Hydrocephalus · ETV vs Ventriculoperitoneal Shunt

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] Hydrocephalus type + age + cause
   Hydrocephalus type (obstructive/communicating)? Age? Cause?
   • Obstructive/non-communicating (aqueductal stenosis, tectal or posterior fossa tumor, cyst) → Obstructive → endoscopic third ventriculostomy
   • Communicating, or infant <1 year, or post-hemorrhage/post-infection → Communicating/infant/post-hemorrhage-infection → shunt
   • Normal pressure hydrocephalus (NPH), positive tap test → NPH positive response → shunt
2. [End] Obstructive → endoscopic third ventriculostomy
   Obstructive → endoscopic third ventriculostomy (ETV) preferred: a stoma in the third ventricle floor lets CSF bypass the obstruction, avoiding an implanted shunt and its infection/blockage/over-drainage; estimate success with the ETV success score (ETVSS: age + cause + prior shunt), higher with older age and aqueductal stenosis or tumoral obstruction; tumoral posterior fossa obstruction often resolves after tumor resection.
3. [End] Communicating/infant/post-hemorrhage-infection → shunt
   Communicating, infant <1 year, post-hemorrhage or post-infection → ETV has a low success rate, prefer ventriculoperitoneal shunt (VPS, adjustable valve); watch for shunt-related infection, blockage, over-drainage and distal complications, needs long-term follow-up and adjustable-valve management.
4. [End] NPH positive response → shunt
   Normal pressure hydrocephalus: classic triad (gait/cognition/incontinence) + positive tap test or lumbar drainage response → ventriculoperitoneal shunt (adjustable valve), with gait improving most; thorough preoperative assessment, those with a positive response benefit more.

Source guidelines & references

• Hydrocephalus surgery (endoscopic third ventriculostomy ETV vs CSF shunt; ETV success score ETVSS, Kulkarni)

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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