Dear Editor:

We read the publication on “Hydrocephalus associated to congenital Zika syndrome and shunting” with a great interest [1]. Jucá et al. concluded that “This series points out the possibility of hypertensive hydrocephalus development in CZS patients. Affected children may benefit from VP shunt insertion. These findings suggest a dual pathology association: fetal brain disruption and primary cortical malformation by the virus itself and hypertensive hydrocephalus [1].” The observation of hydrocephalus in infected infant is totally different from the finding in our country where the infected infant is usually asymptomatic [2] and the neuroimaging usually shows negative finding [3, 4].

Nevertheless, in case that there is hydrocephalus, there is still no specific guideline for management. Placing of shunt might be a good alternative but placing of shunt in Zika virus-infected case should be seriously considered on its risk and benefit. The important possible complication is the shunt failure due to the induction of subclinical meningoventriculitis [5].