Hydrocephalus · Shunt vs ETV

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type (obstructive/communicating) + cause
   Obstructive or communicating? Cause? Acute?
   • Obstructive (aqueductal stenosis/posterior fossa mass and other non-communicating) → Obstructive → ETV
   • Communicating (post-SAH/post-infectious/leptomeningeal) → Communicating → VP shunt
   • Normal pressure hydrocephalus NPH (gait/cognition/incontinence triad) → NPH → shunt after tap test
   • Acute obstruction/deteriorating consciousness → Acute obstruction → EVD
2. [End] Obstructive → ETV
   Obstructive (aqueductal stenosis etc.) → endoscopic third ventriculostomy (ETV), avoiding shunt dependence; treat the cause first for a posterior fossa mass.
3. [End] Communicating → VP shunt
   Communicating → ventriculoperitoneal shunt (VP shunt, adjustable valve); watch for infection/over-drainage/blockage.
4. [End] NPH → shunt after tap test
   Normal pressure hydrocephalus (gait/cognition/incontinence triad) → shunt for those with a positive tap test; weigh benefit against risk.
5. [End] Acute obstruction → EVD
   Acute obstructive hydrocephalus/deteriorating consciousness → emergency external ventricular drain (EVD) for decompression, then definitive management.

Source guidelines & references

• Hydrocephalus management (ETV vs ventriculoperitoneal shunt; NPH tap test)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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