Hydrocephalus

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, dramatically reducing 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.
Illustration comparing normal central spinal fluid circulation with central spinal fluid buildup on the brain

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.

Main types and causes in children

Congenital

This type is present at birth and can be the result of genetic abnormalities or problems in fetal development.

Acquired

This type can develop at any age as a result of injury or disease.

Communicating

In this type, CSF is not absorbed properly after it leaves a network of four brain cavities, called ventricles, where it's produced. It's called "communicating" because CSF can still flow among the ventricles. Causes include bleeding in the brain, and infection.

Noncommunicating

In this type, also called obstructive hydrocephalus, CSF is blocked in one or more of the passages between ventricles. Causes include narrowing of a key passage; bleeding in the brain of a premature infant; or a blockage such as a cyst or tumor.

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 the most advanced surgery for treating hydrocephalus in some infants, eliminating the need for a shunt. 

Pediatric neurosurgeon Lissa Baird, M.D., was the first in Oregon to perform the minimally invasive technique, called ETV/CPC. She has world-class expertise in the surgery after training with the pediatric neurosurgeon who developed it, Dr. Benjamin Warf of Boston Children’s Hospital.

How it works

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

She 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 abdomen — can be life-saving treatment. But 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.

Dr. Baird is among an elite group of U.S. pediatric neurosurgeons with expertise in flexible neuroendoscopy. She has excellent outcomes with ETV/CPC, with more than 75 percent of patients remaining shunt-free, according to a recent analysis.¹

Comprehensive care Illustration of a hydrocephalus shunt draining central spinal fluid from the brain to the abdomen

For children who need a shunt, Doernbecher offers top-notch surgical expertise and excellent outcomes.

Pediatric neurosurgeons Nathan Selden, M.D., and Christina Sayama, M.D., have national reputations for excellence in treating hydrocephalus and other conditions. In addition, our team includes specialists and technology for all aspects and phases of care. This includes:

  • A “quick-brain” MRI scanner to check for shunt complications. This rapid imaging requires no sedation and, unlike a CT scan, uses no radiation. 
  • Precise protocols for immediate, effective treatment for children with possible shunt complications.

Related conditions

Chiari malformation

The pediatric specialists at Doernbecher Children's Hospital offer advanced care for Chiari malformation, including a less-invasive procedure with equally good results.

Spina bifida

Doernbecher provides complete care for spina bifida with both an integrated pediatric spine clinic and Oregon's only program for ongoing care into adulthood.

Learn more