Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) accumulates in the brain’s ventricles, leading to increased pressure and ventricular enlargement. It can be congenital (present at birth) or acquired later due to infection, hemorrhage, trauma, or tumor. If left untreated, it may cause developmental delay, vision loss, or neurological injury. Modern neurosurgery offers effective solutions through ventriculoperitoneal shunt placement or endoscopic third ventriculostomy (ETV), restoring normal CSF flow and preventing complications.
Symptoms
Symptoms vary with age and the underlying cause, but early recognition is crucial for preventing brain damage.
In Infants
- Rapid head enlargement or bulging fontanelle (“soft spot”)
- Separated skull sutures
- Downward deviation of eyes (“sunset sign”)
- Vomiting, irritability, poor feeding
- Delayed development or seizures
In Older Children and Adults
- Headache, nausea, vomiting
- Blurred or double vision
- Gait imbalance or clumsiness
- Urinary incontinence
- Cognitive decline or lethargy
Diagnosis
Diagnosis begins with cranial ultrasound in infants and MRI or CT scan in older children. These imaging studies show ventricular enlargement and help determine whether the hydrocephalus is communicating (free CSF flow) or non-communicating (obstructive).
Additional tests include:
- Neuroendoscopy for direct visualization of obstruction
- Intracranial pressure (ICP) monitoring in complex cases
- Infection screening if previous shunt or meningitis is suspected
Treatment Options
- Ventriculoperitoneal (VP) Shunt Surgery: The most common and time-tested procedure for hydrocephalus. A thin silicone catheter is placed from the brain’s ventricles to the abdominal cavity, where the excess fluid is safely absorbed. A pressure-regulated valve ensures balanced drainage and prevents overdrainage. Modern programmable shunt systems allow noninvasive adjustment of flow according to patient needs.
- Endoscopic Third Ventriculostomy (ETV): An excellent shunt-free alternative for obstructive hydrocephalus (such as aqueductal stenosis). Using a small endoscope, a new pathway is created at the floor of the third ventricle to allow CSF to bypass the obstruction and circulate normally. This technique eliminates long-term shunt dependency in many patients.
- Shunt Revision or Infection Management: In patients with existing shunts, malfunction or infection may require partial or complete revision. Infections are treated with antibiotics and temporary external ventricular drainage until a new sterile shunt can be placed.
- Combined and Specialized Care: In premature infants or children with complex malformations, surgery is often coordinated with neonatology, ophthalmology, and rehabilitation teams for optimal developmental outcomes.
Recovery & Follow-Up
After shunt or ETV surgery, most children stay in the hospital for 2–5 days. Parents are educated to recognize early signs of shunt malfunction such as vomiting, headache, irritability, or drowsiness. Regular follow-up imaging (ultrasound, MRI) ensures ventricular size stability. Shunt systems can function for many years, but periodic monitoring is vital. Children treated with ETV are followed to confirm sustained CSF circulation and neurological progress.
When to See a Pediatric Neurosurgeon
Seek urgent evaluation if your child has rapid head growth, vomiting, sleepiness, or eye movement abnormalities. Early surgical intervention prevents irreversible brain damage and allows normal development.