CONTENT 

WHAT IS HYDROCEPHALUS 

1.       Hydrocephalus is a condition in which a large amount of spinal fluid builds up in the head.  

2.     Spinal fluid (also called cerebral spinal fluid or CSF) is made in small areas in the brain called ventricles.   

3.     The ventricles are four (4) cavities or hollow areas in the brain that are filled with the fluid.   

4.     The brain makes new spinal fluid daily. 

5.     Spinal fluid bathes the brain (keeps it moist) and cushions it from blows to the head. 

6.     The fluid flows out of the ventricles, bathes the brain, travels down the spinal column and ends up in the bloodstream. 

      Normal Ventricles                                        Abnormal Ventricles 

WHAT CAUSES HYDROCEPHALUS 

1.       Hydrocephalus occurs when spinal fluid cannot get out of the ventricles (where it is made) or if too much spinal fluid is made (rare). 

2.     Hydrocephalus may exist before birth or something may happen after birth that can cause it, such as: 

a.      Infection in the brain 

b.     Bleeding in the brain  

c.      Tumors 

d.      Head injury 

e.      Birth defects that involve the brain. 

  HOW IS HYDROCEPHALUS DIAGNOSED 

There are several tests that can be done to diagnose hydrocephalus and to , find out how it is doing.  These tests are: 

1.       Head Ultrasound 

2.     CT or CAT SCAN:  Stands for Computerized Axial Tomography. 

3.     MRI:  Stands for Magnetic Resonance Imaging. 

4.     The doctor will decide if your baby needs any of these tests. 

 HOW IS HYDROCEPHALUS TREATED 

1.       Pressure on the brain from the fluid buildup can cause the brain to be damaged, so a small tube is placed in the baby’s brain to bypass the blocked area and drain spinal fluid to another area where it can be absorbed. 

2.     The tube is a small, very soft plastic tube about the size of the ink tube inside a pen.  It is referred to as a shunt.   

3.     There are two (2) main types of shunts: 

4.     The most common type of shunt is a Ventriculo-Peritoneal (VP) Shunt.   

            VP Shunt

HOW DOES THE SHUNT WORK

1.       Surgery is needed to insert the shunt (tube).   

2.     The shunt has 3 parts: 

a.      A short tube that is inserted into the ventricle 

b.     A reservoir that lets the spinal fluid drain away from the ventricle only 

c.      A long thin tube that goes from the reservoir to the belly.  This catheter is coiled in the belly area so that it extends (uncoils) as the baby grows.   

3.     Some shunts have a pump (flushing device) that is used to test the shunt to see if it is working.  The pump looks like a small lump under the scalp. 

4.     The shunt tubing looks like a large vein that runs down your baby’s body.   

5.     Hair will cover the cut on his scalp. 

  HOW IS IT INSERTED 

1.       There are at least 2 cuts made for the shunt placement 

a.      A horseshoe-shaped cut is made above and slightly behind the ear where the tube enters the head.  If the shunt has a pump, there will be a small raised area about the size of a quarter behind the ear. 

b.     A small straight cut is made on the tummy where the end of the tube is in the belly. 

2.     Sometimes other cuts are made in the neck area and in the chest area to help thread the tube down to the belly.   

a.         If these cuts are made the stitches are usually removed 10-14 days after surgery. 

3.     A small hole is made in the skull and the shunt tube is passed into the ventricle in the brain. 

4.     The other end of the tube is passed under the skin behind the ear into the belly (abdomen). 

5.     A small one-way valve or opening in the tube controls the flow of spinal fluid out of the brain when pressure from the fluid builds up. 

6.     This one-way valve or opening also prevents the flow of fluid back into the brain. 

7.     If the shunt has a pump, the neurosurgeon (brain doctor) will tell you if, when, and how to press on the pump (we call this “pumping the shunt”). 

  DOCTOR VISITS 

1.       Your baby needs to be followed by a neurosurgeon after discharge from the hospital.  A neurosurgeon is a doctor with special education and training in brain surgery.  He is the surgeon who will put your baby’s shunt in. 

2.     Your baby may also need to see a pediatric neurologist.  A pediatric neurologist is a doctor with special education and training in the development and working of a child’s brain. 

3.     Your baby’s head will be measured with each visit to the doctors. 

4.     The neurosurgeon will decide when any scans need to be repeated. 

 WHAT DO PARENTS NEED TO KNOW 

1.       Handle your baby the same way you would any baby. 

2.     "Back To Sleep" is the recommended position for sleep. 

3.     Your baby can tolerate being held in different positions; you can bounce him, or play with him like any baby.

4.     Your baby will probably need the shunt all of his life.   

5.     If the shunt has a pump, the neurosurgeon (brain doctor) will tell you if, when, and how to press on the pump (we call this “pumping the shunt”). 

6.   The shunt may need to be replaced due to an infection, if it is not working properly (blocked) or if your baby outgrows the shunt tubing.  This is called a “shunt revision.” 

7.  Blocked shunt:  The shunt can get plugged and stop draining spinal fluid.  This causes the spinal fluid to build up pressure in the ventricle.  Signs the shunt is not working may include one or more of the following: 

8.  Infections:  The shunt can get infected.  It is important to make sure infections like ear infections, throat infections, boils or any skin infection are treated quickly.  Signs the shunt is infected may include: 

9.     Specific instructions from your baby’s neurosurgeon will be sent home with you. 

10.  It’s important that you call your doctor right away if you suspect any problems with the shunt. 

  THE FUTURE 

1.       The outcome of hydrocephalus depends on the original cause or problem, which part of the brain is involved, and the severity of the problem. 

2.     While many children with hydrocephalus have neurological problems, some are normal. 

3.     It’s important for your baby to be seen by a doctor who specializes in infant/child development. 

4.     We refer you to a community program (Child Service Coordination) that helps you work with your baby if there are any developmental problems.  Please feel free to contact them after your baby has arrived at home.  Their phone number locally is (910) 433-3803.   

  CALL THE DOCTOR IF… 

1.       You think your baby’s shunt may not be working or it may be infected.

2.     You think your baby is not acting as he/she usually does. 

Reviewed/Revised:

1/97, 1/99, 6/01, 4/03, 8/05, 4/07