

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