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Updated: Jul 5, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
[Neuroendoscopy. Its usefulness in the hydrocephalus management of children in developing countries]
Juan C Jiménez-León1, Cristina S Jiménez, Yaline M Betancourt
1Departamento de Neurocirugía, Escuela de Medicina, Universidad de Carabobo, Valencia, Venezuela. neurojcj@gmail.com
Insights
Endoscopic third ventriculostomy (ETV) offers a shunt-free alternative for pediatric hydrocephalus, particularly post-infectious cases. This neuroendoscopic technique avoids shunt complications and reduces costs for managing cerebrospinal fluid circulation issues.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Medical Technology
Context:
- Hydrocephalus presents a significant global health challenge, disproportionately affecting children in developing regions.
- In Latin America, common causes include poor prenatal care, neonatal sepsis, meningitis, and ventriculitis, disrupting cerebrospinal fluid (CSF) circulation.
- Traditional shunt-based treatments for hydrocephalus carry inherent risks and complications.
Purpose:
- To evaluate the efficacy of neuroendoscopy, specifically endoscopic third ventriculostomy (ETV), as a primary treatment for pediatric hydrocephalus.
- To present a neuroendoscopic approach as an alternative to shunt implantation, detailing the technique and its application.
- To introduce an algorithm for managing hydrocephalus in children under one year old, focusing on ETV.
Summary:
- A study of 100 pediatric hydrocephalus patients treated with ventriculoscopy followed by ETV between 2001-2006 in Venezuela.
- The technique, alone or with choroid plexus cauterization (CPC), is effective for various hydrocephalus types, including post-infectious, myelomeningocele-associated, and obstructive.
- The study emphasizes ETV's role in preventing shunt dependency and its associated complications.
Impact:
- Neuroendoscopy, particularly ETV, presents a cost-effective and safer alternative to shunts for managing pediatric hydrocephalus.
- This approach minimizes complications related to shunts, improving outcomes and reducing long-term healthcare burdens.
- The findings support the wider adoption of neuroendoscopic procedures in pediatric neurosurgery for hydrocephalus treatment.
Abstract:
Hydrocephalus is a huge burden, specially in the poor countries with a big proportion of sick children with this condition, against the countries with good sanitarian conditions. In Latinamerica the most common etiological factors of hydrocephalus are associated with bad prenatal controls, neonatal sepsis and consequent meningitis and ventriculitis. The hydrocephalus is a consequence of the damage in the circulation of the cerebrospinal fluid (CSF). Neuroendoscopy specially third ventriculostomy, associated in some patients with choroid plexus cauterization, represents an alternative method to manage this condition avoiding shunts and its complications. Endoscopic third ventriculostomy (ETV) alone or with choroid plexus cauterization (CPC) is an emerging and very useful technique to manage hydrocephalus specially in children with: ventriculitis as a consequence of meningitis, myelomeningocele, obstructive hydrocephalus idiopathic or seconday to posterior fossa tumors. One hundred consecutive children (100) underwent ventriculoscopy preceding EVT as an initial treatment of hydrocephalus since January 2001 to July 2006, median age was 15.5 months with a range between 2-48 months, 55% are males of our Institution in Valencia, Venezuela. We describe the normal and pathological ventricular anatomy with emphasis in the endoscopic technique and its challenges. We present how the EVT works to prevent the shunt implantation. In the future, neuroendoscopy prevents the use of shunts to treat hydrocephalus in children, avoiding its complications and cost. Neuroendoscopy is a neurosurgical technique everyday most common to manage hydrocephalus and intraventricular lesions in the world. We report an algorythm to use in children younger than 1 year of age with postinfectious hydrocephalus (PIHC) or associated with myelomeningocele. We stress the use of EVT as an alternative because of its low cost to treat hydrocephalus avoiding the complications and dependency of shunts.
