**9. Prospects for the use of LSO**

The prospective research should be aimed at studying subtle mechanisms of CSF resorption in order to identify the possibilities of its prosthetics in case of impaired CSF circulation and hydrocephalus development. It is necessary to determine the role of lymphatic vessels and the glymphatic system in the outflow of CSF, as well as to assess the importance of vascular plexuses as the only sources of CSF production, which is questionable.

Informative criteria determining the perspective of the method of treatment of children with hydrocephalus are histobiological and anatomical-topographic features of the root cause of the disease, the presence and level of ventricular-subarachnoid dissociation, the severity of deformation of the cerebrospinal cavities, resistance to resorption of CSF, morphometric features of intracranial fluid-containing cavities, the pressure-volume index of the ratio of the CSS, and brain compliance.

In our opinion, it is promising to study the tissue characteristics of the periventricular white matter of the brain in communicating and occlusive hydrocephalus by diffusion MRI, with a quantitative assessment of the measured diffusion coefficient (ICD) and fractional anisotropy (FA) [37]. The choice of rational tactics for the treatment of children with hydrocephalus, first of all, implies taking into account and personifying these specific features of the disease manifestation (**Figure 13**).

**Figure 13.** *High-tech instrument for analyzing intracranial pressure data.*

*CSF Bypass Surgery in Children with Hydrocephalus: Modern Possibilities, Prospects… DOI: http://dx.doi.org/10.5772/intechopen.110871*

Conducting CSF shunting operations with the selection of shunting systems require more accurate automated support, as well as digital processing and monitoring of intracranial pressure data. Modern software capabilities can allow for pressure monitoring, compliance calculation, graphical representation of pressure changes over time, external data export, etc. [51].

Improving software methods will reduce the risk of unsatisfactory results of hydrocephalus treatment by optimizing the selection of valve throughput parameters.

Thus, in the absence of currently alternative methods of surgical treatment of aresorptive hydrocephalus, it is necessary to further improve fluid shunting systems valves so that to make them capable of adapting to changing parameters of fluid circulation, including the principle of feedback.

#### **10. Conclusions**

It should be recognized that currently, the only effective and nonalternative method of treating aresorptive hydrocephalus is liquor bypass surgery. Performing LSO remains a priority mode of correcting hydrocephalus when etiotropic correction of the disease turns out to be impossible. To identify the individual features of the pathogenesis and severity of hydrocephalus, not only impaired CSF circulation, deformation of the cerebrospinal cavities and brain, but also a change in the biomechanical properties of the CSS, and evaluation of craniocerebral disproportion are significant. These mechanisms are mutually burdening each other, and their priority is variable and may change during the course of the disease, the treatment of hydrocephalus including.

The existing methods of diagnosing hydrocephalus in children based on quantitative indicators of biomechanical properties of CSF, parameters of CSF circulation, and craniocerebral ratio are sufficiently developed and informative. Strong relationship established between pulse fluctuations of intracranial pressure, brain compliance, "pressure-volume" ratio of CSF, and CSF circulation is of

**Figure 14.** *Tactics for the treatment of hydrocephalus.*

diagnostic significance. Evaluation of pulse fluctuations of intracranial volume allows minimally invasive personalized quantification of the parameters of CSF circulation and biomechanical properties of the CSS and craniocerebral ratio (**Figure 14**).

When choosing a treatment method, preference is given to pathogenetic interventions. The leading diagnostic method for hydrocephalus is a quantitative assessment of hydrocephalus, parameters of CSF circulation, and biomechanical properties of CSF (PVI, compliance, cerebrospinal pressure curve).

Evaluation of CSF circulation parameters and the CSS compliance requires modern hardware. In this regard, new evaluation methods are currently being developed and the existing ones are being improved to make the study accurate, minimally invasive, and informative.
