Did you know that September is National Hydrocephalus Awareness Month? As one of four neurosurgery nurse practitioners at Gillette Children's Specialty Healthcare, I help our team take care of numerous patients with hydrocephalus, and answer many questions about this condition from patients, families and staff. I also help lead the Hydrocephalus Association Walk at the Mall of America (photos below) to generate funds for research and create awareness! Here are the five most frequently asked questions about hydrocephalus and shunts.
What causes hydrocephlaus?
Cerebrospinal fluid (CSF) is a water-based solution that flows in a certain path within our brain and spinal canal. Usually, there is an even rate between how much CSF a person is making and how much CSF his/her body is absorbing. Hydrocephalus occurs when there is a disruption in this balance or a block in the normal flow of CSF that naturally happens. CSF can build up within the ventricles (fluid spaces) of the brain and can cause pressure to be dangerously high in the brain. There are many causes of hydrocephalus. Babies can be born with congenital hydrocephalus. Also, patients may have a high risk of developing hydrocephalus when they are babies because of an underlying diagnosis, such as spina bifida. Other causes of hydrocephalus are acquired obstructions in CSF flow, like brain hemorrhage, brain tumor, or trauma.
How is hydrocephalus treated?
Although there are a few medications that may temporarily treat hydrocephalus, the usual treatment involves surgery. The most common treatment for hydrocephalus is a surgically implanted shunt. This is a device that moves CSF from the ventricles of the brain to an area in the body where the patient can safely absorb it, most commonly within the sac that holds the abdominal organs, called the peritoneum. Working shunts can keep a patient’s brain at a normal pressure, but unfortunately can malfunction. The average life of a shunt is about 5 years, but the range of shunt life is days to decades long. The surgery to fix a non-working shunt is called a shunt revision.
My child has never had a shunt malfunction, how will I know if it isn’t working/what will it be like?
Every patient is different, but common symptoms of a shunt malfunction are headache, vomiting, sleepiness, and irritability. I often tell patients, families, and caregivers to remember that it is not up to them to know if a shunt is working or not, it is up to them to let us know if they are concerned. The neurosurgery team will help sort out if a patient’s symptoms are because of a shunt malfunction or something else. Often times we use different imaging studies, like a head CT or brain MRI to get more information about the shunt’s function. Remember that most episodes of vomiting and fever are not shunt related.
Will the doctor shave my child’s head during surgery?
Usually the pediatric neurosurgeons at Gillette Children's Specialty Healthcare do not need to shave a child’s hair for shunt placements or revisions. Often, the surgeons will use dissolvable stitches that will not need to be removed after surgery as well.
Are there activity restrictions for patients that have shunts?
Our team generally does not recommend strict activity limitations for patients with shunts. We do recommend avoiding scuba diving and sky diving due to the pressure dynamics, but otherwise encourage patients to be active and involved in the activities they wish to pursue. Of course, we always remind patients and families to wear helmets appropriate for sports and activities as part of our general health recommendations.