Future directions for therapy of childhood hydrocephalus: a view from the laboratory

A personal perspective on the study of experimental models of hydrocephalus is offered. Many animal models are available; each has its own advantages and disadvantages. Detailed study of more than one model is needed to clarify the pathogenesis of hydrocephalus-induced brain damage in the immature nervous system. Further information is needed about the mechanism of axonal injury in periventricular tissue, changes in the extracellular compartment, water dynamics within brain tissue, the role of neurotrophic factors in hydrocephalus, and the sites of injury in chronic 'arrested' hydrocephalus. Insight into the multifactorial nature of the brain damage may allow us to develop supplemental pharmacologic therapies, which could protect the brain and promote recovery in the pre- and postshunt period.