Boston Children's Hospital has been a worldwide innovator in diagnosing and treating hydrocephalus for decades. Our clinicians have extensive experience in treating children, adolescents and adults with all forms of the condition, and can diagnose and help parents prepare for hydrocephalus in utero.
We use minimally invasive techniques—medical and surgical procedures that use small incisions and miniaturized cameras and tools—whenever we can. In fact, Children's has a Center for Minimally Invasive Surgery that is a global leader in creating and refining new surgical approaches.
The excessive intracranial pressure caused by the buildup of fluid in hydrocephalus can lead to serious, long-term neurological damage, so prompt treatment is a must.
The treatments our Children's team uses to address hydrocephalus are:
- shunt placement
- endoscopic third ventriculostomy (ETV)
- combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC)
Highly experienced in all of these procedures, neurosurgeons at Children's will work with you and your family to determine which approach best suits your child.
In the 1950s, Children's physicians became the first pediatric hospital to treat hydrocephalus by shunting—draining cerebrospinal fluid through a small, hollow tube that is inserted under the child's skin while he is under anesthesia. Today, shunt placement is the most common and widely used treatment for hydrocephalus.
During the procedure, the shunt is placed either into one of the brain's ventricles, or into the fluid space in the spine. It extends to a place in the body where the excess cerebrospinal fluid can be safely absorbed—usually, either the peritoneal cavity (the space containing organs in the belly), the heart or the chest cavity.
A one-way valve on the shunt regulates the flow of fluid. Many shunts today can also be adjusted externally, using a magnetic device that changes the pressure limit without requiring another incision and surgery. Children's neurosurgeons have helped to design and test several versions of the externally programmable shunt.
A child who has had a shunt placement will need regular medical evaluations to ensure that the device is working properly. Like any machine, shunts may need adjustment or even replacement over time, and must be checked by a neurosurgeon on an ongoing basis.
Your treatment team will carefully review instructions for your child's at-home shunt care and recommended long-term monitoring.
Endoscopic third ventriculostomy (ETV)
For some children whose hydrocephalus is caused by a blocked connection between the third and fourth ventricles of the brain, the endoscopic third ventriculostomy procedure (ETV) can be a desirable alternative to shunting. This minimally invasive procedure—which Children's neurosurgeons have helped to introduce and adapt—essentially cures hydrocephalus in children whose disease stems from an obstruction between the ventricles. It also eliminates a future dependence on shunts.
During the ETV procedure, the neurosurgeon uses a tiny camera and a miniature surgical instrument to create an opening in the floor of the third ventricle in the brain. This allows the entrapped fluid to escape from the ventricles into its normal circulation pathway. Usually, the trapped cerebrospinal fluid begins draining immediately after the opening is made; when successful, no further intervention is needed.
This minimally invasive surgery takes only about an hour, and children recover very quickly. Your neurosurgeon will continue to see your child regularly after undergoing ETV to make sure her intracranial pressure remains stable and that no complications develop.
Combined endoscopic third ventriculostomy/choroid plexus cauterization (ETV/CPC)
Benjamin Warf, MD, Children's neurosurgeon and director of Neonatal and Congenital Anomaly Neurosurgery, has pioneered a promising new treatment for hydrocephalus in infants: the combined endoscopic third ventriculostomy/choroid plexus cauterization procedure, or ETV/CPC.
The ventricles of the brain produce cerebrospinal fluid through four rich capillary beds—one in each ventricle—called choroid plexus. Historically, neurosurgeons had treated some cases of hydrocephalus by cauterizing the choroid plexus in the first and second ventricles, thereby reducing the production of fluid.
The technique had largely been abandoned, until Warf began combining it with endoscopic third ventriculostomy (ETV) and showed this combined procedure was superior to ETV alone in infants.
During choroid plexus cauterization, the neurosurgeon:
- makes a small incision in the child's scalp
- removes a tiny window of bone in the skull
- inserts a miniature tube called an endoscope outfitted with:
- an eye piece at the top attached to a video camera
- a wire passing through the endoscope that conducts precise electrical charges
- two tiny lights
- a lens at the end of the tube
- advances the endoscope into the fluid spaces inside the brain (the ventricles)
- performs the ETV by making an opening in the floor of the third ventricle
- identifies the choroid plexus in the first and second ventricles
- turns on the electrical charge once the tube is in position, cauterizing the choroid plexus in these two ventricles (but preserving the choroid plexus in the third and fourth ventricles, allowing continued production of cerebrospinal fluid)
Dr. Warf combines this choroid plexus cauterization technique with the endoscopic third ventriculostomy procedure to treat some children with hydrocephalus. The dual strength of this approach reduces the production of cerebrospinal fluid in the first and second ventricles, while eliminating blockages between the third and fourth ventricles at the same time.
Dr. Warf has published a study that reveals the combined ETV/CPC procedure is more effective in treating infants younger than 1 year than ETV alone. ETV/CPC has also proven to be a successful treatment for most infants with both hydrocephalus and spina bifida.
Dr. Warf is training pediatric neurosurgeons in Africa and elsewhere in the ETV/CPC technique, with a goal of drastically reducing dependence on shunts in the developing world. Learn more about his work.
Lifelong considerations for a child with hydrocephalus
The keys to treating hydrocephalus are:
- early detection
- prompt treatment
- diligent prevention of infection during surgery
Relieving excess intracranial pressure through shunting, ETV or ETV/CPC avoids the threat of continuing neurological damage. However, some children may continue to experience symptoms, such as headaches, which can persist even when intracranial pressure appears normal.
Unfortunately, no procedure can reverse neurological damage that may have occurred before your child was treated. Understanding that many children with hydrocephalus are living with these long-term complications, Children's neurosurgeons and neurologists work closely with many other specialists at the hospital—including neuropsychiatrists, social workers, behavioral and learning specialists—to help our patients with lasting cognitive and developmental problems.
Learn more about some of the caregivers you will meet during your child's treatment.
Please note that neither Boston Children's Hospital nor the Hydrocephalus Program at Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.
Helpful links for parents and families
Helpful links for teens
Helpful links for younger children