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What is hydrocephalus?

The word hydrocephalus comes from the Greek ‘hydro’, meaning water and ‘cephalous’ meaning head.

Hydrocephalus is the medical term given to a condition causing the build up of cerebrospinal fluid within the skull. cerebrospinal fluid is a watery fluid that is constantly produced and then reabsorbed. As a result the brain and spinal cord are bathed in cerebrospinal fluid. This fluid acts as a buffer that provides some cushioning to the brain against impact, provides nourishment and removes waste.

Illustration of brain inside child's head where the cerebrospinal fluid has built up in the ventricles compared to a normal brain

If the flow of cerebrospinal fluid becomes blocked (obstructive hydrocephalus) or is prevented from draining away (communicating hydrocephalus) then cerebrospinal fluid will build up within the ventricular system causing hydrocephalus. Hydrocephalus causes an increase in pressure within the skull which is called raised intracranial pressure (ICP).

What effect does raised intracranial pressure (ICP) have?

If intracranial pressure (ICP) is left untreated, cerebrospinal fluid will build up in the system and causes part of the brain to swell. This compresses the brain tissue and raises the pressure within your child’s head. As this pressure builds up it affects the function of the brain and over time will cause damage.

What causes hydrocephalus?

Your child can be born with hydrocephalus (called congenital hydrocephalus) or something may have happened (called acquired hydrocephalous).

Causes of congenital hydrocephalus

Often the cause of congenital hydrocephalus cannot be determined. It is important to note the congenital does not mean the condition is hereditary.

Causes of acquired hydrocephalus

These occur after birth from causes such as infections, tumours or head injuries.

How do you diagnose hydrocephalus?

There are 2 ways we can check for hydrocephalus.

Medical imaging

The doctors can look at the inside of your child’s head by using a few methods of imaging. These include CT (computerised tomography), cranial ultrasound and MRI (magnetic resonance imaging). Your doctor will discuss with you the best option for your child.

ICP monitoring

Intracranial pressure monitoring measures the pressure inside the head, using a pressure monitor. This is put into your child’s skull during surgery while they are under general anaesthetic.

A thin wire runs from under the skull to the outside where it connects to the pressure monitoring equipment. The pressure will then be monitored for a period of time (usually 24 to 48 hours). A computer records these results.

What are the long term effects of hydrocephalus?

The effects of hydrocephalus vary from one individual to another. Many children grow up to develop well and achieve a normal intelligence. However, there can be learning difficulty associated with hydrocephalus. This can be issues with:

  • concentration
  • reasoning
  • memory problems
  • co-ordination
  • motivation
  • organisational problems

What are the symptoms of hydrocephalus?

Symptoms vary between individuals. The most common symptoms for babies are:

  • increased head size (usually over a short period of time)
  • a tense or bulging soft spot
  • thin shiny skin with distended veins on the scalp
  • drowsiness
  • being sick
  • irritability
  • downward-looking eyes
  • occasional seizures or fits
  • poor feeding

The most common symptoms for children 2 years of age and older are:

  • headaches
  • feeling sick and uninterested in food or drink
  • being sick
  • irritability
  • drowsiness, sleepy and being hard to wake
  • balance problems
  • changes in behaviour
  • downward-looking eyes
  • seizures
  • sensitivity to bright lights (photophobia)
  • deteriorating school performance

How is hydrocephalus treated?

The doctors treating your child will determine the best treatment for your child. The methods that are used are:

  • ventricular tap
  • ventricular reservoir
  • shunts
  • neuro-endoscopic third ventriculostomy (ETV)

Why does my child need surgery?

We need to treat the hydrocephalus to prevent it getting worse. If we do not treat the hydrocephalus in a timely manner the fluid in your child’s head will continue to build up and put further pressure on your child’s brain. This will cause them to become very unwell. If left untreated, children with hydrocephalus are at risk of developing visual and learning difficulties, seizures and having a reduced level of consciousness.

In small babies. the team may monitor your child for a period of time before proceeding with surgery. Our team is experienced in managing hydrocephalus in young babies and will ensure that surgery is done at the most appropriate time for your child.

There are no alternatives to surgery that will treat acute hydrocephalus successfully. If hydrocephalus is left untreated there is a risk your child’s condition will worsen leading to a medical emergency.

What happens in the future?

Your child will have life long follow up with the neurosurgical team and continued support from the clinical nurse specialists and ward staff. All of our neurosurgical team work for adult services so you can continue with the same doctors into adulthood.

Further resources

Please read our resource for more information about risks of anaesthetics.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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