Cerebrospinal Fluid Diversion Procedures in the Pediatric Population

Hydrocephalus is a relatively common condition the pediatric neurosurgeon is facing on a daily basis. The term is defined as an imbalance between the production and absorption of the cerebrospinal fluid (CSF), resulting in increased intracranial pressure. There are several forms of hydrocephalus, such as congenital hydrocephalus that is associated with congenital malformations such as myelomeningocele or congenital aqueductal stenosis, or acquired hydrocephalus that occurs secondary to different pathologies, such as intraventricular hemorrhage, infection, or neoplasm. The treatment of hydrocephalus dates back to the dawn of civilization, and through the years different techniques were used to treat this condition. The main techniques include the use of shunt system to move the excessive fluids from the brain to a different chamber in the body (e.g., peritoneal cavity), while the other main treatment technique involves the creation of a different path for the passage of CSF, such as a third ventriculostomy. There is a growing interest in recent years in relation to the use of endoscopic procedures such as endoscopic third ventriculostomy with to without choroid plexus, as an optional way to replace the shunt as the main treatment method for hydrocephalus. On the other hand, there is ongoing effort of making shunt systems more effective while finding ways to minimize to risk for complications, such as shunt infections.