Hydrocephalus is the accumulation of cerebral spinal fluid within the ventricles of the brain. This buildup of fluid causes the ventricles to become bigger, putting pressure on the surrounding brain tissue. Many of our PLGA children will require treatment for hydrocephalus. Undiagnosed, hydrocephalus can become life-threatening. Early diagnosis and treatment are critical for PLGA kids.

Symptoms

The symptoms can vary with the age of the child and how quickly the hydrocephalus develops. In infants the symptoms can include a larger than normal head, a bulging fontanelle, sleepiness, irritability and vomiting. Older children may complain of headache and nausea. Vomiting and sleepiness are not uncommon. The child may not be able to look up with his/her eyes.

Treatments

The most common treatment is a shunt that goes from the head draining fluid into the abdomen (a ventriculo-peritoneal or VP shunt). About 40,000 shunt related operations occur in the United States each year. There are several different types of shunts and valves that a neurosurgeon can chose from depending on the situation. Note: programmable shunts settings can be changed during an MRI. Thus, those children with programmable shunts will need to see the neurosurgeon after an MRI to reset the shunt.

In some cases a neurosurgeon can correct hydrocephalus with a different procedure called a third ventriculostomy. In these situations, the neurosurgeon is able to endoscopically create a hole in the floor of the ventricle allowing the fluid to drain out. With a third ventriculoscopy, no hardware is left in the body. Sudden closures can occur with third ventriculostomy. So, patients need to be aware of this potential problem.

Although some patients can go a decade or more without ever having a problem with their shunt, it is possible for shunt failure to develop years after it has been placed. It is important for shunted individual to learn the signs of potential serious complications Җ particularly obstruction and infection. The Hydrocephalus Association reports that 50% or shunted individuals will need a revision within 2 years.

Life-Threatening Complications

A critical aspect of managing hydrocephalus is being well informed and staying vigilant about potential life-threatening complications. Most problems associated with shunting or ETV occur weeks or even years after the surgery. When things are going well, it is easy to forget about hydrocephalus and having a shunt or an ETV. Complications include:

  • Shunt Infection
  • Shunt Malfunction
  • Shunt Obstruction
  • Subdural Hematoma
  • Overdrainage
  • Underdrainage

Symptoms of shunt malfunction vary considerably from person to person, but tend to be similar each time for a particular person. Often the symptoms that existed before treatment return when something is going wrong.

In infants, signs include a full and tense fontanel (soft spot), bulging of the scalp veins and swelling or redness along the shunt tract. Also watch for symptoms like unusual vomiting, irritability, sleepiness and decreased interest in eating. Be aware that medication with a side effect of drowsiness can mimic or mask signs of shunt malfunction and should be used with caution in those with hydrocephalus, especially infants and young children.

When the child is older and the fontanel and other sutures between the skull bones are closed, you no longer have the same warning signs. Children and adults may experience headaches, vomiting, irritability and tiredness. Swelling along the shunt tract occurs less frequently. In the event of an abrupt malfunction, a child may develop symptoms very rapidly, in a matter of hours or days. Without treatment, coma, and even death, may result.

Older children and young adults may also become increasingly tired, have difficulty waking up and staying awake, experience personality changes and, unless treated promptly, may go into a coma.

For more information about complications, please consult your doctor and review the Hydrocephalus Association’s Complications Support Guide

Developments in Treatments for Hydrocephalus

At the July 2nd, 2008 International Society of Pediatric Neuro-Oncologists meeting in Chicago, more than 100 families with children suffering from brain tumors gathered to ask questions directed at an interdisciplinary panel of pediatric brain tumor physicians. In this short video, Dr. Wong shares with the audience some of the new insights into treatment of hydrocephalus in pediatric brain tumor patients.

 

Reading materials on Hydrocephalus include: