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Alternatives to shunting.

G Cinalli1

  • 1Department of Pediatric Neurosurgery, "Santobono" Hospital, Naples, Italy. gcinall@tin.it

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|December 22, 1999
PubMed
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Pediatric neurosurgeons can now choose between extracranial cerebrospinal fluid (CSF) shunts and neuroendoscopic surgery for hydrocephalus treatment. The best option depends on hydrocephalus etiology, surgeon expertise, and technique efficacy.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Medical Technology

Background:

  • Growing awareness of mechanical and infectious complications associated with extracranial cerebrospinal fluid (CSF) shunts.
  • Rapid advancements in neuroendoscopic surgical techniques offer an alternative to traditional shunting.

Purpose of the Study:

  • To review the history and current state of alternative treatments to shunting for pediatric hydrocephalus.
  • To aid pediatric neurosurgeons in selecting the most appropriate treatment based on various factors.

Main Methods:

  • Review of historical data and current literature on neuroendoscopic procedures.
  • Analysis of factors influencing treatment decisions, including etiology identification and surgeon familiarity.
  • Categorization of treatments based on main pathophysiological groups of pediatric hydrocephalus.

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Main Results:

  • Neuroendoscopy presents a viable alternative to shunting for pediatric hydrocephalus.
  • Treatment choice is multifactorial, influenced by preoperative findings, surgeon's skill, and perceived efficacy of alternatives.
  • The review covers specific conditions like aqueductal stenosis, posterior fossa tumors, meningomyelocele, Dandy-Walker malformation, and posthemorrhagic hydrocephalus.

Conclusions:

  • Pediatric neurosurgeons have two primary treatment options for hydrocephalus: shunting and neuroendoscopy.
  • The decision-making process requires careful consideration of the hydrocephalus cause, available surgical expertise, and the effectiveness of each approach.
  • A comprehensive understanding of both historical and current techniques is crucial for optimizing patient outcomes.