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Our approach

Hydrocephalus in childhood may be due to prematurity, genetics, bleeding in the brain and/or tumors. Cohen Children’s has numerous treatments available which are tailored to the cause.  Endoscopic treatments without shunting are always a consideration and are utilized frequently.  Insertions of cerebrospinal fluid shunt are often needed for treatment. Our surgeons are experts at both of these types of treatments and the nuances of even the most complex cases.

Whenever possible, we use MRI for diagnosis rather than CT scan, to limit the patient’s exposure to radiation. We’ve just opened a new MRI suite on the top floor of the hospital featuring state-of-the-art equipment, and we have a sedation program specifically for conducting MRI, led by our pediatric anesthesiologists.

Hydrocephalus requires lifelong observation, even after successful treatment. Cohen Children’s  pediatric neurosurgeons will continue to follow up with your child after they turn 21. If further treatment is required, it will be done at a Northwell Health facility for adults, ensuring a smooth transition and continuous care.

Overview 

Hydrocephalus is a condition that is caused by an increase of cerebrospinal fluid (CSF) in and around the brain. Normally, the circulating CSF is constantly replenished and absorbed, so that the amount of fluid inside the brain and skull remains basically constant over the course of a lifetime.

A brain cyst, or arachnoid cyst, is when part of the brain’s membrane forms a pouch and fills with CFS. Brain cysts are less common than hydrocephalus but can be treated using similar techniques.

Causes & risk factors

In childhood, hydrocephalus may be due to prematurity, genetics, bleeding in the brain and tumors. We offer numerous treatments that are tailored to the cause. Endoscopic treatments without shunting are always a consideration and used frequently. Insertions of cerebrospinal fluid shunt are often needed for treatment. Our surgeons are experts at both of these types of treatments and the nuances of even the most complex cases. 

Symptoms 

Adults with hydrocephalus and brain cysts often have a combination of symptoms that can help establish the diagnosis, including headaches, mental confusion, difficulty walking, urinary incontinence and vomiting. In addition, their head circumference is above normal.

Infants with hydrocephalus may have enlargement of the head and bulging of the “soft spot” or fontanelle. This is commonly the first sign of early hydrocephalus and often requires ultrasound or MRI for evaluation. 

Treatment options 

The traditional treatment for hydrocephalus is insertion of a shunt, or a tube that goes from the brain to elsewhere in the body, to drain the excess fluid using a one way pressure valve.

Newer treatments involve minimally invasive endoscopic techniques, which can be used depending on the cause and nature of the hydrocephalus.  For instance, an endoscopic third ventriculostomy is when we insert a camera and create a new hole in the bottom of the brain, creating a new passageway without having to implant a shunt. In addition to or in place of this treatment, we may perform choroid plexus coagulation, where we use electric current to manipulate the brain to produce drastically less cerebrospinal fluid, so that the absorption and production ratio falls back in alignment.

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