Indications for shunt insertion or III ventriculostomy in hydrocephalic children, guided by lumbar and intraventricular infusion tests

The best therapeutic management for infantile hydrocephalus is not always o bvious. Traditionally, shunt insertion has been performed when CSF dynamics have been considered abnormal. However, in cases of noncommunicating hydro cephalus endoscopic III ventriculostomy (ETV) has become a well-established treatment modality, but despite clinical and radiological information clin ical improvement is not obtained in all cases. A reliable preoperative inve stigative procedure helping to select hydrocephalic children for ETV, shunt insertion or no operation, is urgently needed. We report three cases of in fantile hydrocephalus, in which our operative management was guided by the results of cerebrospinal (CSF) infusion tests. With a lumbar infusion test we assessed the CSF resorption capacity, and thus whether shunting was indi cated. Comparing the results with those of an intraventricular infusion tes t, we assessed the presence of any structural blockage of the CSF circulati on between the ventricles and the subarachnoid compartment, which would ind icate a possible effect of an ETV. Performance of both a lumbar infusion te st and a subsequent intraventricular infusion test in hydrocephalic childre n seems to provide valuable information for the decisionmaking on surgery.