Y-shaped branched ventriculo-peritoneal shunt for adult multiloculated hydrocephalus

Abstract

Multiloculated hydrocephalus (MLH) due to neurosurgical manipulation, hemorrhage, infection, or tumors is uncommon in adults and cannot be easily resolved by endoscopic fenestration or unilateral ventriculo-peritoneal shunt (VPS) and no consensus on surgical strategy for MLH has yet been reported. The goal of treatment is to restore communication between trapped ventricular compartments, [1] and current treatment methods include microsurgical fenestration of separate entrapments by endoscopy or craniotomy, shunt surgery with multiple catheters placed in trapped compartments, or combinations of these modalities. [2] The existing evidence seems to favor neuro-endoscopy as the first line of treatment over traditional shunt placement. However, due to individual anatomic complexity and CSF hydrodynamics, each MLH case must be evaluated individually. The decision on which treatment to apply is based on individual anatomy, underlying pathology, available techniques, and the experience of the treating surgeon. Therefore, no procedure proposed by the literature should be ruled out a priori. [1] Y-shaped branched VPS has complementary advantages with endoscopic fenestration in treating complicated MLH and is still the treatment of choice for communicating hydrocephalus and after failure of endoscopic fenestration.Xiaohui Ren and Chuanwei Yang contributed equally to the work.