Hydrocephalus is the most common condition treated in pediatric neurosurgery. Most commonly this is done using ventricular shunts of various types, and in specific conditions, with endoscopic procedures. The indications for shunt insertion and revision are common to North American neurosurgical practice. However the results of shunting, measured as the time until the shunt fails or the infection rate vary considerably. A review done by the BCCH neurosurgeons demonstrated that in Canada for the period of 1989 to 2001, shunt insertions for hydrocephalus had longer duration of function and lower risk of infection if inserted by experienced surgeons. Even within the experienced surgical group, results varied, with BCCH surgeons having the longest duration of function and lowest infection rates in the high experience group.
In recent years many children, who previously would have had shunts inserted, are being treated with endoscopic procedures to bypass the blockage to the flow of cerebrospinal fluid. Most commonly this involves an endoscopic third ventriculostomy (ETV). In more complicated cases we have been able to do more endoscopic procedures with the help of image guidance tecniques and intraoperative ultrasound. The group has defined imaging cirteria that predict success of ETV. Using these criteria the success rates for the control of symptomatic hydrocephalus is over 80%.