OHSU Doernbecher provides state-of-the-art care for hydrocephalus.

• Our pediatric neurosurgeons are national leaders in treating this complex disorder.
• We are among the few children’s hospitals to offer a minimally invasive technique that avoids shunts in some infants. It dramatically reduces complications and follow-up surgeries.
• We have rapid, radiation-free imaging for continuing care. 

Understanding hydrocephalus

Hydrocephalus, sometimes called “water on the brain,” is the most common condition treated by pediatric neurosurgeons. Most patients are younger than 6 months old when diagnosed.

Hydrocephalus occurs when too much cerebrospinal fluid, or CSF, builds up. This clear liquid flows in and around the brain and spinal cord to cushion them against injury. CSF also delivers nutrients, removes waste and helps maintain the brain’s proper equilibrium.

If CSF is blocked by disease or injury, it can build up and put pressure on brain tissue, possibly causing damage. In infants, whose skull bones aren’t fused, hydrocephalus can cause the head to expand.

Symptoms

Symptoms vary depending on age and type. They include:

• Headaches
• Vomiting 
• Drowsiness
• In infants, an uncommonly large head or a sudden increase in head size
• Poor feeding 
• A decline in thinking abilities, affecting school or work 
• Irritability 
• Blurred or double vision 
• Slow heart rate 
• Problems with balance and coordination 
• Seizures 
• “Sunset” eyes, with the eyes forced downward so the lower lid covers part of the iris, making it look like a setting sun

Leading-edge treatment

Doernbecher Children’s Hospital offers ETV/CPC, the most advanced surgery for treating hydrocephalus in some infants. This procedure eliminates the need for a shunt. 

How it works

The surgeon guides a flexible neuroendoscope, a tiny telescope with attached surgical equipment and computer-aided navigation, through a small incision in the skull. 

The surgeon creates a small opening in the floor of a ventricle, a CSF-filled cavity in the brain. This procedure, called endoscopic third ventriculostomy, or ETV, allows CSF to flow through more of the brain and be absorbed. 

A second procedure, performed at the same time, treats tissue inside the ventricle. It’s called choroid plexus cauterization, or CPC. It may reduce the brain’s ability to produce CSF. ETV and CPC also may work together to restore the brain’s equilibrium. 

Why this matters

A shunt — a surgically placed valve and tubing that drains CSF from the brain to the belly — can be lifesaving treatment. It also carries lifelong risks, including: 

• Shunt malfunctions that require follow-up surgeries
• Infections that can result in learning disabilities and other problems 
• Potentially serious shunt failures 

In successful ETV/CPC, patients need only one surgery. In addition, ETV failure almost always occurs in the first year, when the risk of serious complications is low.

Learn more

• Hydrocephalus Information Page, National Institute of Neurological Disorders and Stroke
• Hydrocephalus Association, an advocacy group with information and support 
• National Hydrocephalus Association, another advocacy group with information for patients and families