Treatments for Hydrocephalus

The pediatric neurosurgeons at the Pediatric Neurosurgery Program, along with the multidisciplinary team of expert physicians, treats hydrocephalus  

Hydrocephalus, which, in Greek, translates as water (hydro) and head (cephalus), is an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles (cavities) in the brain. It is one of the most common problems treated in pediatric neurosurgery.  Neonatal units from all over the Los Angeles metropolitan area refer pre-term infants who develop hydrocephalus to the Maxine-Dunitz Children’s Health Center for care.  Our physicians have extensive experience in the surgical treatment of hydrocephalus including minimally invasive endoscopic placement of ventriculoperitoneal shunts and endoscopic third ventriculostomy.  

CSF is produced in the ventricles (fluid spaces in the brain), circulates through the ventricular system and is then absorbed into the bloodstream. CSF protects the brain and spinal cord, contains nutrients and proteins that nourish the brain and carries away waste. Hydrocephalus occurs when there is an imbalance between the amount of CSF that is produced and the rate at which it is absorbed. As the CSF builds up, it causes the ventricles to enlarge and increases pressure in the head. It occurs in about 2 out of 1,000 births. Hydrocephalus that is congenital (present at birth) is caused by a complex interaction of environmental and genetic factors, such as spina bifida. Acquired hydrocephalus is most commonly caused by intraventricular hemorrhage, meningitis, head trauma, tumors or cysts.

The most effective and common treatment for hydrocephalus is surgical insertion of a shunt, although an endoscopic third ventriculostomy (ETV) is also an increasingly common treatment. A shunt is a flexible tube that diverts the flow of CSF from the ventricular system into another region of the body, such as the peritoneal (abdominal) cavity, where it can be absorbed. The surgical placement of a shunt is typically a relatively short and uncomplicated procedure. 

Though not appropriate for every patient and not a cure for hydrocephalus, a third ventriculostomy may be a good alternative to a shunt.  Less invasive than the shunt procedure because surgeons need only make a small hole in the skull (3-4 mm), a third ventriculostomy allows movement of cerebrospinal fluid (CSF) through a small perforation made in the floor of the third ventricle.  The perforation allows CSF to be diverted into open spaces in the brain, bypassing the obstruction and relieving pressure.

The third ventriculostomy is usually performed on patients over six months of age and physicians often prefer that the patient is over age 2.  Patients who have previously had a shunt may be good candidates for the procedure.

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