Hydrocephalus is a serious neurological condition caused by an abnormal buildup of cerebrospinal fluid (CSF) in the brain. For children, this can lead to increased brain pressure, which, if untreated, can affect cognitive, neurological and physical development. Addressing pediatric hydrocephalus early is essential to ensuring your child’s good health and well-being.
In this guide, we’ll explore the types of pediatric hydrocephalus, available treatment options, and how the New Jersey Pediatric Neuroscience Institute (NJPNI) provides expert care for patients with hydrocephalus.
What Is Pediatric Hydrocephalus?
Pediatric hydrocephalus occurs when the brain's normal circulation and drainage of CSF is disrupted. The excess fluid leads to increased pressure that can damage brain tissue and impair function. Normally, a child’s brain makes 5-15 cc ( 1- 3 teaspoons) of fluid every hour. This fluid circulates around the brain and is absorbed at the same rate.
Types of Pediatric Hydrocephalus
Communicating Hydrocephalus: Communicating hydrocephalus occurs when the brain is making fluid, and it circulates, but is not being absorbed well. Sometimes this occurs in the setting of macrocephaly ( a large head size). Babies with macrocephaly are often referred to a pediatric neurosurgeon. These infants will usually be sent for an ultrasound of the brain. The ultrasound may show that the CSF spaces are enlarged. Most infants outgrow this condition, that is called Benign Enlargement of the Subarachnoid Spaces (BESS) or Benign External Hydrocephalus (BEH).Infants with BESS or BEH are usually followed until age three years. Occasionally though, the communicating hydrocephalus does not resolve. In rare cases, these children require a ventriculoperitoneal shunt if they developed hydrocephalus with progressively enlarging ventricles.
Obstructive Hydrocephalus: This occurs when a blockage prevents the flow or circulation of CSF through the brain’s ventricles.
Normal Pressure Hydrocephalus (NPH): More common in older individuals but sometimes seen in children, this condition results from impaired CSF absorption, leading to symptoms despite “normal” pressure levels.
Accurate diagnosis is critical in determining the most effective treatment strategy for your child.
Advanced Treatment Options for Pediatric Hydrocephalus
Shunt System
The ventriculoperitoneal shunt system is one of the most widely used treatments for hydrocephalus. It involves surgically placing a small tube in the brain to redirect excess CSF to another part of the body, such as the abdominal cavity, where it can be absorbed.
Key Features:
Includes a valve to regulate CSF flow and pressure.
Can be adjusted for long-term use, making it a reliable option for children.
Effectiveness:
Shunts are a proven solution for managing hydrocephalus over the long term.
Endoscopic Third Ventriculostomy (ETV)
ETV is a minimally invasive procedure in which a small camera (endoscope) is used to create a bypass in the brain’s ventricles, allowing CSF to flow freely.
Benefits:
Often used for obstructive hydrocephalus.
Avoids the need for lifelong shunt management in some cases.
Considerations:
Not always a permanent solution; success depends on the individual case.
Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization (ETV/CPC)
This advanced technique combines the benefits of ETV with the reduction of CSF production by cauterizing the choroid plexus.
Advantages:
Particularly effective for infants and young children.
Reduces the likelihood of future complications by addressing both fluid flow and production.
Considerations:
Requires thorough evaluation by a pediatric neurosurgeon to ensure suitability.
Managing Normal Pressure Hydrocephalus (NPH)
While NPH typically affects older individuals, the treatment parallels pediatric hydrocephalus in many ways, especially through the use of shunts.
Symptoms of NPH:
Gait disturbances
Cognitive decline
Urinary incontinence
Treatment:
A ventriculoperitoneal (VP) shunt is commonly used to manage NPH, alleviating symptoms and improving quality of life.
