Shunt procedure
If hydrocephalus is diagnosed, treatment will depend on the age of the child, the cause of the cerebral spinal fluid build-up (whether from a blockage, overproduction of fluid, or another problem), and the child's overall health.
Shunt procedures, which have been the standard of care for decades, involve surgically implanting one end of a catheter (flexible tube) into a ventricle of the brain and placing the other end in the abdominal cavity, chambers of the heart, or space around the lungs where fluid is drained and absorbed by the bloodstream. A valve in the shunt system regulates flow to prevent over-draining and under-draining.
While shunting is often an effective treatment for hydrocephalus, there is a high chance of failure and complications. About 30% of shunts will stop working within the first year, with about 5% failing in each subsequent year, causing symptoms to recur. A child will need to have surgery to correct the problem – whether it requires replacing a catheter or valve or replacing the entire shunt. Most kids who undergo shunting will require subsequent operations over their lifetimes to regulate shunt problems.
Infections are another side effect of shunting, and occur in 5%-10% of shunt operations. Kids will develop typical signs of infection, like fever and neck stiffness, and may feel tenderness along the shunt or belly pain. Most infections develop within the first several months after a shunt procedure and require temporary removal of the device while a child receives intravenous antibiotics for up to 2 weeks.
Ventriculostomy
A second, increasingly more common treatment for hydrocephalus is an endoscopic third ventriculostomy. During this procedure, a small opening is made in the bottom of the third ventricle (one of four ventricles in the brain) to allow fluid to exit the brain.
This minimally invasive approach involves placing an endoscope (small lighted camera) inside the brain to provide surgeons with a view of the surgical site on a computer monitor. Then, using very small instruments, the doctor will make a tiny hole in the bottom of the third ventricle, where a thin membrane separates the inside and outside of the brain. This new "evacuation route" permits fluid to drain normally into the spaces outside the brain while bypassing any obstructions that are causing a backup, so the body can reabsorb the CSF back into the bloodstream as it normally would.
When deemed appropriate, third ventriculostomies are the procedure of choice for kids older than 6 months of age due to a higher efficacy rate and lower risk of infection than shunting. Those who undergo the procedure have up to a 90% chance of long-term success, with little need for follow-up procedures.
Third ventriculostomies also have shown promise in newborns and may be offered as a treatment to these younger patients in the near future.
With timely treatment, many kids with hydrocephalus go on to lead normal lives. Those with more complex medical problems, like spina bifida or bleeding in the brain from prematurity, may experience a higher rate of complications due to their underlying medical conditions. In these kids, early intervention greatly improves the chances of recovery.