Hydrocephalus in

Children
Athenas Reyes
 What is hydrocephalus?
● Hydrocephalus is an abnormal build-up of
cerebrospinal fluid (CSF) in the ventricles inside
the brain.

● CSF moves around the brain and spinal cord on

a specific pathway. When too much CSF gets
trapped anywhere along this pathway, it can
expand the ventricles and put pressure on the
brain.
Causes

1. Obstruction: (most common cause) due to malformation or narrowing of

channels, the fluid flow stops and is accumulated in the ventricles
2. Poor Absorption: Due to conditions like inflammation of the tissues, CSF is
poorly absorbed in blood vessels, leading to increased volume.
3. Overproduction: caused when the tissues lining the ventricles produce an
increase quantity of fluid.
 CSF

● CSF performs various functions such as keeping the

brain buoyant, preventing brain injury by acting as a
cushion, keeping the brain and tissues clear of
waste products and helping to maintain a constant
pressure within different parts of the brain.

● In a normal person, the pressure created due to

cerebrospinal fluid is constant. This is because the
amount of fluid secreted is in balance with the
amount of fluid removed by absorption through blood
vessels. The fluid easily moves from one ventricle to
another with the help of channels.
2 types of Hydrocephalus:

1. Communicating Hydrocephalus: build-up of pressure

from too much CSF that is not being properly absorbed.
2. Non-communicating Hydrocephalus: build-up of
pressure from CSF when a blockage occurs within the
brain.
➔ Some causes of non-communicating hydrocephalus
maybe a tumor, a blood clot, or a narrowing part of the
CSF pathway found at birth.
● A person born with hydrocephalus is said to have
congenital hydrocephalus. Those who develop it later in
life are said to have acquired hydrocephalus.
 Signs & Symptoms in a Child:

1. Sleepiness
2. Blurred or double vision
3. irritability
4. Seizures
5. Vomiting
6. Thin scalp
7. “Setting-sun” eyes (eyes fixed downward)
How is hydrocephalus in a child treated?

The goal of treatment is to reduce the pressure

inside the baby’s head.
Ventriculoperitoneal shunt (VP) is often used to
direct fluid into the abdomen.
The shunt usually runs behind your baby’s ear. The
tubing goes under your baby’s skin to the belly, heart,
or lung.
The drainage location is decided based on the
baby’s condition, age, and other factors.
The belly is generally the first choice.
Peer review article #1:
Ventriculoperitoneal (VP) shunt surgery is the predominant mode of therapy for patients with hydrocephalus. However, it
as potential complications that may require multiple surgical procedures during a patient’s lifetime.

Objective: to review long-term experience and evaluate the risk factors for VP shunt failure after initial shunt surgery
and after subsequent revisions

Methods: Pt’s who underwent VP shunt surgery for hydrocephalus were included. Medical charts, operative reports,
imaging studies, and clinical follow up evaluations were reviewed and analyzed retrospectively.

Results: A total of 1015 patients at the time of VP shunt surgery were included.Adult patients less than, or equal to 17
years accounted for 70% of patients. The overall shunt failure rate requiring shunt revision was 46.3%, revision occurred
during the first 6 months. The shunt revision rate was significantly greater in pediatrics than in adult.

Conclusion: The findings indicate that age at shunt replacement, etiology of hydrocephalus, type of hydrocephalus, and
previous treatments before shunt surgery were independenlty significantly associated with shunt survival
Peer review article #2
Background: VPS is associated with complications that may lead to shunt revisions. This study studied the surgical
outcome of pediatric patients with HC in a population based setting

Methods: the medical charts and imaging findings of 80 patients less than 16 years of age who required VPS secondary
to HC were studied.

Results: Patients <6 months old had a higher shunt revision rate compared with patients >6 months old.. The most
common causes of HC requiring VPS were tumors, congenital defects and intraventricular hemorrhage

Conclusion: Half of patients with shunts required revision. Most revisions were done during the first year after the initial
VPS.
You can work on..
● Interventions that will help baby roll over

● Head control exercises

For Example: If the baby has trouble raising their head, lay the
baby in prone position and put a toy within reach to stimulate
interest and movement.

➔ Prone reaching for object

Cont’d
● To help them develop head control when lying face
up, take their upper arms and pull them gently until
their head hangs back a little, then lay them down
again.
References
1. Manohar, N., Masapu, D., Deepti, B. S., & Chakrabarti, D. (2017). Airway Management in an Infant With Huge
Hydrocephalus. AANA Journal, 85(4), 248–249.
2. Tervonen, J., Leinonen, V., Jääskeläinen, J. E., Koponen, S., & Huttunen, T. J. (2017). Rate and Risk Factors for Shunt
Revision in Pediatric Patients with Hydrocephalus-A Population-Based Study. World neurosurgery, 101, 615–622.
https://doi.org/10.1016/j.wneu.2017.02.030
3. Reddy, G. K., Bollam, P., & Caldito, G. (2014). Long-term outcomes of ventriculoperitoneal shunt surgery in patients
with hydrocephalus. World neurosurgery, 81(2), 404–410. https://doi.org/10.1016/j.wneu.2013.01.096