**6. Liquor shunting operations (LSO)**

To correct persistent disorders of CSF circulation when it is impossible to use etiotropic treatment of decompensated hydrocephalus, LSO are used. The CSF shunting system is known to be an artificial analogue designed to compensate for disorders of CSF circulation, while its adequate functioning is determined by individual biomechanical parameters of the CSS.

Clinical and neuroimaging criteria, as well as their relationship with quantitative indicators of cerebrovascular circulation and cerebrovascular conjugation, determine the effectiveness of surgical treatment of hydrocephalus in children. Their importance while planning neurosurgical intervention is often underestimated. Solving these important tasks involves studying the disease aspects and taking into account how individual characteristics of the patient manifest—to develop a pathogenetically sound diagnostic system and personalize the hydrocephalus surgical treatment tactics.

In this regard, it is relevant to objectively evaluate these indicators and develop a system of minimally invasive monitoring of the viscoelastic properties of the CSS within the preoperative planning structure and to assess the effectiveness of hydrocephalus surgical treatment, taking into account changes in fluid dynamics.

Liquor anastomosis can be performed using shunts of various systems. The proximal part of the shunt is located in the cavity of the lateral ventricle, then the catheter passes through the brain substance, the soft and hard meninges, and bone and is connected to the pump. The pump is fixed to the bones of the skull and located directly under the skin. The pump valve regulates the pressure of the CSF at a predetermined level and allows it to pass in one direction only—from the cranial cavity to the extracerebral cavities. The distal part of the shunt is attached to the pump; it passes under the skin in the soft tissues of the neck and then, depending on the type of bypass surgery, plunges into the right atrium, transverse sinus, abdominal, pleural cavities, etc. (**Figure 5**).

Treatment of children with hydrocephalus involves various LSO. The removal of the CSF is carried out using implantable valve systems into the peritoneal cavity, with the inexpediency of classical methods, extracranial removal of CSF into the bloodstream (right atrium, jugular vein, sinuses of the dura mater, etc.) is used [28].

Indications for the CSF shunting operations with permanently implanted valve systems are persistent violations of CSF resorption, limiting the ability to normalize CSF circulation within the CSF system;

When choosing the parameters of the throughput of the CSF shunting system, they proceed from the results of measuring the biomechanical properties of the CSS and CSF circulation during surgery.

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

#### **Figure 5.**

*Types of CSF bypass surgery. A—Scheme of ventriculoperitoneostomy. B—Scheme of lumboperitoneostomy. C—Scheme of ventriculoatriostomy. D—Scheme of ventriculosynustransverzostomy. 1—Ventricular catheter; 2—Bypass system valve; 3—Peritoneal catheter; 4—Lumbar catheter; 5—Atrial catheter; 6—Sinus catheter.*

Types of LSO:

