J Korean Neurosurg Soc.  2017 May;60(3):301-305. 10.3340/jkns.2017.0101.013.

Multiloculated Hydrocephalus: Open Craniotomy or Endoscopy?

• Lee YH
• Kwon YS
• Yang KH

• KMID: 2382764
• DOI: http://doi.org/10.3340/jkns.2017.0101.013

Abstract

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.

Keyword

Craniotomy; Endoscopy; Hydrocephalus; Multiloculated

MeSH Terms

Brain
Catheters
Cerebrospinal Fluid
Craniotomy*
Endoscopy*
Hematoma
Hemorrhage
Hemostasis
Humans
Hydrocephalus*
Hydrodynamics
Length of Stay
Membranes
Neurosurgery
Pathology
Subdural Effusion

Figure

• 

  Fig. 1 A six-month-old female was diagnosed with multiloculated hydrocephalus on MRI due to previous neonatal meningitis. A–C: Preoperative axial T2 images showed multiloculated hydrocephalus with severe cerebromalacia; D and E: Photographs of endoscopic fenestration. F–H: Follow up MRI after two years showed the ventricles had decreased in size and demonstrated one proximal indwelling shunt catheter via the right Kocher’s point. During the follow up period, the patient did not require revision of the shunt. MRI: magnetic resonance imaging.

Reference

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