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Hydrocephalus

What is hydrocephalus?

Hydrocephalus (hi-droh-sef-ah-lus) is an abnormal accumulation or build up of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. CSF is normally found in the 4 ventricles (spaces in the brain) and around the brain and spinal cord. CSF is constantly produced by the brain, absorbed into the blood stream, and eventually leaves the body through the kidneys. The increase in CSF can cause the ventricles to become enlarged, which may cause pressure on the brain. If not treated, brain injury can occur. A child can get hydrocephalus if the body does not reabsorb the CSF that is produced, or if the flow of the fluid is blocked.

What is the treatment?

Mild cases of hydrocephalus often do not require treatment and patients are observed over time with scans repeated as needed. There are 3 main types of surgery for hydrocephalus: 1. An External Ventricular Drain (EVD) is surgically placed to temporarily drain CSF into a bag outside the body. This relieves pressure on the brain and allows for healing after an injury. This is only used in the hospital setting and is not a long-term solution. 2. A Ventriculo-Peritoneal Shunt or VP Shunt is a tube put in the head to direct the flow of CSF from the ventricles of the brain to a space in the peritoneal cavity inside the abdomen (belly). This is the most common way to treat hydrocephalus. Sometimes the tube can be placed into the heart or outside the lungs instead of in the abdomen. This is used when permanent assistance is needed for the CSF to flow properly.

brain ventricles shunt

How is hydrocephalus diagnosed?

Tests that can be done to check for hydrocephalus include: Ultrasonography (ultrasound) - uses highfrequency sound waves to outline the size of the ventricles. Computerized tomography scan (CT scan) - uses a computer to take a head X-ray, which records pictures of the ventricles and the brain. Magnetic resonance imaging (MRI) - uses magnets and computers to produce pictures of the ventricles.

peritoneal cavity

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3. An endoscopic third ventriculostomy is useful if CSF flow is blocked. The surgeon uses an endoscope, a thin tube with a light on the end, to make a hole in the bottom of the third ventricle. This increases the flow of CSF in the central nervous system. This procedure is usually done along with placing a shunt and is not typically effective when used alone.

What else do I need to know?

Often the child may take a shower ­ even with stitches ­ the surgeon will determine this and inform you. If your child has an incision on the abdomen, avoid active play, lifting more than 5-10 pounds depending on the age and size of the child or straining for 4 to 6 weeks after surgery. Use sunscreen on the incision scar for 1 year to prevent permanent darkening. If your child has a programmable shunt, avoid strong magnetic sources near or moving over the shunt. Magnets in toys and refrigerators are not strong and do not present a risk to the child as long as they maintain a distance of at least 10 inches away from the valve of the shunt. If your child has a programmable shunt and needs an MRI, be sure to have the shunt checked afterward by a member of the neurosurgical team.

What can I expect after surgery?

Your child may spend up to several days in an intensive care unit after surgery. Then your child is transferred to a medical/surgical unit or directly to home. Your child may have a slight fever for 2 or 3 days after surgery.

How should I care for my child at home?

Keep the incision clean and dry until your doctor tells you it is okay to wash it. Until that time, do not wash or soak; give your child sponge baths. When it is okay to start cleaning the incisions, follow these steps once a day, or as directed by the surgical staff. 1. Wash your hands with antibacterial soap, rubbing all surfaces briskly, or use an alcohol hand sanitizer. 2. Dampen a clean washcloth with water and apply antibacterial soap. 3. Use a gentle, circular motion to clean from one end of the incision to the other. 4. Rinse the washcloth and with a gentle circular motion, rinse from one end of the incision to the other. 5. Gently pat dry with a clean cloth. 6. Apply a small amount of antibiotic ointment to the incision, if ordered by the doctor. 7. Wash your hands again.

When should I call the clinic?

Risks to watch for following surgery and shunt placement include infection, obstruction or malfunction of shunt. Call the clinic right away if: All ages: fever higher than 101.5° F within 6 months of surgery the incision or shunt is painful, red, swollen, or warm to the touch clear or other drainage from the incision vomiting (throwing up) irritable (crabby or fussy) sleepiness, hard to wake eyes appear to be looking downward loss of previous abilities seizures behavior changes

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For infants, call the clinic right away if: high-pitched cry when baby's head is upright, the fontanel (soft spot) still feels full to the touch bulging of scalp veins enlargement of the head For older children, call the clinic right away if: decreased appetite nausea (upset stomach) headache that does not go away with pain medicine blurred or double vision fall off in school performance

Questions?

This sheet is not specific to your child, but provides general information. If you have any questions, please call the clinic. For more information on Hydrocephalus, contact the Hydrocephalus Association at 1-888-598-3789 or visit their web site at http://www.hydroassoc.org. For more reading material about this and other health topics, please call or visit the Family Resource Center library, or visit our web site: www.childrensmn.org/A-Z.

Children's Hospitals and Clinics of Minnesota Patient/Family Education 2525 Chicago Avenue South Minneapolis, MN 55404 Last Reviewed 2/2013 Copyright

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