Alternative Methods in the Surgical Treatment of Hydrocephalus

Hydrocephalus is a condition with a major impact on the noble cerebral substance, which, in the absence of a rapid and effective solution, generates significant morbidity and mortality. It is an eminently surgical pathology. The surgical solutions imagined are very numerous: ventriculo-cisternostomies, ventriculoperitoneal shunts, ventriculocardiac shunts, ventriculopleural shunts, ventriculobiliary shunts, ventriculovesical shunts, lumboperitoneal shunts, etc., with broader or narrower indications, sometimes with complications that can limit/restrict the procedure, requiring successive revisions or replacement of the method. Testing the viability and durability of each method imagined has been a constant concern during decades of neurosurgical practice. The occurrence of limited efficacy or complications recorded for each method in particular has generated attempts to improve and optimise the surgical technique, successive revisions of the method, or the choice of another surgical technique. The test of time has confirmed that the ventriculoperitoneal and ventriculocardiac shunts are the most viable and indicated in most etiopathogenic entities of hydrocephalus. This aspect has not limited the concerns for finding alternative surgical treatment solutions for situations in which their efficacy is exceeded or compromised. Ventriculoepiploic shunt, transomphalic extraperitoneal ventriculoportal shunt, and right transcephalic ventriculosubclavicular/ventriculocaval/ventriculocardiac shunt are innovative methods that may represent backup solutions in case of therapeutic failure.