Hydrocephalus | Diagnosis and Treatment

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How is hydrocephalus diagnosed?

When a baby is born with hydrocephalus, it doesn’t usually develop until the third trimester of the mother’s pregnancy. Fetal ultrasound is used to diagnose hydrocephalus when a baby is still in the womb.

In infants and older children, hydrocephalus is diagnosed with one or more of the following tests:

  • Ultrasound – this is a type of imaging that uses high-frequency sound waves to take pictures of the body's organs.
  • Computed tomography (CT) scans CT scans use x-ray equipment and powerful computers to create detailed images of the head and brain.
  • Magnetic resonance imaging (MRI) – MRI uses a combination of electromagnets and radio waves to take detailed images of the brain.
  • Intracranial pressure monitoring – this test measures the pressure in a child's skull.

What are the treatments for hydrocephalus?

Hydrocephalus needs to be treated with surgery. There are three options:

  • Shunt placement — This is the most common treatment for hydrocephalus. During the procedure, a shunt (a thin, flexible tube) is placed in the brain or spinal cord to drain the extra fluid. A one-way valve on the shunt regulates the flow of fluid. Many shunts can also be adjusted externally, using a magnetic device. Shunts need adjustment and replacement over time, and must be checked by a neurosurgeon on an ongoing basis.
  • Endoscopic third ventriculostomy (ETV) — This surgery may be an option for some children whose hydrocephalus is caused by a blocked connection between the third and fourth ventricles of the brain. This is a minimally invasive procedure that creates an opening in the floor of the third ventricle in the brain, allowing trapped fluid to escape into its normal pathway. 
  • Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC) — This procedure can be used to treat some infants with hydrocephalus. It combines ETV with CPC, which closes off areas in the brain (called choroid plexus) that produce cerebrospinal fluid. This approach reduces the amount of cerebrospinal fluid, while also eliminating blockages. This surgery was pioneered by Benjamin Warf, MD, neurosurgeon at Boston Children's Hospital and director of Neonatal and Congenital Anomaly Neurosurgery. 

Expert care for children with hydrocephalus

The Boston Children's Hydrocephalus Program has been diagnosing and treating children with hydrocephalus for decades. Our clinicians have extensive experience in treating children, teens and adults with all forms of the condition and can diagnose hydrocephalus before a baby is born.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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