Complications Associated with Surgical Treatment of Hydrocephalus

Excessive accumulation of cerebrospinal fluid (CSF) in the brain is a condition known as hydrocephalus. It may cause a life-threatening increase in intracranial pressure (ICP). Nonsurgical treatment of hydrocephalus includes continuous CSF drainage, repetitive lumbar punctures (Lim et al., 2009), or osmotic diuretics such as mannitol or glycerol, but their effects are transient and limited. Surgical treatment is needed to resolve the critical condition caused by increased ICP. Hydrocephalus can be classified as communicating or obstructive (non-communicating). In selecting surgical treatment, it is important to judge which is involved. Communicating hydrocephalus occurs when CSF flow is not blocked at any part of the passages connecting the ventricles. In obstructive hydrocephalus, CSF flow is blocked along one or more narrow passages between the ventricles. Hydrocephalus is treated by surgical insertion of a shunt system, such as a ventriculoperitoneal shunt (VP shunt), lumboperitoneal shunt (LP shunt) or ventriculoatrial shunt (VA shunt). The LP shunt should not be used in patients with obstructive hydrocephalus, because it can induce tentorial herniation leading to death. A limited number of patients with obstructive hydrocephalus are candidates for third ventriculostomy by neuroendoscope. Below, we review articles focusing on complications associated with various types of CSF diversion procedure.