Loculated hydrocephalus: is neuroendoscopy effective and safe? A 90 patients’ case series and literature review

Abstract

Introduction Loculated hydrocephalus is a complex condition in which different non-communicating compartments form within the ventricular system due to different etiology, mainly intraventricular hemorrhage and infection. Since the end of the twentieth century, neuroendoscopy has been explored as a therapeutic option for loculated hydrocephalus with non-univocal results. Methods We performed a retrospective analysis of 90 patients who underwent endoscopic treatment for loculated hydrocephalus from January 1997 to January 2021 (mean age: 2 years, range 7–21). We included 37 (41.1%) children with multiloculated hydrocephalus, 37 (41.1%) with isolated lateral ventricle, 13 (14.4%) with excluded temporal horn, and 3 (3.3%) with isolated fourth ventricle. We compared our results with those available in literature. Results A mean of 1.91 endoscopic procedure/patient were performed (only one endoscopy in 42.2% of cases). Complications of neuroendoscopy and of shunt surgeries were recorded in 17 (18.9%) and 52 (57.8%) children, respectively. Twenty-six (28.9%) children were shunt-free at the last follow-up, 47.8% have only one shunt. Discussion The first goal of neuroendoscopy is to increase the rate of shunt-free patients but, when it is not possible, it aims at simplifying shunt system and reducing the number of surgical procedures. In our series, neuroendoscopy was able to achieve both these goals with an acceptable complication rate. Thus, our results confirmed neuroendoscopy as a valid tool in the long-term management of loculated hydrocephalus. Neuronavigation and intraoperative ultrasound could increase the success rate in cases with distorted anatomy.

Neuroendoscopic Techniques in the Treatment of Hydrocephalus

“…In El-Grandour's study of uniloculated hydrocephalus including 31 children cases, the annual shunt revision rate fell from 2.7 to 0.25% [79]. Alice Noris's study seems to confirm these findings, with 75.6% of patients having no shunt or only one shunt implanted after neuroendoscopy [70]. Despite these encouraging findings, the rate of patients without shunts is low.…”

“…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].…”

“…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]. Intraventricular septations or obstructions between the site of CSF production and the tip of the ventricular catheter can present a barrier to the flow of CSF and result in an accumulation of fluid in the excluded compartments [70]. Intraventricular septations develop secondarily from meningitis or ventriculitis, germinal matrix intraventricular hemorrhage, congenital brain anomalies, and postoperative gliosis [38,70].…”

“…Intraventricular septations or obstructions between the site of CSF production and the tip of the ventricular catheter can present a barrier to the flow of CSF and result in an accumulation of fluid in the excluded compartments [70]. Intraventricular septations develop secondarily from meningitis or ventriculitis, germinal matrix intraventricular hemorrhage, congenital brain anomalies, and postoperative gliosis [38,70]. Patients with loculated hydrocephalus and intraventricular arachnoid bands or arachnoid cysts with extension into the ventricles are ideal candidates for intraventricular neuroendoscopy.…”

“…Consequently, the second-best treatment is considered to be the implantation of a simplified shunt Neuroendoscopic Techniques in the Treatment of Hydrocephalus DOI: http://dx.doi.org/10.5772/intechopen.111508 system. Most neuroendoscopic procedures appear to achieve these goals in loculated hydrocephalus [38,70,79]. Following endoscopic fenestration, fewer shunt revisions per year are necessary [33,73,79].…”