Neuroendoscopic treatment of multiloculated hydrocephalus in children

Spennato, Pietro; Cinalli, Giuseppe; Ruggiero, Claudio; Aliberti, Ferdinando; Trischitta, Vincenzo; Cianciulli, Emilio; Maggi, G

doi:10.3171/ped.2007.106.1.29

Cited by 40 publications

(51 citation statements)

References 33 publications

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“…However, 10 of 13 patients combined from recent series had acceptable outcome without the need for a shunt after the procedure (Table 1). 8,11,13,15,16,21,25 Foraminoplasty may be performed safely in the presence of a thin avascular membrane covering the foramen. 13 However, if the foramen is atretic or obscured, there is increased risk of injury to the fornix.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy

Kalhorn

Strom²,

Harter

2011

FOC

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Section: Discussionmentioning

confidence: 99%

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy

Kalhorn

Strom²,

Harter

2011

FOC

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“…2,15,21,28 With the broadening use of neuroendoscopy, it became used in the setting of multiloculated hydrocephalus. 9,10,19,24,25,32,39 The advantage of using an endoscope for visualization in contrast to open cyst fenestration is obvious because it minimizes the size of skull opening, brain retraction and trauma, and facilitates deep access mainly through preformed and existing cavities. One advantage in endoscopic shunt placement is that the surgeon has intraoperative control of the position of the inserted catheters, thereby potentially decreasing the risk of malpositioning.…”

Section: Discussionmentioning

confidence: 99%

“…15 Treatment options for multiloculated hydrocephalus consist of microsurgical fenestration of cysts, shunting in which multiple catheters are placed in several cystic compartments, endoscopic fenestration in which communications are established to the ventricles, or a combination of these methods. 2,9,19,21,32 Endoscopy in patients with multiloculated hydrocephalus is challenging, because the orientation along normal anatomical landmarks is missed, but this disadvantage can be avoided by utilization of neuronavigation. 1,4,11,12,14,30 This retrospective study presents our experience with navigated endoscopic surgery for the treatment of multiloculated hydrocephalus.…”

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confidence: 99%

Navigated endoscopic surgery for multiloculated hydrocephalus in children

Schulz¹,

Böhner

Knaus³

et al. 2010

PED

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Object Multiloculated hydrocephalus remains a challenging condition to treat in the pediatric hydrocephalic population. In a retrospective study, the authors reviewed their experience with navigated endoscopy to treat multiloculated hydrocephalus in children. Methods Between April 2004 and September 2008, navigated endoscopic procedures were performed in 16 children with multiloculated hydrocephalus (median age 8 months, mean age 16.1 ± 23.3 months). In all patients preoperative MR imaging was used for planning entry sites and trajectories of the endoscopic approach for cyst perforation and catheter positioning. Intraoperatively, a rigid endoscope was tracked by the navigation system. For all children the total number of operative procedures, navigated endoscopic procedures, implanted ventricular catheters, and drained compartments were recorded. In addition, postoperative complications and radiological follow-up data were analyzed. Results In 16 children, a total of 91 procedures were performed to treat multiloculated hydrocephalus, including 29 navigated endoscopic surgeries. Finally, 21 navigated procedures involved 1 ventricular catheter and 8 involved 2 catheters for CSF diversion via the shunt. The average number of drained compartments in a shunt was 3.6 ± 1.7 (range 2–9 compartments). In 9 patients (56%) a navigated endoscopic procedure constituted the last procedure within the follow-up period. One additional surgery was necessary in 3 patients (19%) after navigated endoscopy, and in 4 patients (25%) 2 further procedures were necessary after navigated endoscopy. Serial follow-up MR imaging demonstrated evidence of sufficient CSF diversion in all patients. Conclusions Navigated endoscopic surgery is a safe and effective treatment option for multiloculated hydrocephalus. The combination of the endoscopic approach and neuronavigation further refines preoperative planning and intraoperative orientation. The aim of treatment is to drain as many compartments as possible and as soon as possible, thereby establishing sufficient CSF drainage with few ventricular catheters in single shunt systems. Close clinical and radiological follow-up is mandatory because multiple revisions are likely.

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“…Only the combination of morphological and functional data would finally lead to a correct classification of patients affected by multiloculated hydrocephalus and to the selection of the most (2) appropriate treatment. Indeed, current subclassification of this nosological entity is merely based on morphological data, 18 lacking any relation to different treatment strategies. Recently, a classification also taking into account the absorptive capacity has been proposed.…”

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confidence: 99%

Role of magnetic resonance ventriculography in multiloculated hydrocephalus

Gandhoke

Frassanito

Chandra

et al. 2013

PED

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Object In this paper the authors' goal was to investigate the clinical usefulness of Gd-enhanced MR ventriculography (MRV) in pediatric patients affected by multiloculated hydrocephalus. Methods Eighteen patients (11 boys and 7 girls, age range 2–14 months) with a diagnosis of multiloculated hydrocephalus were included in the study. After injection of gadodiamide (0.02–0.04 mmol) into the lateral ventricle by tapping the anterior fontanel, sagittal, coronal, and axial T1-weighted MR images were acquired. The location of the septations and the sites of obstruction of CSF flow were assessed. Postoperative MRV was obtained to confirm the results of endoscopic treatment in most complex cases. Results No adverse events were observed after injection of contrast medium into the ventricular system. Preoperative MRV accurately defined the exact morphology of septae and ventricular walls in all cases. In 1 case the diagnosis of multiloculated hydrocephalus was ruled out. Sites of obstruction of CSF flow within the ventricular system were also well established. In 4 cases the multiple compartments were proven to intercommunicate. Postoperative MRV was useful in assessing the functional status of third ventriculostomy, aqueductoplasty, and other endoscopic fenestrations. Conclusions Magnetic resonance ventriculography is a safe, effective, and reliable technique. The accurate definition of the anatomy of the ventricles and the site of obstruction in multiloculated hydrocephalus can help to plan the most appropriate treatment and minimize the number of procedures. Although MRV is also useful during postoperative follow-up to determine the results of endoscopic treatment, it should be limited to particularly complex cases, due to its invasiveness.

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Neuroendoscopic treatment of multiloculated hydrocephalus in children

Abstract: Neuroendoscopic procedures are a valid alternative to shunt revision in the management of multiloculated hydrocephalus. Early diagnosis comprising close monitoring with high-resolution magnetic resonance imaging and early treatment are the keys of success.

Cited by 40 publications

References 33 publications

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy

Navigated endoscopic surgery for multiloculated hydrocephalus in children

Role of magnetic resonance ventriculography in multiloculated hydrocephalus

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