Hydrocephalus is a condition in which abnormal accumulation of cerebrospinal fluid (CSF) in the brain causes increased intra cranial pressure inside the skull. This is usually due to blockage of CSF outflow in the brain ventricles or in the sub arachnoid space at the base of the brain. The word hydrocephalus comes from the Latin, meaning "water in the head".

Hydrocephalus is the most common complication of a Grade 3 and Grade 4 IVH. Unfortunately, 65% - 100% of surviving premature babies with a Grade 4 IVH, will suffer from persistent hydrocephalus. This complication is the result of a hydraulics problem created by a severe bleed. Blood clots and scar tissue can plus the normal drainage of cerebrospinal fluid out of the ventricles, disrupting its flow and reabsorbtion. If too much fluid accumulates, the ventricles can swell. The pressure this creates must be relieved by removal of fluid from the ventricles to avoid irreversible brain injury or death. Charlie suffers from Post IVH Hydrocephalus and will require placement of a shunt. 

          Initial Shunt Placement

June 2004 - A VP Shunt is inserted directly into Charlie's brain, which carries excess fluid from the ventricles to the inside of the abdomen, where it can be reabsorbed. Charlie's shunt is in the right ventricle and he has enough tubing to grow well over 6ft tall. The tubing runs from the shunt itself, down through his neck into his abdomen. An important component of the shunt is the reservoir. It controls the amount of cerebrospinal fluid that flows through the shunt, and ensures that it doesn't drain too quickly to too slowly. The valve can also be used by the neurosurgeon to access the functioning of the VP shunt. The shunt can be adjusted using a magnetic device that is completely painless to Charlie. Since getting his shunt, Charlie has really "come out of his shell", so to speak. Prior to surgery, his eyes had a "sunset" appearance and seemed to protrude from his face. Now, they have somewhat receded. He is able to interact and make eye contact, which is a HUGE relief because he couldn't do it before the shunt. The only downside, other than having hydrocephalus itself, is shunt malfunction and infection. A malfunctioning shunt requires another surgery (called a revision) to change or fix the system. Unfortunately, the average number of shunt revisions is about ten in one's lifetime. That's TEN surgeries. Shunt infections usually occur around the time of surgery, so we think we are out of the woods, although the key word here is "think". Charlie will need his VP shunt for the rest of his life as Hydrocephalus is a life-long condition. There will be certain activities he will not be able to participate in. He won't be a Notre Dame Football player, but it's possible he could be the coach. Wouldn't Brian be so proud?

A shunt is a one way valve used to drain excess cerebrospinal fluid from the brain and carry it to other parts of the body. This valve usually sits outside the skull, but beneath the skin, somewhere behind the ear. Although a shunt generally works well, it may stop working if it disconnects, becomes blocked, or it is outgrown. If this happens the cerebrospinal fluid will begin to accumulate again and a number of physical symptoms will develop such as listlessness, headaches, irritability, light sensitivity, sound sensitivity, nausea, vomiting, dizziness, vertigo, migraines, some extremely serious, like seizures. The shunt failure rate is also relatively high and it is not uncommon for patients to have multiple shunt revisions within their lifetime. The diagnosis of cerebro-spinal buildup is complex and requires expertise.

October 17, 2004 - Charlie had begun to show signs of ICP (intercranial pressure),so his neurosurgeon ordered a CT-Scan for Monday afternoon. After the scan, it was decided that Charlie needed surgery to perform maintenance on his shunt because it wasn't working as well as the doctor had liked. So at 5:30pm he went into surgery and was out by 6:30pm. Dr. Johnson felt like the surgery was a success and that the shunt should drain off the CSF fluid like it is supposed to. Unfortunately, kids with hydrocephalus undergo several surgeries for shunt malfunction and it seems that Charlie is no exception. The good news is that now that the pressure is relieved, he is back to his normal, happy little self and we are thankful for that. He is even walking better because he is able to bend his knees, which he really wasn't doing last week. The bad news is that he will probably be having another cranial reconstruction surgery sooner than we had planned. It's difficult to tell from the pictures, but his forehead has started to "point" outward between his eyes and that could be caused by premature closure of yet, another suture. We have to be cautious because we can't allow the pressure to build up behind his eyes, possibly causing damage to his vision. We go back to the neurosurgeon on November 1st, so we will know more then.