How Is Hydrocephalus Diagnosed?
DiagnosisHydrocephalus and intracranial cysts may be caused by other conditions, which is why an accurate diagnosis is critical to determining the most effective treatment.
In addition to a physical examination and complete medical history, a neurological examination is typically performed to identify alterations in your child’s brain function and mental status. This exam consists of assessing eye movements, vision, hearing, swallowing, motor function, sensation, balance, and coordination.
Brain imaging tests can help provide a detailed picture of the brain, allowing the physician to identify any excess cerebrospinal fluid.
- Computed tomography (CT) scan uses X-rays to create an image of the brain or spine.
- Magnetic resonance imaging (MRI) uses magnetic fields to create an image. MRI offers very detailed information based on specific imaging sequences that your neurosurgeon may request. Frequently, an additional MRI scan is requested even though one has already been done.
- Ultrasound may also be used as part of the diagnostic process, taking advantage of the open soft spot on an infant’s head through which the ultrasound waves can travel.
How Is Hydrocephalus Treated?
TreatmentIf a hydrocephalus diagnosis has been made, there are rarely options other than surgery for treatment.
If a definable mass is obstructing cerebrospinal fluid (CSF) flow, it may be possible to remove the mass and allow normal flow to resume. However, the blockage usually cannot be removed, and surgical intervention to reroute the fluid is typically needed to treat hydrocephalus.
Shunt placement
Surgery for hydrocephalus often means implanting a shunt, a small tube that drains the excess fluid from the brain to another location in the body — usually the abdominal cavity — for reabsorption. A device called a ventriculoperitoneal shunt drains excess CSF from the brain to the abdominal cavity. These shunts are very effective in relieving hydrocephalus, but they do carry a risk of infection or blockage.
The placement of a shunt allows patients to lead a normal life. The shunt may need to be repaired or replaced during a person’s lifetime.
Endoscopic third ventriculostomy
More recently, treatment for obstructive (noncommunicating) hydrocephalus can be done using an advanced minimally invasive endoscopic approach called endoscopic third ventriculostomy (ETV). The surgery is quick and safe, taking approximately 30 minutes. This is a minimally invasive surgical alternative to shunt placement.
This minimally invasive “shunt-free” technique involves the use of small caliber endoscopes. ETV involves making a small (just 3 or 4 mm) opening between the third ventricle and the subarachnoid space, therefore reestablishing normal CSF flow. The majority of patients stay in the hospital for only one night. Because there is no implanted device, there is no risk of shunt infection or mechanical malfunction.
Follow-up treatment
It is important for the doctors taking care of a child with hydrocephalus to have expertise in determining whether the problem has resolved or requires additional treatment. Resolved hydrocephalus may leave behind enlarged ventricles that are stable. It can sometimes be difficult to distinguish between enlarged, stable ventricles and unstable ones.
Often the decision about whether additional hydrocephalus treatment is necessary will be based on many factors, including symptoms, neurological exam findings, changes in activity level, or school performance. In addition to this, the patient will often have serial radiographic exams to look for changes in the ventricles.
FAQs
Trust NewYork-Presbyterian for Hydrocephalus Treatment
The pediatric neurosurgeons at NewYork-Presbyterian are known for their success in performing some of the most technically demanding and innovative neurosurgery procedures in children.
Because we are part of a world-class medical center, we have the ability to centralize care for our patients and connect them to providers in more than 100 specialties and subspecialties.
When the time comes, we can also provide the support patients and their families need to ensure a smooth transition from pediatric to adult care.