Pediatric Hydrocephalus
Pediatric hydrocephalus occurs when cerebrospinal fluid (CSF) builds up within the brain’s ventricles, causing them to enlarge and sometimes increasing pressure on the brain. Early evaluation helps determine the cause and whether treatment is needed to protect neurological function and development.
Quick Answer
Pediatric hydrocephalus is a buildup of cerebrospinal fluid (CSF) within the brain’s ventricles. It may be present at birth or develop later and can look very different in infants than in older children. When treatment is needed, the two most common approaches are a VP shunt or Endoscopic Third Ventriculostomy (ETV), depending on the child’s age, anatomy, and cause of hydrocephalus.
Key Takeaways
- Hydrocephalus causes cerebrospinal fluid (CSF) to build up within the brain’s ventricles.
- Signs differ by age — infants may develop rapid head growth, while older children may have headaches, vomiting, vision changes, or balance problems.
- Imaging helps confirm enlarged ventricles and identify what is disrupting normal CSF flow.
- Treatment may involve a VP shunt or Endoscopic Third Ventriculostomy (ETV), depending on the child’s anatomy and underlying cause.
- Children treated for hydrocephalus need ongoing follow-up as they grow.
Pediatric Hydrocephalus at a Glance
| Condition | Pediatric hydrocephalus |
|---|---|
| What it is | A buildup of cerebrospinal fluid (CSF) within the brain’s ventricles that can increase pressure |
| Who it affects | Infants, children, and adolescents |
| Common causes | Congenital brain abnormalities, aqueductal stenosis, spina bifida, Chiari malformation, brain tumors, bleeding, infection, or inflammation |
| Common symptoms | Enlarging head size in infants; headaches, vomiting, vision changes, balance problems, or developmental changes in older children |
| Diagnosis | Neurological examination with ultrasound, MRI, or CT when appropriate |
| Treatment | VP shunt placement or Endoscopic Third Ventriculostomy (ETV), depending on the cause and anatomy |
| Long-term outlook | With timely treatment and follow-up, many children with hydrocephalus lead active, healthy lives |
Understanding Pediatric Hydrocephalus
Cerebrospinal fluid (CSF) is a clear fluid that surrounds and cushions the brain and spinal cord. Normally, it circulates through fluid-filled spaces in the brain called ventricles and is then absorbed into the bloodstream.
Hydrocephalus develops when that circulation is disrupted. CSF may become blocked, may not be absorbed normally, or—less commonly—may be produced in excess. As fluid accumulates, the ventricles enlarge and pressure inside the skull may increase.
What Causes Hydrocephalus in Children?
Hydrocephalus may be present at birth or develop later in infancy or childhood. Causes can include:
- Aqueductal stenosis or other congenital abnormalities affecting CSF flow
- Spina bifida and Chiari malformation
- Brain tumors or cysts that obstruct CSF pathways
- Bleeding within the brain, including intraventricular hemorrhage in premature infants
- Meningitis or other infections
- Inflammation or scarring that interferes with normal CSF circulation
Why Early Evaluation Matters
A child’s brain is still developing, so persistent pressure or progressive ventricular enlargement can affect neurological function and development. Early evaluation helps determine whether hydrocephalus is stable or progressing and whether treatment is needed.
Signs & Symptoms
The signs and symptoms of pediatric hydrocephalus vary with a child’s age, how quickly cerebrospinal fluid accumulates, and the underlying cause. Because an infant’s skull has not yet fully fused, hydrocephalus can look different in babies than it does in older children.
Common Signs & Symptoms
- Rapidly increasing head circumference
- Bulging or tense soft spot (fontanelle)
- Prominent scalp veins
- Downward-looking eyes (“sunsetting”)
- Poor feeding or repeated vomiting
- Excessive sleepiness or irritability
- Seizures
Common Signs & Symptoms
- Persistent or worsening headaches
- Nausea or vomiting
- Vision changes or double vision
- Difficulty walking or maintaining balance
- Changes in school performance, attention, or behavior
- Developmental changes or loss of previously acquired skills
- Excessive sleepiness
- Seizures
When to Seek Immediate Medical Care
Seek urgent medical attention for a sudden severe headache, repeated vomiting, unusual difficulty waking, a new seizure, loss of consciousness, or rapidly worsening neurological symptoms. For a child with a shunt, these symptoms may also signal a shunt problem that needs prompt evaluation.
Diagnosis
Diagnosis begins with your child’s medical history, neurological examination, and assessment of growth and development. In infants, head circumference and the appearance of the fontanelle can provide important clues.
Imaging the Brain and CSF Pathways
Imaging confirms whether the ventricles are enlarged and helps identify what may be interfering with normal cerebrospinal fluid flow.
- Cranial ultrasound may be used in young infants while the fontanelle remains open.
- MRI provides detailed images of the brain and ventricular system without ionizing radiation and can identify an obstruction, tumor, Chiari malformation, or other structural cause.
- CT may be used when rapid imaging is needed or MRI is not appropriate.
Determining Whether Treatment Is Needed
Enlarged ventricles do not automatically mean a child needs surgery. Your pediatric neurosurgeon considers symptoms, neurological findings, head growth, developmental changes, imaging, and the underlying cause to determine whether hydrocephalus is stable or requires treatment.
Treatment
Treatment is individualized based on your child’s age, symptoms, imaging findings, anatomy, and the cause of hydrocephalus. When surgery is needed, the goal is to relieve pressure and restore or redirect the flow of cerebrospinal fluid.
VP Shunt Placement
A ventriculoperitoneal (VP) shunt uses a thin catheter and valve system to redirect excess CSF from the brain’s ventricles to the abdomen, where the fluid can be absorbed.
May be considered when: A child needs reliable CSF diversion and the cause or anatomy is not well suited to an endoscopic bypass.
Endoscopic Third Ventriculostomy (ETV)
ETV creates a small opening in the floor of the third ventricle so CSF can bypass certain obstructions and circulate through an alternate pathway.
May be considered when: The child’s age, anatomy, and cause of hydrocephalus make an endoscopic bypass likely to succeed.
Shunt Revision & Long-Term Follow-Up
Children with shunts need ongoing follow-up because a shunt can become blocked, infected, disconnected, or require revision over time. Families are taught which symptoms may signal a shunt problem and when to seek evaluation.
Children treated with ETV also require follow-up. ETV can allow selected children to avoid an implanted shunt, but the opening can occasionally close and hydrocephalus can recur.
How We Choose the Right Treatment
There is no single procedure that is best for every child. The decision between observation, shunt placement, ETV, or another approach depends on the cause of hydrocephalus, ventricular anatomy, age, prior treatment, symptoms, and likelihood of long-term success.
The Diagnosis-to-Treatment Pathway
1. Evaluation
Your pediatric neurosurgeon reviews symptoms, head growth, development, neurological findings, and medical history.
2. Imaging
Ultrasound, MRI, or CT confirms ventricular enlargement and helps identify what is disrupting normal CSF flow.
3. Treatment Planning
Your child’s age, anatomy, symptoms, underlying cause, and prior treatment are considered together.
4. Treatment
When treatment is needed, CSF flow may be restored or redirected with VP shunt placement, ETV, or another individualized approach.
5. Long-Term Follow-Up
Symptoms, neurological development, imaging, and treatment function are monitored as your child grows.
Frequently Asked Questions
Hydrocephalus can result from conditions that block normal cerebrospinal fluid flow or interfere with its absorption. Causes include congenital brain abnormalities, aqueductal stenosis, spina bifida, Chiari malformation, brain tumors, bleeding within the brain, infection, or inflammation. In some children, the cause is present at birth; in others, hydrocephalus develops later.
Yes. Hydrocephalus may be congenital and present at birth, or it may develop later in infancy or childhood. Prenatal imaging sometimes identifies enlarged ventricles before birth, while other children are diagnosed after symptoms or changes in head growth appear.
Possible signs in infants include rapidly increasing head circumference, a bulging or tense fontanelle, prominent scalp veins, downward-looking eyes, poor feeding, vomiting, irritability, excessive sleepiness, or seizures. Symptoms vary, so concerning changes should be evaluated by a medical professional.
Not every child follows the same course, but hydrocephalus that is causing progressive ventricular enlargement, increased pressure, or neurological symptoms often requires treatment to restore or redirect CSF flow. Your pediatric neurosurgeon will base the recommendation on symptoms, imaging, anatomy, and the underlying cause.
A VP shunt redirects excess cerebrospinal fluid through a catheter to the abdomen, where it can be absorbed. ETV creates an internal opening that allows CSF to bypass certain obstructions without an implanted shunt. ETV is not appropriate for every child; candidacy depends on age, anatomy, and the cause of hydrocephalus.
Some children remain dependent on a shunt long term, while others may eventually become candidates for a different CSF treatment. Shunt needs vary widely, and a shunt should never be assumed to be unnecessary without evaluation by a neurosurgeon.
Many children with well-managed hydrocephalus attend school, participate in activities, and lead active lives. Recommendations depend on a child’s neurological development, underlying condition, treatment, and individual needs. Your care team can provide guidance about school accommodations and activity restrictions when necessary.
Hydrocephalus can affect development when increased pressure or the underlying neurological condition interferes with brain function. Early treatment, developmental monitoring, therapy when needed, and ongoing pediatric neurosurgical follow-up can help support a child’s development and quality of life.
Pediatric Hydrocephalus Specialist at Atlantic Brain and Spine
Kate T. Carroll, MD, is a fellowship-trained pediatric neurosurgeon providing specialized care for children with hydrocephalus, shunts, and other cerebrospinal fluid disorders.
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