Surgery for Hydrocephalus in Children

Neurosurgeons at Hassenfeld Children’s Hospital at NYU Langone manage pediatric hydrocephalus by performing surgery to drain cerebrospinal fluid from the ventricles in the brain to other parts of the body. This helps alleviate the enlarged ventricles, or brain cavities, caused by the condition.

Shunt Surgery

Surgically implanting a shunt in a ventricle is the most common way to treat hydrocephalus in infants and children. A shunt is a small, flexible tube and valve system that allows fluid to drain. It is placed in the ventricle to drain cerebrospinal fluid away from the brain and into the body, where it can be absorbed.

Most shunt systems include three parts: a thin, flexible tube called a ventricular catheter that is inserted into a ventricle to drain spinal fluid; a valve to regulate the flow of spinal fluid; and a second catheter to drain the fluid into the body. A shunt is a permanent device, and people who have shunts may need additional surgeries throughout their lives to replace or repair their shunts.

In this brief procedure, a surgeon makes a small incision in the back of the head and places one end of a catheter into a ventricle. The other end of the ventricular catheter is placed under the skin and then usually to the abdominal cavity, where spinal fluid can drain and be absorbed.

The end of the catheter can also be placed at other sites in the body, such as a chamber of the heart or areas around the lung. A surgeon decides where the catheter ends based on your child’s needs. Most shunt placements take 15 to 30 minutes with about 1 hour of general anesthesia.

After surgery, the valve device regulates the spinal fluid pressure and controls its flow through the shunt tubing to prevent draining too much or too little fluid. This device is connected to the ventricular catheter and lies below the skin, usually on top of the head or behind the ear.

Your child stays in the hospital for neurological observation for the first 24 hours after surgery. Most children leave the hospital one to two days later, although some children may have to stay in the hospital for a few days following the procedure for additional monitoring.

Endoscopic Third Ventriculostomy

For children with noncommunicating hydrocephalus, doctors may perform a surgical procedure called endoscopic third ventriculostomy, or ETV. In this procedure doctors make a small hole in the floor of a cavity in the brain called the third ventricle. This hole allows cerebrospinal fluid to enter the area under and around the brain where it normally flows, where it is then reabsorbed into the bloodstream.

Endoscopic third ventriculostomy eliminates the need to implant a permanent drainage tube, but some children may need to have a shunt implanted later in life. A doctor carefully selects candidates for this surgery based on the child’s brain structure and age.

What to Expect After Surgery

After shunt surgery, your child has stitches where the surgeon implanted the shunt. Small incisions are made mostly on the head, abdomen, and sometimes the neck. Keeping the incision sites dry and clean is important for preventing infection. Your child’s doctor advises you on how to care for your child’s incisions.

If your child has pain after surgery, your neurosurgeon usually recommends over-the-counter medication, such as acetaminophen, as needed.

Both procedures require follow-up visits with your child’s neurosurgeon to monitor postoperative healing and ensure that your child’s symptoms are decreasing. Additional ultrasounds, MRI, or CT scans may be performed to show the changes in the ventricles after a shunt and help monitor shunt function.

Shunt systems typically require regular follow-up with your child’s doctors, including your pediatrician and neurosurgeon, to watch for complications. Shunt complications may include infection, mechanical failure, obstructions, or the need to lengthen or replace the catheter. If complications do occur, surgery to replace the failed part or the entire shunt system may be needed.

Your child’s doctor may recommend evaluation by a neurologist as well as physical, occupational, or speech therapy after surgery to address any impairment caused by hydrocephalus.