Endoscopic treatment of loculated hydrocephalus

Abstract

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.

Intraventricular and Intravenous Tobramycin with Ceftazidime for Ventriculitis Secondary to Pseudomonas aeruginosa

“…18,[30][31][32][33][34][35][36] This was apparent in our patient before intraventricular tobramycin was instituted because the highest CSF concentration was only 1.3 µg/mL despite a concurrent therapeutic peak serum concentration of 7.1 µg/mL. Our patient experienced variable CSF trough tobramycin concentrations, which ranged from 6.5 to 30.5 µg/mL on 5 mg/day intraventriculary.…”

“…[33][34][35][36][37][38][39][40] The potential exists for neuronal tissue irritation and necrosis with high CSF drug concentrations. Our patient had four seizure episodes, one shortly before abscess drainage and daily thereafter for 3 more days.…”

Ventricular endoscopy in the pediatric population: review of indications

“…Success of endoscopic fenestration in the setting of middle fossa arachnoid cysts is well-documented [91,98,99]. In work by Spacca et al, 90 % of the pediatric cohort treated demonstrated clinical improvement, and 73 % of cysts treated reduced in size or completely resolved following intervention [79].…”

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

“…The neuroendoscope has now become established as a means of performing minimally invasive neurosurgery, with particular indications in the treatment of hydrocephalus, biopsy of intraventricular lesions, and penetration of cystic lesions. 13,14,17,18) Applying a navigation system to a rigid endoscope allows real-time navigation of the rigid endoscope tip, and improves the understanding of anatomical structures observed through the endoscope, leading to improved treatment outcomes and safety. Flexible endoscopes can be used in areas difficult to approach by rigid endoscopes, to biopsy tumor lesions, observe the sylvian aqueduct, and evacuate intraventricular and intraparenchymal hematomas.…”