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Shunt technology and endoscopic ventricular surgery

The management of cerebrospinal fluid (CSF) disorders via CSF diversion is now a complex clinical science, requiring a detailed understanding of CSF physiology in both the normal and diseased brain. Successful treatment of this group of disorders requires a comprehensive knowledge of all the available shunt types, their similarities, differences, and idiosyncrasies. The rapid development of endoscopic neurosurgical techniques makes treating this group of patients without a shunt often a real possibility, and arguably is now a core neurosurgical skill. In this chapter we will summarize the CSF physiology in the normal state, and explain the principles of CSF diversion before going on to describe the various shunt types available. A section will be devoted to endoscopic CSF diversion techniques, including a detailed explanation of third ventriculostomy.