Hydrocephalus
Information on hydrocephalus
Signs and symptoms
For under the age of 1 year old:
- Enlargement of their head (getting larger)
- The fontanelle (soft spot on top of head) may become full and hard.
- Your baby may vomit or refuse feeds
- Your child may sleep more
- Irritability-more difficult to settle/comfort
- Downward looking eyes (Cannot look upwards)
- May have a high pitched cry
- Seizures / fits
For toddlers and older children:
- Enlargement / head getting larger
- Headache orvomiting
- Dizziness
- Seizures / fits weakness in legs or arms.
- Drowsiness / sleeping a lot
- Irritability / change in personality
- Visual (eye) problems / Sensitivity to lights
- Loss of previous ability- for example weakness in legs or arms
How is Hydrocephalus treated?
If your child develops hydrocephalus, they will need an operation to relieve the pressure caused by a build-up of fluid (CSF). This fluid can be drained in various different ways.
Ventricular Access Device
A Ventricular Access Device (VAD) is sometimes inserted in babies to allow drainage of fluid (CSF). They are inserted usually in babies that are not quite big enough for shunts. They may also be used for babies that have some blood in their fluid chambers. Once the babies reach an optimum weight and once the blood is cleared from the fluid chambers, the baby can then proceed to have a shunt inserted if it is required.
Ventriculoperitioneal (VP) Shunt
A shunt is a tube which is inserted into the fluid chambers (ventricles) and is passed down into the lining of the child’s tummy. It allows the excess fluid from the ventricles to drain, preventing it from building up in the child’s brain causing symptoms. Inside the shunt there is a valve that controls the flow of the CSF.
There are two different types of shunts – a). fixed pressure b) programmable.
Once your child’s shunt is inserted, the neurosurgery doctor or nurse will inform you which one was inserted, and they will give you documentation (shunt alert card) detailing all the information about the shunt. It is important that you keep this card safe and bring it with you to all hospital appointments.
Ventriculoatrial (VA) shunt
Sometimes if there are issues with the tummy absorbing this fluid, the neurosurgeon may decide to put the shunt in the heart. This shunt will be placed in the ventricles (fluid chambers) of the brain and passed down to the right atrium of the heart instead of the abdomen.
Endoscopic Third Ventriculostomy (ETV)
This operation involves the neurosurgeon making a small hole in the third ventricle in the brain to allow the fluid (CSF) to drain. Not all children may be suitable for this type of operation so your consultant will discuss this with you and your child. An MRI scan will probably be performed prior to this surgery.
What happens after I have a shunt inserted or an ETV performed?
The child will be discharged once they are comfortable, eating and drinking and mobilising around the ward. This can be quite quickly post shunt and ETV. For some children, they may be discharged after 1-2 days and for others it may take a few days longer to adjust to having a shunt inserted or an ETV performed. If it is the child’s first shunt, they will have two wounds (one on their head and one on their tummy). Advice will be given by the neurosurgical team how to care for these wounds, and they will be checked at the follow up out-patients appointment. For most children, they will have dissolvable sutures inserted. Once discharged from hospital, an appointment will be made for you to return to the Neurosurgery Advanced Nurse Practitioner (ANP) clinic for 4-6 weeks.