Chronic hydrocephalus associated with spina bifida

Chronic hydrocephalus associated with spina bifida constitutes a challenging problem for the neurosurgeon. Indeed, in spite of the numerous investigations carried out on the subject, the physiopathogenesis of this type of hydrocephalus remains relatively obscure in relation to its multifactorial etiology. In utero and in the neonatal period, the ventricular dilation seems, in fact, to depend mainly on abnormal fluid exchanges between the ventricles and cerebral parenchyma, whereas in later life obstructive phenomena appear to play a major role. Such a variable interplay of functional and obstructive factors accounts for the difficulties experienced in establishing the surgical indication in untreated patients with chronic hydrocephalus, and in planning the correct surgical management. In this respect, the study of CSF dynamics may provide very useful information.