Abstract
Most of childhood hydrocephalus are originating during infancy. It is considered to be a complex disease since it is developed on the basis of heterogeneous pathophysiological mechanisms and different pathological conditions as well as during different age groups. Hence, it is of relevant importance to have a practical concept in mind, how to categorize hydrocephalus to surgically better approach this disease. The current review should offer further basis of discussion on a disease still most frequently seen in Pediatric Neurosurgery. Current literature on pathophysiology and classification of pediatric hydrocephalus has been reviewed to integrate the different published concepts of hydrocephalus for pediatric neurosurgeons. The current understanding of infant and childhood hydrocephalus pathophysiology is summarized. A simplified concept based on seven factors of CSF dynamics is elaborated and discussed in the context of recent discussions. The seven factors such as pulsatility, CSF production, major CSF pathways, minor CSF pathways, CSF absorption, venous outflow, and respiration may have different relevance and may also overlap for the individual hydrocephalic condition. The surgical options available for pediatric neurosurgeons to approach hydrocephalus must be adapted to the individual condition. The heterogeneity of hydrocephalus causes mostly developing during infancy warrant a simplified overview and understanding for an everyday approach. The proposed guide may be a basis for further discussion and may serve for a more or less simple categorization to better approach hydrocephalus as a pathophysiological complex disease.
Highlights
Hydrocephalus is a condition of CSF circulation disturbance with imbalanced CSF flow dynamics of various reasons and develops as a symptom of an underlying disease
Despite a relevant progress which was made during the last century, Dandy’s classification remains still important because his concept remains our basis for decision making on how to treat the hydrocephalus either with a shunt in communicating conditions or by endoscopic fenestration to reestablish communication of CSF between internal and external CSF spaces in non-communicating hydrocephalus
In contrast to a rather complex classification of pathophysiology, the therapeutic options we apply as pediatric neurosurgeon are rather limited but are still a challenge to apply in the optimal way
Summary
Hydrocephalus is a condition of CSF circulation disturbance with imbalanced CSF flow dynamics of various reasons and develops as a symptom of an underlying disease. Shizuo Oi established a multi-categorical classification that has taken different categories and subtypes of hydrocephalus into account, mainly patient characteristics, CSF pathophysiological conditions, and treatment options. This classification defined hydrocephalus as a complex disease given a theoretical number of more than 75 million subtypes of hydrocephalus [55]. Research on molecular level of cellular and microvascular CSF transport is an utmost important basis for the understanding of CSF dynamics [1, 33, 54] All these approaches for a better understanding of physiology and pathophysiology are intensely discussed in recent literature [36]. The present report tries to integrate different ideas of hydrocephalus pathophysiology and develop a model for a practical understanding of a complex pathophysiological condition
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