Key Points

• Hydrocephalus is not a single disease entity. Treatment should be formulated based on an understanding of the underlying condition.

• Ventricular size is not the sole index by which hydrocephalus and the need for treatment should be evaluated; always correlate with the clinical picture before embarking on surgery.

• A wide range of shunt products are available for the treatment of hydrocephalus; it is recommended that the clinician becomes familiar with the use of a particular shunt system and reserves the more novel shunt valves for specific problem cases.

• The clinical presentation of shunt malfunction is extremely variable; shunt malfunction should always be considered in the presence of new or unexplained symptoms.

• When presented with cases of shunt malfunction, consider whether there is an opportunity to simplify complex shunt systems or perform endoscopic third ventriculostomy.

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