The term “waterhead baby” is a non-medical and often sensitive phrase used to describe an infant with Hydrocephalus. This neurological condition involves the excessive accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles. This buildup causes the ventricles to enlarge, putting pressure on the surrounding brain tissue. While the name literally translates from Greek to “water on the brain,” the fluid involved is not water but CSF, a clear, saltwater-like substance. Prompt diagnosis and treatment are necessary to manage the pressure and minimize potential neurological damage.
The Mechanism Behind Hydrocephalus
Cerebrospinal Fluid (CSF) is a substance that acts as a cushion for the brain and spinal cord, delivers nutrients, and removes waste products. The majority of this fluid is continuously produced by specialized tissue called the choroid plexus, located within the four interconnected chambers of the brain, known as ventricles. In a healthy individual, the body maintains a precise balance by producing and absorbing CSF at a constant rate.
Hydrocephalus occurs when this delicate equilibrium is disrupted, leading to a net accumulation of fluid inside the skull. This imbalance arises from one of three primary mechanisms. The most common issue is a blockage that prevents the fluid from flowing normally through the ventricular pathways or into the open spaces surrounding the brain. Another possibility is impaired reabsorption of CSF into the bloodstream through the arachnoid granulations, where the fluid is normally drained. The third, and least frequent, cause is an overproduction of CSF by the choroid plexus.
Identifying Signs in Infants
The signs of hydrocephalus in infants differ significantly from those in older children or adults because a baby’s skull bones have not yet fused together. The flexible skull allows the head to expand in response to the increased fluid pressure, which is often the first and most noticeable sign.
Parents may observe an unusually rapid increase in the baby’s head circumference or a head size that appears significantly larger than average. The soft spot on the top of the head, known as the fontanelle, may appear tense, bulging, or firm to the touch. Other physical manifestations include prominent, stretched veins across the scalp and a downward deviation of the eyes, sometimes referred to as the “setting sun” gaze.
Infants may also exhibit changes in behavior and feeding habits. Common symptoms include unusual irritability, excessive sleepiness, or being less alert than normal. They may also experience poor feeding, projectile vomiting, or a high-pitched, inconsolable cry.
Underlying Causes and Classifications
Hydrocephalus is broadly categorized based on when it first appears, distinguishing between congenital and acquired types. Congenital hydrocephalus is present at birth, often resulting from developmental abnormalities during fetal growth or genetic factors. A common cause is aqueductal stenosis, a narrowing of the small passage connecting the third and fourth ventricles, which restricts CSF flow.
Acquired hydrocephalus develops after birth, sometimes due to a neurological event or injury. Causes can include complications from premature birth, such as bleeding within the brain’s ventricles (intraventricular hemorrhage), infections like meningitis, tumors, or head trauma.
The condition is further classified by the mechanism of fluid buildup. Non-communicating hydrocephalus, also called obstructive hydrocephalus, is defined by a physical blockage within the ventricular system that prevents the flow of CSF. Communicating hydrocephalus occurs when there is no clear obstruction between the ventricles, but the issue lies in the fluid’s impaired reabsorption into the bloodstream after it leaves the ventricles.
Current Treatment Approaches
The primary goal of treating hydrocephalus is to relieve the pressure on the brain by restoring or diverting the flow of cerebrospinal fluid. Treatment is almost always surgical, as there is currently no method for curing or preventing the condition.
The most common intervention is the surgical placement of a shunt system, a device designed to divert the excess CSF. A flexible tube is inserted into the brain’s ventricle and routed under the skin to another part of the body, typically the peritoneal cavity in the abdomen, where the fluid can be safely absorbed. The shunt contains a valve that regulates the flow and pressure of the CSF, maintaining it within a normal range. Shunts require lifelong monitoring because they can become blocked, infected, or malfunction over time, often necessitating further surgical procedures known as revisions.
An alternative procedure for some patients is the Endoscopic Third Ventriculostomy (ETV). This minimally invasive surgery uses a small camera to create a tiny opening in the floor of the third ventricle. This opening creates a new pathway for the CSF to bypass a blockage and flow into the natural absorption spaces.
For infants, ETV is sometimes combined with choroid plexus cauterization (CPC) to reduce the amount of CSF the brain produces, which can improve the procedure’s success rate. ETV offers the benefit of potentially remaining device-free, but its success depends on the specific cause of the hydrocephalus.