Brain, Nervous System and Mental Conditions

Hydrocephalus Treatment

Most children with hydrocephalus need surgery to help the cerebrospinal fluid (CSF) drain from their head, using a shunt , to some other part of their body that can absorb the fluid. Rarely, treatment involves making a channel in the brain so CSF can flow through the brain a different way. This may be an option only for certain causes of hydrocephalus.

Shunts

Areas a VP shunt placement. Reprinted from 'Principles of Neurosurgery,' 2nd edition, Edited by Setti S. Rengachary, Richard G. Ellenbogen, Copyright (2005), with permission from Elsevier

The three places where a shunt can be put in the head.

The most common treatment for hydrocephalus is surgery to put in a shunt. The shunt is used to drain extra CSF from ventricles in your child's brain to some other part in their body. There, the fluid is absorbed. The goal of putting in a shunt is to drain the CSF that your child's body makes each day (about a pint). This creates normal pressure inside your child's head.

The shunt has three parts:

  1. A tube that goes into the ventricle where fluid is building up.
  2. A valve that controls how much fluid drains out. This controls the pressure in your child's head and keeps fluid flowing away from the brain only.
  3. A tube that comes off the valve and goes into some other part of the body.

In most cases, the tube that comes off the valve goes into the belly (abdomen). This is called a ventriculoperitoneal (pronounced ven-trick-yoo-lo-pair-ih-tuh-NEE-ahl) shunt (VP shunt). In some cases, the tube goes into an upper chamber in the heart (atrium) or into the lining of the lung instead.

Placement of a VP shunt. Reprinted from 'Principles of Neurosurgery,' 2nd edition, Edited by Setti S. Rengachary, Richard G. Ellenbogen, Copyright (2005), with permission from Elsevier

Placement of a shunt from the head to the belly.

Our neurosurgeons use different shunts and valves, based on your child's needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. Any time your child has an MRI, this type of valve must be reset. Our neurosurgery nurse practitioners can reset these valves.

Endoscopy

An endoscope is a thin tube that carries a light and a camera. Surgeons can use it to see inside the body and perform surgeries. Surgery using an endoscope (endoscopy) requires smaller cuts (incisions) than open surgery. It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.

Some children have a complex condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scarring creates many small pockets of CSF that do not connect with each other.

In the past, doctors treated multiloculated hydrocephalus by placing a separate shunt in each pocket that held fluid. Now, using an endoscope, they can make small holes in the pockets. This connects the pockets so your child needs only one shunt.

Endoscopic Third Ventriculostomy (ETV)

The approach made by an endoscope. Reprinted from 'Principles of Neurosurgery,' 2nd edition, Edited by Setti S. Rengachary, Richard G. Ellenbogen, Copyright (2005), with permission from Elsevier

An endoscope being used to make a hole in the ventricle so the patient can avoid needing a shunt.

For a small number of children, an endoscopic third ventriculostomy (ETV) surgery may be a treatment option. This surgery replaces the need to have a shunt. Most often it's done in children who have a narrow or blocked channel leading out of their ventricles (aqueductal stenosis). Depending on your child's brain structures and age, the neurosurgeon may talk with you about doing an ETV instead of putting in a shunt.

During an ETV, the neurosurgeon makes a small hole in your child's skull. Then the neurosurgeon uses a rigid endoscope to go into the third ventricle and make a hole in the bottom of it. CSF flows out of this hole and reaches the normal places around the brain where it is absorbed.

Children who have an ETV may avoid complications linked with shunts, such as getting infections or needing a shunt replaced (shunt revision). In carefully selected patients, ETV has a high success rate. Some children who have an ETV need to have a shunt put in later.

Choroid Plexus Cauterization

If your child's body isn't absorbing CSF well, a choroid plexus cauterization (CPC) may be a treatment option. This would be done during the same surgery as ETV. It's done to decrease the amount of CSF made in your child's brain. This may help avoid the need for a shunt in the future.

In CPC, the neurosurgeon uses a flexible endoscope to reach the choroid plexus in the lateral ventricles  each side of the brain. Then the surgeon sends an electric current to this tissue. The current burns the tissue so it doesn't make as much CSF. CPC may lower the level of fluid enough that your child's body can keep up with absorbing it.