Multiloculated Hydrocephalus : Open Craniotomy or Endoscopy?

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.

Y-shaped Ventriculo-peritoneal Shunt for Adult Complicated Hydrocephalus: Report of 28 Illustrative Cases

“…Therefore, this strategy for complicated hydrocephalus was reliable. The incurrence of infection as a result of the shunt implantation in the literature varies widely from 0.17% to 13.2% [4]. Consistent with previous reports, the rate of infection in our study was 3.6%.…”

“…The existing evidence at case series level seems to favor neuro-endoscopy as the rst line of treatments over traditional shunt surgery [3]. However, VPS is still the treatment of choice in communicating hydrocephalus or in patients after the failure of endoscopic fenestration [4]. Besides, the decision on what treatment to apply should be based on individual anatomy, underlying pathology, available techniques, and the experience of the treating surgeon [5].…”

Endoscopic treatment of complex multiloculated hydrocephalus in children, steps that may help to decrease revision rate

“…Both microsurgical and endoscopic septal fenestration techniques have been described to serve the aforementioned surgical goals. [ 1 , 8 , 18 , 27 , 29 , 30 ] They can communicate the cysts to be eventually drained by a single shunt catheter. Little published data exist that assess both surgical approaches in details.…”

Management of Arachnoid Cysts: A Comprehensive Review

“…A study done by Jung Won Choi et al reviewed the surgical outcomes of intracranial arachnoid cysts and concluded that fenestration of cysts is associated with more surgical complications [ 11 ]. However, some studies suggest that neuroendoscopy remains a superior approach, with a lower risk of surgical complications associated with craniotomy and shunting [ 12 - 13 ]. In a case series on the endoscopic approach, a success rate of up to 71–81% has been documented [ 12 ].…”

“…However, some studies suggest that neuroendoscopy remains a superior approach, with a lower risk of surgical complications associated with craniotomy and shunting [ 12 - 13 ]. In a case series on the endoscopic approach, a success rate of up to 71–81% has been documented [ 12 ]. Furthermore, with associated hydrocephalus, the possibility of larger spaces makes this treatment option easier to execute.…”