Endoscopic treatment of complex multiloculated hydrocephalus in children, steps that may help to decrease revision rate

Abstract

Background: Multiloculated hydrocephalus (MLH) is associated with increased intracranial pressure, with intraventricular septations, loculations, and isolation of parts of the ventricular system. Search continues for ideal surgical remedy capable of addressing the dimensions of the problem. We aimed to evaluate endoscopic septal fenestration and pellucidotomy combined with proximal shunt tube refashioning and further advancement into isolated loculations of the ventricular system containing choroid plexus. Methods: This retrospective study was conducted on 55 patients with symptomatic complex MLH who underwent endoscopic surgery. The collected data included patients’ age, gender, presenting manifestations, operative details, rate of remission of preoperative clinical and imaging signs, postoperative complications, redo surgery, or extra shunt hardware insertion. Patients were divided into Group A (underwent the standard technique of endoscopic multiseptal wide fenestration and final ventriculoperitoneal shunt insertion) and Group B (modified technique by adding extra side ports along the proximal shunt hardware). Results: Groups A and B included 25 and 30 patients, respectively. The percentage of patients showing improvement of almost all manifestations was higher in Group B compared to Group A, with no significant difference (P > 0.05). Group B had lower rate of complications (20% vs. 36%, P = 0.231), insertion of two shunts (16.7% vs. 20%, P = 1.000), and redo surgery (20% vs. 44%, P = 0.097). Conclusion: The modified technique was associated with better outcomes in terms of the use of single shunt and redo surgery. Launching randomized clinical trials to compare the two techniques are recommended to ascertain the efficacy of the modified technique.

Intraventricular endoscopy and intraventricular antibiotics in the treatment of multiloculated hydrocephalus with ventriculitis in a neonate and an infant: Two case reports

“…In addition, we utilized the experience of one of our colleagues (a skull base specialist neurosurgeon) in cerebral endoscopy. [ 1 , 5 , 6 , 13 , 19 , 21 , 22 , 24 ]…”

“…In addition, we utilized the experience of one of our colleagues (a skull base specialist neurosurgeon) in cerebral endoscopy. [1,5,6,13,19,21,22,24] Because the results were very effective and without associated morbidity, we used this endoscopic technique in the second pediatric case. us, intraventricular endoscopic septostomy is currently one of the first choices for treating septate hydrocephalus to minimize morbidity and the number of ventricular catheters required.…”

Navigation guidance in neuroendoscopic management of complex hydrocephalus

“…Continuous intraoperative irrigation leads to less collapse of the ventricle and therefore less brain shift. [1][2][3][4][5] 1:13 Case 1. A 10-month-old female child was operated for ruptured meningomyelocele at birth.…”

“…Continuous intraoperative irrigation leads to less collapse of the ventricle and therefore less brain shift. 1 – 5 …”

Neuroendoscopic Techniques in the Treatment of Hydrocephalus

“…Neuroendoscopic techniques have been extended to foraminoplasty of the foramens of Monro and Magendie as well as to endoscopic fourth ventriculostomy [67][68][69]. The fenestration of loculated hydrocephalus is another endoscopic technique widely used in the treatment of hydrocephalus [38,[70][71][72]. The presence of one or more non-communicating isolated compartments within the ventricular system that tend to enlarge despite a functioning shunt system is defined as loculated hydrocephalus [73].…”