Fetal Hydrocephalus

Hydrocephalus, or “water on the brain,” is a condition associated with a buildup of cerebrospinal fluid (CSF) in or around the brain. If left untreated, this can lead to brain tissue stretching, significantly affecting your child’s growth and development.

Hydrocephalus is often present in cases of Myelomeningocele (spina bifida), but can develop without Myelomeningocele. The factors that cause it may be genetic. Fortunately, there are very effective treatments that can reduce the complications caused by Hydrocephalus.

water

This graphic shows a baby with a build up of fluid in the cavities around the brain.

How is Hydrocephalus Diagnosed During Pregnancy?

During a prenatal ultrasound between 15 and 35 weeks gestation, the physician can see whether the ventricles in the baby’s brain are enlarged and whether there is evidence of increased pressure within the brain. If so, then Hydrocephalus is diagnosed.

Usually, a fetal MRI is performed next to see more detailed images of the brain. This may reveal an anatomic reason for the Hydrocephalus. Occasionally, the ultrasound and MRI show increased levels of cerebrospinal fluid within the brain without evidence of increased pressure on the brain. This condition is referred to as Ventriculomegaly and is actually more common than Hydrocephalus. Ventriculomegaly is usually caused by a brain injury or improper development, so it is important to differentiate Hydrocephalus from Ventriculomegaly

How is Hydrocephalus Managed and Treated During Pregnancy?

Hydrocephalus during pregnancy is usually managed by observation. At this time, there is no fetal treatment for this disorder. The fetus is watched carefully for signs of distress, which may indicate a need for early delivery. The best way to improve the outcome for the baby is to delay delivery until the baby is as mature as possible. This timing will be determined by the mother and her prenatal care provider, along with recommendations from the SSM Health Cardinal Glennon St. Louis Fetal Care Institute team.

How Does Hydrocephalus Affect My Baby After Delivery?

In babies who have Hydrocephalus evaluation after delivery is extremely important. This evaluation will likely include imaging studies, such as a CT, MRI or ultrasound. A detailed neurological exam at birth, along with an examination of the head size and soft spots (fontanels) will be done to verify the diagnosis of Hydrocephalus.

If there is increased pressure on the brain at birth, neurosurgery may be necessary. There are two surgical options offered at SSM Health Cardinal Glennon Children's Hospital:

  • Fetal shunt: device that allows the pressure in the brain to normalize by draining the fluid into the abdominal cavity, where the fluid can be reabsorbed
  • Endoscopic third ventriculostomy (ETV): minimally-invasive procedure that creates an opening in the floor of the third ventricle in the brain, allowing fluid to flow into its normal pathway

The impact of Hydrocephalus on the baby is somewhat unpredictable and can vary in severity. Because it injures the brain, Hydrocephalus can cause complications and symptoms of brain damage. Individuals with Hydrocephalus may have epilepsy, learning disabilities, short-term memory loss, problems with coordination, vision problems, and/or early puberty. Because of these issues, babies with Hydrocephalus are provided with developmental therapy, such as physical therapy and occupational therapy, as early as possible. In milder cases, or cases that have had early treatment, a baby with Hydrocephalus may develop completely normally.

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