One of the most common fears expectant parents share with me is about unexpected problems during pregnancy. Among these, hydrocephalus is a condition that sometimes shows up even before a baby is born — and naturally, this can cause a lot of worry. As a neurosurgeon, I want you to know that early detection makes a big difference, and with today’s scans and treatment options, there is hope and help for your baby.

What is Hydrocephalus?
In simple terms, hydrocephalus is a buildup of excess cerebrospinal fluid (CSF) in the brain. This fluid normally surrounds the brain and spinal cord, protecting and nourishing them. But when too much fluid accumulates, it can put pressure on the developing brain.

As I often explain to parents, “Everybody has fluid in the brain. The brain is suspended in this fluid called CSF — and there’s a normal system that produces, circulates, and absorbs it daily.” Problems occur when something blocks this flow or prevents proper absorption.

Can Hydrocephalus Be Detected During Pregnancy?
The good news is that yes, hydrocephalus can sometimes be detected before birth. Today’s prenatal ultrasounds are far more detailed than they used to be. Many cases are picked up during routine scans in the third trimester.

“There are children who, when they do the antenatal ultrasounds, they are able to see that these babies have large ventricles,” I often share with expectant parents. The ventricles are fluid-filled spaces in the brain — if they appear larger than normal, it may be a sign of hydrocephalus.

However, not every case is clear-cut. Some mild cases may not be obvious until later scans, or even after birth when head size and development are monitored more closely.

Why Does This Happen?
Hydrocephalus can be congenital, meaning it develops before birth, often due to a small blockage in the brain’s fluid pathways. A common cause is aqueductal stenosis, which narrows the channel between parts of the brain where CSF flows. Infections during pregnancy, genetic conditions, or other developmental problems can sometimes contribute as well.

What Happens After Detection?
If hydrocephalus is detected during pregnancy, the obstetrician and pediatric specialist will monitor your baby’s growth with more frequent scans. In most cases, we wait until birth to decide on treatment. “We wait for the baby to be born and then we take a call on what needs to be done,” I tell parents. Only very rarely, and in highly specialized centers, is any attempt made to treat hydrocephalus before birth.

After birth, we perform a thorough physical exam and a detailed MRI scan to confirm the diagnosis and decide on the best treatment. If needed, we may place a VP shunt, which safely drains excess fluid, or do an endoscopic procedure to restore normal fluid flow.

A Word for Parents
Hearing that your baby might have hydrocephalus is scary — I understand that deeply. But I also want you to know that this condition is treatable, and most children go on to live healthy lives with timely care.

If you’re expecting and have concerns, don’t hesitate to ask questions. Trust your doctor, attend your scans, and remember — early detection and good planning can make all the difference.