Neuroendoscopic Management of Multiloculated Hydrocephalus

A bstract Objectives: Multiloculated hydrocephalus (MH) refers to the presence of isolated cerebrospinal fluid (CSF) compartments or discrete fluid-filled compartments in relation to the ventricular system of the brain despite the presence of a functioning shunt system. The objective of treatment in these cases is to reduce the number of surgical interventions, control hydrocephalus, simplification of complex shunts, and decrease post-operative morbidity. Materials and Methods: We report four cases presenting with signs and symptoms of increased intracranial pressure due to multiloculated hydrocephalus. Magnetic resonance imaging (MRI) of the brain and computed tomography (CT) ventriculogram were suggestive of multiple intraventricular loculations with obstructive hydrocephalus. Results: Endoscopic septostomy was planned along with ventriculoperitoneal shunt to negotiate a single ventricular catheter through all the loculations for all the patients. Conclusion: Neuroendoscopy is the current treatment of choice for multiloculated hydrocephalus. Neuronavigation as an aid to neuroendoscopy makes it more effective and safer for the patients. The combination of a minimally invasive endoscopic approach with CT ventriculogram and neuronavigation facilitates preoperative planning and intraoperative orientation in distorted cerebral anatomy and lack of normal brain features. The endoscopic shunting of formed connections ensures adequate catheter position and prevents the recurrence of occlusion. The aim of the operation is the drainage of the maximum possible number of cavities using a minimal number of the proximal catheter and shunt systems.