Pediatrics

Hydrocephalus and Intracranial Cysts

NewYork-Presbyterian is home to the best pediatric neurology & neurosurgery program in New York

Hydrocephalus and intracranial cysts are conditions that result from the abnormal buildup of cerebrospinal fluid (CSF) in the brain. Both conditions affect newborns and children of all ages and, if left untreated, can lead to intellectual, developmental and physical disabilities. Children with hydrocephalus or intracranial cysts need specialized care like that found at NewYork-Presbyterian, where expert pediatric neurosurgeons collaborate with other pediatric specialists to determine the root cause of the problem and create a comprehensive treatment plan that gives your child the best chance to live to their fullest potential. At NYPH we have the most refined and innovative diagnostic and therapeutic tools available to insure optimal care for each child.

What is Hydrocephalus?

Hydrocephalus is a condition that is caused by an increase of cerebrospinal fluid (CSF) in and around the brain that can occur at the time of birth or during infancy, childhood or adolescence.

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. Hydrocephalus occurs when the orderly balance of cerebrospinal fluid (CSF) in the brain is altered. This disruption can occur when CSF is overproduced, or not properly absorbed and/or obstructed by a blockage.

Hydrocephalus can occur during pregnancy, and when it does, it is labeled congenital hydrocephalus. Other instances of hydrocephalus arise after birth. Possible causes include bleeding, infection, trauma, tumors, vascular problems, spina bifida, and structural problems.

There are two main types of hydrocephalus, and they occur in different compartments of the brain. This distinction provides a solid foundation for determining management options:

Non-communicating hydrocephalus, also called obstructive hydrocephalus, occurs when there is a blockage of CSF flow anywhere within the ventricles that limits flow to the subarachnoid space, the surfaces of the brain and spinal cord where CSF resorption normally takes place.
Communicating hydrocephalus results from impaired reabsorption of CSF into the subarachnoid space of the brain therefore limiting CSF to gain access into the venous circulatory system. The internal circulation of CSF within the ventricles is normal.

Symptoms of Hydrocephalus

Symptoms of hydrocephalus are age dependent. During early infancy, hydrocephalus is usually detected by the family or pediatrician as macrocephaly (an abnormally large head); macrocephaly rarely occurs later in infancy and childhood.

Common symptoms for newborns and infants include:

Vomiting
Eye gaze pointed downward
Nystagmus (involuntary eye movements)
Progressive weakness and spasticity
Poor feeding
Failure to thrive
Delay or loss of developmental milestones
Unusual sleepiness
Irritability
Poor head control
A bulging “soft spot” at the top of the head

Symptoms during older childhood and adolescence may include:

Headache
Vomiting and nausea
Urinary incontinence
Visual disturbances, such as blurred vision or diplopia
Nystagmus (involuntary eye movements)
Irritability
Eye gaze pointed downward

If your child has any of these symptoms, he or she should be evaluated to determine if diagnostic imaging is needed, because hydrocephalus can cause neurological damage as it puts pressure on surrounding brain tissue. Since many of these symptoms can be caused by a range of other conditions, an accurate diagnosis is critical.

What is an Intracranial Cyst?

An intracranial cyst is a small, benign collection of fluid that develops when part of the brain’s membrane forms a pouch and fills with CSF. The exact cause of a primary intracranial cyst, which develops in a fetus during pregnancy, is unknown. Arachnoid cysts represent the most common form of intracranial cyst. These can occur in various locations in the brain and seldom cause symptoms. Other less common forms of cysts are secondary cysts, which can be caused by a variety of conditions including trauma (a fall, accident, or other injury), infection, brain tumor, developmental malformation, or as a complication of brain surgery. MRI is very accurate in determining the type of cyst and treatment options if needed.

Symptoms of an Intracranial Cyst

Symptoms of an intracranial cyst depend on the cyst’s size and location. Small cysts are usually asymptomatic and are discovered only incidentally. Large cysts may cause cranial deformation or macrocephaly as a result of hydrocephalus, particularly among infants and young children whose skulls still have fontanels. Some cysts can cause noncommunicating hydrocephalus by direct compression on the normal intraventricular circulation.

Symptoms may include:

Headache or increased intracranial pressure
Nausea and vomiting
Seizures
Vertigo
Developmental delay
Behavioral changes
Decreased cognitive performance
Hemiparesis (weakness or paralysis on one side of the body)
Ataxia (lack of muscle control) or difficulties with balance and walking
Hearing and vision disturbances

An intracranial cyst that causes any of these symptoms needs to be evaluated for possible treatment, as it may continue to grow and cause neurological damage as it puts pressure on surrounding brain tissue. Since many of these symptoms can be caused by a range of other conditions, an accurate diagnosis is critical.

About Our Program

The NewYork-Presbyterian pediatric neurosurgery program, operating across NewYork-Presbyterian Morgan Stanley Children’s Hospital and NewYork-Presbyterian Komansky Children’s Hospital, is the largest regional provider of pediatric neurosurgery services in the tristate area. Our pediatric neurosurgery team has clinical expertise across a full range of conditions including brain and spinal cord tumors, epilepsy, hydrocephalus, craniosynostosis, vascular disorders, Chiari malformation and syringomyelia, spina bifida and spasticity. Our pediatric neurosurgeons are known for success in performing some of the most technically demanding and innovative neurosurgery procedures in children.

Our pediatric neurosurgeons use minimally invasive surgery whenever possible to ensure the best results and the fastest recovery possible. Across our state-of-the-art facilities, we employ the latest and least invasive devices and techniques, such as the endoscope, robotics, and surgical planning software, for the best possible outcomes.

Because we are part of a world-class medical center, we have the ability to centralize care for our patients and connect our patients to providers in more than 100 specialties and subspecialties. When the time comes, we can provide the support patients and their families need to ensure a smooth transition from pediatric to adult care.