Surgical Treatment Options for Pediatric Hydrocephalus

A Practical Approach with Video and Descriptions of Procedures

Slide1: 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

Slide2: 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

Slide3: 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

Slide4: 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

Slide5: 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

Slide6: 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

Slide7: 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

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