Recent progress of surgical treatment in pediatric hydrocephalus

Abstract

'Ventriculo-peritoneal shunting' and 'endoscopic diversion of the intracranial CSF pathway' play a key role in current surgical treatment for childhood hydrocephalus. An adjustable gravitational valve system is a state-of-the-art mechanical design to avoid over-and under-drainage. The two-year shunt survival rate for hydrocephalus with early pediatric ages was 57.4% in our institute and 60.9% in Charite University, Berlin, respectively. Additional operations for over-drainage were performed in 6.3% of our cases. The results suggest that this system is worth setting as a guideline for hydroce-phalic children but requires further refinements. Endoscopic third ventriculostomy (ETV) has become a routine surgical procedure and presents a more than 70% success rate. In 2009, an ETV success score (ETVSS) was proposed for the prediction of percent probability of ETV success. It is frequently used because of its usefulness regarding the indication of ETV. One of the current problems regarding ETV is late failure. The mechanisms and predictors of late ETV failure that might cause rapid deterioration are not still known. Recently, the remarkable results of endoscopic choroid plexus coagulation in combination with third ventriculostomy, reported from experience in Africa, present a new complexity to the puzzle.