Multiloculated Hydrocephalus

2019 ◽  
pp. 1-16
Author(s):  
Graciela Zuccaro ◽  
Javier González Ramos
Keyword(s):  
Multiloculated Hydrocephalus

Role of magnetic resonance ventriculography in multiloculated hydrocephalus

2013 ◽  
Vol 11 (6) ◽  
pp. 697-703 ◽  
Author(s):  
Gurpreet S. Gandhoke ◽  
Paolo Frassanito ◽  
Nagesh Chandra ◽  
Bal K. Ojha ◽  
Anoop Singh
Keyword(s):  
Magnetic Resonance ◽  
Endoscopic Treatment ◽  
Ventricular System ◽  
Third Ventriculostomy ◽  
Csf Flow ◽  
Reliable Technique ◽  
Accurate Definition ◽  
Multiloculated Hydrocephalus ◽  
Definition Of ◽  
Complex Cases

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.

Frameless neuronavigation in intracranial endoscopic neurosurgery

2001 ◽  
Vol 94 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Wolfgang Wagner ◽  
Wolfgang Tschiltschke ◽  
Michael R. Gaab
Keyword(s):  
Third Ventricle ◽  
Colloid Cyst ◽  
Endoscopic Approach ◽  
Arachnoid Cysts ◽  
Tumor Biopsy ◽  
Foramen Of Monro ◽  
Endoscopic Neurosurgery ◽  
Content Type ◽  
Multiloculated Hydrocephalus ◽  
Fine Print

Object. Frameless computerized neuronavigation has been increasingly used in intracranial endoscopic neurosurgery. However, clear indications for the application of neuronavigation in neuroendoscopy have not yet been defined. The purpose of this study was to determine in which intracranial neuroendoscopic procedures frameless neuronavigation is necessary and really beneficial compared with a free-hand endoscopic approach. Methods. A frameless infrared-based computerized neuronavigation system was used in 44 patients who underwent intracranial endoscopic procedures, including 13 third ventriculostomies, nine aqueductoplasties, eight intraventricular tumor biopsy procedures or resections, six cystocisternostomies in arachnoid cysts, five colloid cyst removals, four septostomies in multiloculated hydrocephalus, four cystoventriculostomies in intraparenchymal cysts, two aqueductal stent placements, and fenestration of one pineal cyst and one cavum veli interpositi. All interventions were successfully accomplished. In all procedures, the navigational system guided the surgeons precisely to the target. Navigational tracking was helpful in entering small ventricles, in approaching the posterior third ventricle when the foramen of Monro was narrow, and in selecting the best approach to colloid cysts. Neuronavigation was essential in some cystic lesions lacking clear landmarks, such as intraparenchymal cysts or multiloculated hydrocephalus. Neuronavigation was not necessary in standard third ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid cysts, or for approaching the posterior third ventricle when the foramen of Monro was enlarged. Conclusions. Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

Endoscopic treatment of loculated hydrocephalus

1995 ◽  
Vol 82 (5) ◽  
pp. 780-785 ◽  
Author(s):  
Adam I. Lewis ◽  
Glenn L. Keiper ◽  
Kerry R. Crone
Keyword(s):  
Relative Risk ◽  
Endoscopic Treatment ◽  
Shunt Revision ◽  
Cerebrospinal Fluid Leakage ◽  
Invasive Technique ◽  
Content Type ◽  
Increased Risk ◽  
Multiloculated Hydrocephalus ◽  
Cyst Recurrence ◽  
Cyst Fenestration

✓ Loculated hydrocephalus remains a difficult neurosurgical problem and endoscopes designed to navigate through the ventricular system provide a new option for treatment. The authors review their experience, during the period March 1990 to June 1993, using a steerable fiberscope in 34 cases of loculated hydrocephalus to evaluate the efficacy of endoscopic cyst fenestration. The goals of treatment were to control hydrocephalus, simplify preexisting shunt systems, and reduce operative morbidity. Endoscopic cyst fenestrations reduced the shunt revision rate from 3.04 per year prior to endoscopy to 0.25 per year after the procedure, during a follow-up period ranging from 8 to 45 months, mean 26 months. However, eight patients (23.5%) required 14 repeat operations to control loculated hydrocephalus. After endoscopy, patients with multiloculated hydrocephalus had a nearly fivefold increased risk (relative risk 4.85) for shunt malfunction and more than a twofold increased risk (relative risk 2.43) for cyst recurrence versus patients with uniloculated hydrocephalus. Similarly, six (50%) of 12 patients shunted prior to endoscopy required a repeat endoscopic procedure (relative risk 5.56). Although repeat endoscopic procedures may be required to control hydrocephalus, endoscopic cyst fenestration avoided placement of a shunt in seven (33%) of 21 patients with uniloculated hydrocephalus. One patient, encountered early in the authors' experience, required a craniotomy for fenestration of multiple ventricular cysts. Endoscopic complications included cerebrospinal fluid leakage in one case and ventriculitis in another. The authors conclude that endoscopic treatment of loculated hydrocephalus is a safe, minimally invasive technique that should be considered as the initial treatment option.

Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 100-106 ◽  
Author(s):  
David I. Sandberg ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Pediatric Patients ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Neurological Outcomes ◽  
Multiloculated Hydrocephalus ◽  
Before And After ◽  
Posterior Parietal ◽  
Ventricular Catheters

Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.

Navigated endoscopic surgery for multiloculated hydrocephalus in children

2010 ◽  
Vol 5 (5) ◽  
pp. 434-442 ◽  
Author(s):  
Matthias Schulz ◽  
Georg Bohner ◽  
Hannah Knaus ◽  
Hannes Haberl ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Mr Imaging ◽  
Endoscopic Surgery ◽  
Endoscopic Approach ◽  
Ventricular Catheter ◽  
Endoscopic Procedures ◽  
Additional Surgery ◽  
Multiloculated Hydrocephalus ◽  
Ventricular Catheters ◽  
Csf Diversion

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.

Multiloculated hydrocephalus in infants

Neurosurgery ◽  
1981 ◽  
Vol 8 (6) ◽  
pp. 641???6 ◽  
Author(s):  
V Albanese ◽  
F Tomasello ◽  
S Sampaolo
Keyword(s):  
Multiloculated Hydrocephalus

scholarly journals Multiloculated Hydrocephalus : Open Craniotomy or Endoscopy?

2017 ◽  
Vol 60 (3) ◽  
pp. 301-305
Author(s):  
Yun Ho Lee ◽  
Young Sub Kwon ◽  
Kook Hee Yang
Keyword(s):  
Multiloculated Hydrocephalus

scholarly journals Combined approach of multiloculated hydrocephalus and isolated fourth ventricle

2020 ◽  
Vol 2 (2(May-August)) ◽  
pp. e292020
Author(s):  
Lucas de Souza Rodrigues dos Santos ◽  
Leo Gordiano Matias ◽  
Fernando Luís Maeda ◽  
Humberto Belem De Aquino ◽  
Enrico Ghizoni
Keyword(s):  
Fourth Ventricle ◽  
Late Onset ◽  
External Ventricular Drain ◽  
Ventricular Catheter ◽  
Skin Closure ◽  
Combined Approach ◽  
Left Lateral Ventricle ◽  
Multiloculated Hydrocephalus ◽  
Isolated Fourth Ventricle ◽  
Myelomeningocele Repair

A female newborn patient presents with meningitis and hydrocephalus after lumbosacral myelomeningocele repair and skin closure. An external ventricular drain was used during the meningitis treatment. Patient had a late onset multiloculated hydrocephalus and isolated fourth ventricle on CT scan follow-up. We performed combined approach with a craniotomy, dissection of intraparietal sulcus entering in the atrium of left lateral ventricle and used endoscopic assistance to fenestrate intraventricular septations and to put a ventricular catheter through tentorium to drain both supra and infratentorial ventricles. The patient improved clinically and radiologically.

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