Hydrocephalus

Just a few decades ago, children with hydrocephalus—the buildup of excess fluid in the brain—faced only one possible course of treatment: the use of a device called a shunt to drain the excess fluid. In the video above, neurosurgeon Benjamin Warf, MD—whose pioneering work has earned him a “genius grant” from the John D. and Catherine T. MacArthur Foundation-- demonstrates a one-time, minimally invasive technique—which he originally developed in Africa—which allows some children to avoid the need for shunts.

The following pages will introduce you to the basics about hydrocephalus (which is also referred to as “water on the brain”), as well as the treatment methods—both traditional and emerging—that Children’s uses to treat babies and children with the disease.

• The brain has four cavities, called ventricles, which naturally produce a substance called cerebrospinal fluid.

• Cerebrospinal fluid circulates throughout the brain and spinal column, cushioning and nourishing the nervous system before being reabsorbed into the bloodstream.

Hydrocephalus can occur if:

• an obstruction stops the fluid from flowing naturally
• the bloodstream cannot adequately re-absorb the fluid
• a child's brain produces too much of this fluid

The buildup of too much fluid in the brain creates abnormally high pressure within the skull. If this pressure isn’t relieved, the tissues in the central nervous system can be damaged, blood flow throughout the brain and skull can become dangerously restricted and neurological function can be compromised or lost.

• Hydrocephalus is often a congenital condition, meaning babies are born with it. However, it can also develop in older children.

Sometimes, hydrocephalus is a complication of another condition, such as:

• spina bifida
• an intraventricular hemorrhage
• a spinal cord or brain tumor or lesion
• certain types of infection
• a traumatic head injury

The long-term outlook for a child with hydrocephalus depends greatly on many factors, including how old the child is when symptoms emerge, what causes the problem and how severe the symptoms are.

• Hydrocephalus is a progressive condition, meaning symptoms worsen over time.
• Children with hydrocephalus eventually need a surgical intervention.
• Many children do very well with treatment and can go on to fulfilling, active adult lives. 

How Boston Children's Hospital approaches hydrocephalus

Physicians at Boston Children's Hospital have been leaders in treating hydrocephalus for decades. Many decades ago, Children's became the first hospital in the world to treat children with hydrocephalus by rerouting—in a process known as shunting—excess fluid from the brain into another body cavity. In the years since, clinicians in our Hydrocephalus Program have:

• helped design and test the next generation of shunting devices, including the externally programmable shunt

• introduced and refined the use of minimally invasive surgical techniques—like the endoscopic third ventriculostomy procedure (ETV), and the landmark combined endoscopic third ventriculostomy/choroid plexus cauterization procedure (ETV/CPC) pioneered by Children's neurosurgeon Benjamin Warf, MD—to more effectively treat hydrocephalus while reducing the risk of complications and the need for involved aftercare
   
• taught these potentially life-saving techniques to pediatric neurosurgeons around the world

Our approaches to treating hydrocephalus are both patient-focused and family-centered. We never lose sight of the fact that your child is, first and foremost, an individual—not merely a patient—and we include your family at every stage of the treatment process. 

Hydrocephalus: Reviewed by Benjamin C. Warf, MD
© Children’s Hospital Boston; posted in 2011