Surgical Treatment Options for Pediatric Hydrocephalus
A Practical Approach with Video and Descriptions of Procedures
CSF Physiology and Hydrocephalus
- Hydrocephalus is a disorder of CSF physiology
- Results in increased intraventricular pressure and accumulation of CSF
- Frequently associated with elevated intracranial pressure
- Failure of CSF absorption is common cause of hydrocephalus
Etiology of Hydrocephalus
- Etiology varies, including congenital and acquired causes
- Common congenital causes include aqueduct stenosis and Chiari malformations
- Communicating and non-communicating hydrocephalus have different causes
- Treatment options depend on etiology and patient's age
Endoscopic Third Ventriculostomy (ETV)
- ETV creates a new pathway between the ventricles and subarachnoid space
- Commonly used for non-communicating hydrocephalus
- Success rate depends on age, etiology, and previous shunt placement
- Anatomical considerations and trajectory planning are crucial
Endoscopic Third Ventriculostomy Procedure
- Enter the lateral ventricle and confirm proper positioning
- Navigate to the third ventricle and identify relevant anatomical structures
- Create an ostomy or fenestration in the floor of the third ventricle
- Inspect the pre pontine cistern and ensure adequate CSF flow
Success Factors and Outcomes of ETV
- Age and etiology play a significant role in ETV success
- Certain etiologies, such as obstructive aqueductal stenosis, have higher success rates
- Repeat ETV can be successful in cases of failure
- Late failures can occur, but complications are rare
Temporary Measures for Small Infants
- Small infants with hydrocephalus may require temporary measures
- Ventricular access devices or subdural subgaleal shunt can help stabilize ventricles
- Timing and intervention in small infants is controversial
- Long-term non-surgical options are limited
Conclusion
- Surgical treatment options for pediatric hydrocephalus include endoscopic third ventriculostomy (ETV) and shunting procedures
- ETV success depends on patient factors, etiology, and anatomical considerations
- Temporary measures may be necessary for small infants
- Long-term non-surgical treatment options are limited