What is hydrocephalus? In our daily life, we often associate “big-headed dolls” with rickets, but rarely think of hydrocephalus, which makes children receive long-term calcium supplementation. Hydrocephalus. As a result, the child’s vision, intelligence, hearing, speech, and physical disabilities are caused by the lack of timely and standardized treatment. The early stage of hydrocephalus has no typical symptoms and looks like aliens in movies, and at first glance it looks like rickets. To distinguish them, two things should be observed: whether the child’s head circumference (the length of a circle from the midpoint between the eyebrows to the prominence of the back of the head) is progressively increasing; and whether there are symptoms of intracranial hypertension such as headache and vomiting. If these two main symptoms are present, a preliminary diagnosis of hydrocephalus can be made. The typical hydrocephalus is easily distinguished from rickets. In children with hydrocephalus, the head is large and progresses quickly, the fontanelle is enlarged and bulging, and it looks like a drum, some cranial sutures are also open, the scalp blood vessels are exposed, and both eyes are downward looking, which doctors call “sunset sign”. Some also have symptoms such as frequent vomiting, headache, dizziness, seizures and weakness of lower limbs due to high cranial pressure. Therefore, it is important to be aware of hydrocephalus in infants with large heads. Why do infants develop hydrocephalus? The human nerve center includes the brain and spinal cord, which have a layer of brain water on their surface. Brain water plays a role in protecting and nourishing the brain and spinal cord. Brain water is secreted by the ventricular choroid plexus flowing in a certain direction along the ventricles and cavities of the brain, constantly secreted and constantly flowing to the cerebral veins, which are renewed five and a half times a day. If there is a blockage in the narrow part of this pathway, then the constant secretion, but poor excretion, over time, the more brain water accumulates, hydrocephalus can be formed. Infants with hydrocephalus can be congenital or acquired. The most common cause of acquired hydrocephalus is inflammatory adhesions caused by septic meningitis, followed by trauma or cerebrovascular disease or obstruction of cerebral water channels caused by tumors and parasites. In recent years, meningitis is decreasing, and acquired hydrocephalus is decreasing accordingly, but congenital malformation is relatively more common. If MRI is done, not only can the hydrocephalus be seen clearly, but also the causes of hydrocephalus, such as subcerebellar herniation malformation, middle cerebral aqueduct occlusion, four ventricular foramen atresia, large vein malformation, etc., can be distinguished clearly. Does hydrocephalus necessarily mean a large head? Not necessarily. Light and slow-onset hydrocephalus may not have a large head, so a considerable number of patients only show floppy palsy, or inability to speak, or repeated convulsions, or low intelligence, or headache and vomiting. And they are misdiagnosed as pediatric paralysis, epilepsy, neurological headache and other diseases. Does a large head necessarily mean hydrocephalus? Not necessarily. In rickets, for example, the head may be large, but there is no enlargement of the ventricles, and the size of the head varies with race and individual differences, but generally does not exceed two standard deviations from normal head circumference. Therefore, the “big head doll” should be combined with other clinical manifestations and signs, a comprehensive analysis, to make a correct diagnosis. How to treat hydrocephalus? About 40% of the congenital hydrocephalus can be spontaneously quiescent, and about 1/3 of the quiescent cases can be close to the intelligence of normal children. Therefore, non-surgical treatment is ineffective in most children. At present, neuroendoscopic surgery and ventriculo-abdominal shunt surgery are the main treatments, and our department performs 50 hydrocephalus surgeries every year with good results. How to prevent hydrocephalus? We should pay attention to perinatal health care. Pregnant women should be less exposed to chemicals, radiation and radioactive elements, not to take pills for fetus, and to prevent viral infections. Suspected cases should be actively screened for timely detection and treatment.