Children & families · Conditions
Hydrocephalus and shunts
A build-up of the fluid around the brain. Many children are treated with a shunt, which needs long-term follow-up.
What is it?
Hydrocephalus is a build-up of the fluid that surrounds and protects the brain (cerebrospinal fluid). The fluid spaces inside the brain, the ventricles, become enlarged and press on the surrounding brain. It may be present from birth or develop later, for example after bleeding, infection or a tumour.
What symptoms can it cause?
In babies, the head may grow quickly, the soft spot (fontanelle) may feel full, and your baby may be irritable, feed poorly or vomit. Older children may have headaches (often in the morning), vomiting, drowsiness, blurred vision or changes in behaviour or school performance.
How is it assessed?
Your child will be examined and the head circumference charted. An ultrasound (in young babies), CT or MRI scan shows the size of the ventricles and often the cause.
What are the treatment options?
Treatment depends on the cause and your child's age. Many children are treated with a ventriculoperitoneal (VP) shunt: a thin tube with a valve that drains fluid from the brain to the abdomen, where it is absorbed. For selected children an endoscopic third ventriculostomy (ETV) may avoid a shunt. Some mild, stable cases are watched with scans.
- In hydrocephalus, fluid (CSF) builds up and the ventricles inside the brain become enlarged, pressing on the surrounding brain.
- Through a small burr hole in the skull, a thin, soft ventricular catheter is placed into a lateral ventricle.
- It connects to a small valve under the skin behind the ear. Tubing is passed under the skin of the neck and chest into the peritoneal cavity in the abdomen.
- Extra fluid now drains through the valve, which controls the flow, and is absorbed naturally inside the abdomen.
- As pressure eases, the ventricles become smaller. The shunt stays in place under the skin.
When might surgery be considered?
Surgery is considered when there are signs of raised pressure, the head is growing too quickly, or scans show the ventricles enlarging. The options, benefits and risks are discussed with you in detail.
What to expect from recovery and follow-up
Most children stay in hospital for a few days. Shunts need lifelong follow-up because they can block or become infected, so you will be shown the warning signs to look out for. Regular clinic visits check growth, development and, where needed, scans.
When to seek urgent help
If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600). In a child with a shunt, these symptoms can mean the shunt is not working and need same-day review.
This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.