A 1-year-old child with progressive head growth and irritability has non-communicating hydrocephalus on MRI due to aqueductal stenosis. The preferred surgical treatment is:

• A Ventriculoperitoneal (VP) shunt — standard long-term CSF diversion
• B Lumboperitoneal shunt — only for communicating hydrocephalus
• C Endoscopic third ventriculostomy (ETV) — preferred for obstructive hydrocephalus in children over 6 months, avoids shunt hardware ✓
• D Repeated lumbar punctures — temporizing measure only

Explanation

Endoscopic third ventriculostomy (ETV) is now the preferred first-line surgical treatment for non-communicating (obstructive) hydrocephalus, particularly aqueductal stenosis, in children older than 6 months. It bypasses the obstruction by creating a new CSF pathway from the third ventricle to the basal cisterns, avoiding shunt-related complications (infection, obstruction, revision surgery). VP shunt remains the standard for communicating hydrocephalus or in infants under 6 months where ETV success rates are lower.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.