[The management of children with hydrocephalus in Norway]

Diversion of ventricular fluid to the right atrium or peritoneum became standard treatment of hydrocephalus in childhood in Norway 25 years ago. Initially we believed that the shunting procedure was only necessary to overcome unwanted dilatation of the ventricles and growth of the head during the first years of life. We now realize that most shunted hydrocephalic children become shunt dependent throughout the rest of their lives. The majority of these children do relatively well and the mortality is negligible. The population of children, teenagers and young adults with indwelling shunts is thus steadily increasing and has reached over one thousand individuals in Norway. Routine use of cerebral CT-scans and X-ray of the shunt system is advocated to improve the routine control of these patients as well as during episodes of shunt failure and other complications of shunt surgery. This population of young shunt treated individuals represents an increasing burden to the small neurosurgical departments as well as the pediatric departments and later on also to the neurological departments. The perspective of life long shunt dependency in most of these children may seem depressing. It should not be forgotten, however, that these young individuals have a benign disorder with potential of good long term prognosis. Adequate resources should therefore be allocated to meet these increasing demands and should be regarded as a good investment.