Complex hydrocephalus: Management by “smart shunt”

Abstract

Complex hydrocephalus implies the hydrocephalus, which requires multiple surgeries for the treatment. However, its exact definition of what is “complex” is not clear. Treatment of hydrocephalus in general is regarded straightforward and managed by a VP shunt or endoscopic procedures. Anatomical, pathological, mechanical, and human factors can attribute to form complex hydrocephalus. The author defines “complex hydrocephalus” as those which may require multiple surgeries for the treatment of hydrocephalus when treated standard procedures. Basic concept of handling hydrocephalus in the author’s hands is “the simpler, the better.” Whatever the anatomy or background pathogenesis is complex, a simple surgical procedure often brings better surgical outcome. It should be reminded that simple hydrocephalus does have potential to turn into complex one if anything unfavorable develops or being handled poorly in the clinical course. On the other hand, potentially complex hydrocephalus can be controlled by single or staged procedures if treated appropriately. Most of complex hydrocephalus is the product of maltreated hydrocephalus. The best way to prevent complex hydrocephalus is to avoid complications during the initial treatment of hydrocephalus. The initial surgery is the key for preventing complex hydrocephalus, especially among the pediatric population. Once the case resulted in complex hydrocephalus, every possible effort should be paid to avoid further complication. If any of the endoscopic procedure is indicated, it should be applied first. Avoiding a VP/VA shunt placement is the best choice. An internal shunt with or without endoscopic procedure will help to install a shunt system simple, thus enables avoiding future complications related to the shunt system. In this chapter, the author described nine cases of complex hydrocephalus and how they were treated. It is strongly recommended to implant a single shunt system with the use of the internal shunt or/and endoscopic procedures, which the author calls “smart shunt.” If a VP shunt is unavoidable, the idea of “smart shunt” should be reminded. The simpler the shunt system, the better the clinical outcome.