Multiloculated Hydrocephalus: A Study of 24 Patients Operated by Endoscopic Cyst Fenestration 870

Neurosurgery ◽  
2006 ◽  
Keyword(s):  
Multiloculated Hydrocephalus ◽  
Cyst Fenestration

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.

Endoscopic cyst fenestration in the treatment of multiloculated hydrocephalus in children

2008 ◽  
Vol 1 (3) ◽  
pp. 217-222 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Pediatric Neurosurgery ◽  
Difficult Problem ◽  
Magnetic Resonance Images ◽  
Definitive Treatment ◽  
Shunt Revision ◽  
Neonatal Meningitis ◽  
Third Ventriculostomy ◽  
Shunt Insertion ◽  
Multiloculated Hydrocephalus ◽  
Cyst Fenestration

Object The treatment of multiloculated hydrocephalus is a difficult problem in pediatric neurosurgery. Definitive treatment is surgical, yet the approach remains controversial. The author has therefore reviewed his results with endoscopic cyst fenestration (ECF) in the management of this disease. Methods The author presents the largest series to date of 24 patients with multiloculated hydrocephalus who were treated endoscopically. The group included 10 boys and 14 girls with a mean age of 12.5 months. Uniloculated hydrocephalus was not included in this study because it is a different entity that would be better studied separately. Results Neonatal meningitis was the most common cause (in 9 patients), followed by intraventricular hemorrhage (in 6 patients), postoperative gliosis (in 6 patients), and multiple neuroepithelial cysts (in 3 patients). Multiplanar magnetic resonance images made early diagnosis possible and are indicated if the computed tomography scan shows disproportionate hydrocephalus. Surgical treatment included ECF (in 24 patients), endoscopic revision of a malfunctioning preexisting shunt (in 6 patients), placement of a new shunt (in 15 patients), and third ventriculostomy (in 3 patients). The ECF was easily performed in all cases through devascularization of the cyst wall by coagulation to prevent recurrence. The results are encouraging with improvement of hydrocephalus in 18 patients (75%). The need for shunt insertion was avoided in 3 patients (12.5%). Endoscopy reduced shunt revision rate from 2.9 per year before fenestration to 0.2 per year after fenestration. During the overall mean follow-up period (30 months), repeated ECF was necessary in 8 patients (33%). Six (75%) of these 8 patients had already undergone shunt treatment before endoscopy. Endoscopic complications were minimal (2 cerebrospinal fluid leaks and 2 minor arterial hemorrhages), and there were no deaths (0%). Conclusions An ECF procedure is recommended in the treatment of multiloculated hydrocephalus because it is effective, simple, minimally invasive, and associated with low morbidity and mortality rates.

scholarly journals Multiloculated Hydrocephalus: Surgical Techniques

2020 ◽  
Vol 3 (1(January-April)) ◽  
pp. e722020
Author(s):  
Ricardo de Amoreira Gepp
Keyword(s):  
Intracranial Pressure ◽  
Surgical Techniques ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Routine Practice ◽  
Intraoperative Bleeding ◽  
Pubmed Database ◽  
Multiloculated Hydrocephalus ◽  
Csf Leakage ◽  
Cyst Fenestration

Objective:  Hydrocephalus shunt remains as the most common treatment choice for nonobstructive hydrocephalus, but in some cases multiloculated hydrocephalus (MH) remains a difficult neurosurgical disease despite of the different therapeutic options available.  In children with MH multiple shunt procedures combined with neuroendoscopy may be required.(1) The rationale for neuroendoscopy in such complex cysts and multiloculated hydrocephalus is also to open several compartments to the normal fluid-filled spaces, minimize the number of isolated/loculated CSF spaces, and decrease shunt dependency and the number of proximal shunt catheters.(2) In such cases our major objective is keep the children with one or no one shunt and with one normal intracranial pressure (ICP). Most patients with multiloculated hydrocephalus are infants with a severe disability who present with high intracranial pressure. Multiple shunting was a routine practice so far to normalize the intracranial pressure, but in these cases shunt complications could be quite common including shunt infection, malposition and malfunction which needed more shunt revision surgeries.(1, 3) Neuroendoscopy has changed the treatment options for complex multiloculated hydrocephalus. The possibility to do several fenestrations and change multiples cysts in one simple cyst or ventricle was one important improvement in MH treatment.(4-6) In this review we will discuss aspects related to etiology, surgical techniques, and results in multiloculated hydrocephalus.   Methods: The authors carried out a literature review on multiloculated hydrocephalus and evaluated a series of personal cases operated in the recent years. The keywords loculated hydrocephalus and surgical technique were used in Pubmed database website. Fifty-two articles were obtained and reviewed. From these publications we select the most relevant ones for the presentation. The articles were divided according to the main subject, with articles on etiology, surgical techniques and outcomes were selected. We also reviewed some difficult cases with MH from personal experience. In all of those cases endoscopy procedures were performed associated to shunt procedures in all cases. The authors described some different techniques of cyst fenestration and the association to shunt or not. Results/Discussion: Neuroendoscopy has changed the treatment in MH. This is a very difficult and interesting disease. Common risk factors for the development of MH include intraventricular hemorrhage, bacterial meningitis, shunt infection, and cerebrospinal fluid (CSF) overdrainage from shunt placement (rare). The magnetic resonance imaging (MRI) or computerized tomography (CT) scan with evidence of septations causing marked nonuniform compartmentalization and enlargement within the ventricular system are the most important ways to do the diagnosis of MH. Predisposing factors include low birth weight, prematurity, perinatal complications, and congenital malformation. Although the full pathogenesis of MLH remains unclear, it is known that inflammation leads to subependymal gliosis, which produces glial tufts and septations that occlude the normal ventricle system. Septations also develop via organization of intraventricular exudate and debris from ventriculitis. Despite os clinical history of poor outcome, head circuference increase and prior infection or brain bleeding, we need image to perform the diagnosis. Types of loculated hydrocephalus could be divided in: multiloculated and uniloculated. The most important classification was done by Spennato.(5) He divided in five types: 1) hydrocephalus with multiple intraventricular septations; 2) isolated lateral ventricle/unilateral hydrocephalus; 3) entrapped temporal horn; 4) isolated fourth ventricle; 5) expanding cavum septi pellucidi/cavum vergae Using the endoscope to treat MH has some advantages.(7, 8) This is a less invasiveness and this is very important in kids.(6) Avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. But endoscopy has some risk and possible complications. It also has several disadvantages. A subdural hematoma and/or hygroma may form, but the incidence of this is lower than with open craniotomy. The risk of ventriculitis, CSF leakage (subcutaneous CSF collection), and hemorrhage are reported to be like that with open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy in endoscopy as in open craniotomy.(9) Some new technologies could improve the outcome and avoid risk and complications.(10, 11)  Navigation could be used in two forms: Navigation system is used to planning the entry point and the endoscopy trajectory Endoscopy guided and navigation during all surgical time. The evaluation of results is presented in different ways in the literature. The main outcomes observde for measuring results were: hydrocephalus control or not, number of surgery performed and number of catheters used.(4) Shunt Independence is rare. Conclusion: Multiloculated hydrocephalus is one difficult disease to treat.(4) Neuroendoscopy cyst fenestration was one great improvement in treatment of MH, but after this new procedure the clinical outcome still no so good. Endoscopy is important to decrease the number of shunts and surgeries.  

Partial major hepatectomy with cyst fenestration for polycystic liver disease: indications, short and long-term outcomes

2021 ◽  
pp. 101670
Author(s):  
Olivier Boillot ◽  
Bénédicte Cayot ◽  
Olivier Guillaud ◽  
Jessica Crozet-chaussin ◽  
Valérie Hervieu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Major Hepatectomy ◽  
Polycystic Liver Disease ◽  
Long Term Outcomes ◽  
Polycystic Liver ◽  
Short And Long Term ◽  
Cyst Fenestration

scholarly journals Right Extended Hepatectomy and Cyst Fenestration in a Rare Severe Polycystic Liver Disease: How I Do it Safely

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S190
Author(s):  
S. Roy ◽  
S. Anupurva ◽  
D. Das ◽  
M. Bhoi ◽  
S. Mohanty
Keyword(s):  
Liver Disease ◽  
Polycystic Liver Disease ◽  
Extended Hepatectomy ◽  
Polycystic Liver ◽  
Cyst Fenestration

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.

scholarly journals Polyhedral Fenestration Technique Used for Combined Partial Hepatectomy and Cyst Fenestration for Polycystic Liver Disease: A Small Case Series

2020 ◽  
Vol 104 (3-4) ◽  
pp. 159-165
Author(s):  
Yoshiki Sato ◽  
Daisuke Morioka ◽  
Kazuya Yamaguchi ◽  
Nobutoshi Horii ◽  
Kentaro Miyake ◽  
...  
Keyword(s):  
Liver Disease ◽  
Case Series ◽  
Patient Characteristics ◽  
Control Group ◽  
Polycystic Liver Disease ◽  
Long Term Outcomes ◽  
Ct Volumetry ◽  
Polycystic Liver ◽  
Cyst Fenestration

Objective: To assess the safety and efficacy of “polyhedral fenestration technique” (PFT), which we newly developed, in combined hepatectomy and cyst fenestration (CHCF) for symptomatic polycystic liver disease (PLD). Summary of background data: CHCF for PLD has been reportedly less efficacious for its invasiveness because 50% to 70% patients suffered recurrent symptoms after CHCF. Methods: Patient characteristics, intra- and early postoperative variables were compared between 5 PLD patients undergoing CHCF performed with PFT (PLD group) and 95 patients with diseases other than PLD receiving hepatectomy without biliary reconstruction during the same period (Control group) to assess safety of PFT. Chronological changes in total liver volume (TLV) measured by computed tomography (CT) volumetry as well as recurrent symptoms after CHCF were investigated to assess long-term outcomes. Results: Although ≧ Clavien-Dindo grade 2 complications were more common in the PLD group than in the Control group (PLD vs Control, 5/5[100%] vs 27/95[28%], p=0.004), patient characteristics, intra-, and early postoperative variables, including ≧ Clavien-Dindo grade 3 complications, were comparable among the 2 groups. Postoperative observational period of the 5 PLD patients ranged 30 to 88 months with a median of 63. CT volumetry revealed that TLV continued to reduce up to 1 year after surgery and thereafter retained less than 0.5 times of preoperative TLV in all patients. Recurrent liver enlargement or recurrent symptoms were not observed in any of the 5 PLD patients. Conclusions: Although our case series was very small, newly-developed PFT in CHCF for PLD yielded acceptable safety and excellent long-term outcomes.

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.

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