Navigated endoscopic surgery for multiloculated hydrocephalus in children

Clinical article

View More View Less
  • 1 Departments of Pediatric Neurosurgery and
  • | 2 Radiology, Charité Universitätsmedizin Berlin, Germany
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Multiloculated hydrocephalus remains a challenging condition to treat in the pediatric hydrocephalic population. In a retrospective study, the authors reviewed their experience with navigated endoscopy to treat multiloculated hydrocephalus in children.

Methods

Between April 2004 and September 2008, navigated endoscopic procedures were performed in 16 children with multiloculated hydrocephalus (median age 8 months, mean age 16.1 ± 23.3 months). In all patients preoperative MR imaging was used for planning entry sites and trajectories of the endoscopic approach for cyst perforation and catheter positioning. Intraoperatively, a rigid endoscope was tracked by the navigation system. For all children the total number of operative procedures, navigated endoscopic procedures, implanted ventricular catheters, and drained compartments were recorded. In addition, postoperative complications and radiological follow-up data were analyzed.

Results

In 16 children, a total of 91 procedures were performed to treat multiloculated hydrocephalus, including 29 navigated endoscopic surgeries. Finally, 21 navigated procedures involved 1 ventricular catheter and 8 involved 2 catheters for CSF diversion via the shunt. The average number of drained compartments in a shunt was 3.6 ± 1.7 (range 2–9 compartments). In 9 patients (56%) a navigated endoscopic procedure constituted the last procedure within the follow-up period. One additional surgery was necessary in 3 patients (19%) after navigated endoscopy, and in 4 patients (25%) 2 further procedures were necessary after navigated endoscopy. Serial follow-up MR imaging demonstrated evidence of sufficient CSF diversion in all patients.

Conclusions

Navigated endoscopic surgery is a safe and effective treatment option for multiloculated hydrocephalus. The combination of the endoscopic approach and neuronavigation further refines preoperative planning and intraoperative orientation. The aim of treatment is to drain as many compartments as possible and as soon as possible, thereby establishing sufficient CSF drainage with few ventricular catheters in single shunt systems. Close clinical and radiological follow-up is mandatory because multiple revisions are likely.

Abbreviation used in this paper:

VP = ventriculoperitoneal.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Akai T, , Shiraga S, , Sasagawa Y, , Okamoto K, , Tachibana O, & Lizuka H: Intra-parenchymal tumor biopsy using neuroendoscopy with navigation. Minim Invasive Neurosurg 51:8386, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Albanese V, , Tomasello F, & Sampaolo S: Multiloculated hydrocephalus in infants. Neurosurgery 8:641646, 1981

  • 3

    Albanese V, , Tomasello F, , Sampaolo S, & Picozzi P: Neuroradiological findings in multiloculated hydrocephalus. Acta Neurochir (Wien) 60:297311, 1982

    • Search Google Scholar
    • Export Citation
  • 4

    Alberti O, , Riegel T, , Hellwig D, & Bertalanffy H: Frameless navigation and endoscopy. J Neurosurg 95:541543, 2001

  • 5

    Baldauf J, , Oertel J, , Gaab MR, & Schroeder HW: Endoscopic third ventriculostomy in children younger than 2 years of age. Childs Nerv Syst 23:623626, 2007

    • Search Google Scholar
    • Export Citation
  • 6

    Berry JG, , Hall MA, , Sharma V, , Goumnerova L, , Slonim AD, & Shah SS: A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery 62:445454, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Del Bigio MR, & Bruni JE: Periventricular pathology in hydrocephalic rabbits before and after shunting. Acta Neuropathol 77:186195, 1988

    • Search Google Scholar
    • Export Citation
  • 8

    Drake JM: The surgical management of pediatric hydrocephalus. Neurosurgery 62:Suppl 2 633642, 2008

  • 9

    El-Ghandour NM: Endoscopic cyst fenestration in the treatment of multiloculated hydrocephalus in children. J Neurosurg Pediatr 1:217222, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    Fritsch MJ, & Mehdorn M: Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age. Pediatr Neurosurg 36:183188, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Ganslandt O, , Behari S, , Gralla J, , Fahlbusch R, & Nimsky C: Neuronavigation: concept, techniques and applications. Neurol India 50:244255, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Golfinos JG, , Fitzpatrick BC, , Smith LR, & Spetzler RF: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197205, 1995

    • Search Google Scholar
    • Export Citation
  • 13

    Guzzetta F, , Mercuri E, & Spanò M: Mechanisms and evolution of the brain damage in neonatal post-hemorrhagic hydrocephalus. Childs Nerv Syst 11:293296, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Hopf NJ, , Grunert P, , Darabi K, , Busert C, & Bettag M: Frameless neuronavigation applied to endoscopic neurosurgery. Minim Invasive Neurosurg 42:187193, 1999

    • Search Google Scholar
    • Export Citation
  • 15

    Jamjoom AB, , Mohammed AA, , al-Boukai A, , Jamjoom ZA, , Rahman N, & Jamjoom HT: Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection. Acta Neurochir (Wien) 138:714719, 1996

    • Search Google Scholar
    • Export Citation
  • 16

    Keles GE, , Lamborn KR, & Berger MS: Coregistration accuracy and detection of brain shift using intraoperative sononavigation during resection of hemispheric tumors. Neurosurgery 53:556564, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Kestle JR: Pediatric hydrocephalus: current management. Neurol Clin 21:883895, vii, 2003

  • 18

    Kestle JR, , Drake JM, , Cochrane DD, , Milner R, , Walker ML, & Abbott R III, et al.: Lack of benefit of endoscopic ventriculoperitoneal shunt insertion: a multicenter randomized trial. J Neurosurg 98:284290, 2003

    • Search Google Scholar
    • Export Citation
  • 19

    Lewis AI, , Keiper GL Jr, & Crone KR: Endoscopic treatment of loculated hydrocephalus. J Neurosurg 82:780785, 1995

  • 20

    Mangano FT, , Limbrick DD Jr, , Leonard JR, , Park TS, & Smyth MD: Simultaneous image-guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report. Neurosurgery 58:4 Suppl 2 ONS-E377, 2006

    • Search Google Scholar
    • Export Citation
  • 21

    Nida TY, & Haines SJ: Multiloculated hydrocephalus: craniotomy and fenestration of intraventricular septations. J Neurosurg 78:7076, 1993

    • Search Google Scholar
    • Export Citation
  • 22

    Nimsky C, , Ganslandt O, , Cerny S, , Hastreiter P, , Greiner G, & Fahlbusch R: Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery 47:10701080, 2000

    • Search Google Scholar
    • Export Citation
  • 23

    Oertel JM, , Baldauf J, , Schroeder HW, & Gaab MR: Endoscopic options in children: experience with 134 procedures. Clinical article. J Neurosurg Pediatr 3:8189, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Oi S, & Abbott R: Loculated ventricles and isolated compartments in hydrocephalus: their pathophysiology and the efficacy of neuroendoscopic surgery. Neurosurg Clin N Am 15:7787, 2004

    • Search Google Scholar
    • Export Citation
  • 25

    Oi S, , Hidaka M, , Honda Y, , Togo K, , Shinoda M, & Shimoda M, et al.: Neuroendoscopic surgery for specific forms of hydrocephalus. Childs Nerv Syst 15:5668, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    Pandya SK, , Deshpande DH, & Dastur HM: Multicystic hydrocephalus (a preliminary report). Neurol India 22:188194, 1974

  • 27

    Rohde V, , Haberl EJ, , Ludwig H, & Thomale UW: First experiences with an adjustable gravitational valve in childhood hydrocephalus. Clinical article. J Neurosurg Pediatr 3:9093, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Sandberg DI, , McComb JG, & Krieger MD: Craniotomy for fenestration of multiloculated hydrocephalus in pediatric patients. Neurosurgery 57:1 Suppl 100106, 2005

    • Search Google Scholar
    • Export Citation
  • 29

    Sasidharan P, , Marquez E, , Dizon E, & Sridhar CV: Developmental outcome of infants with severe intracranial-intraventricular hemorrhage and hydrocephalus with and without ventriculoperitoneal shunt. Childs Nerv Syst 2:149152, 1986

    • Search Google Scholar
    • Export Citation
  • 30

    Schroeder HW, , Wagner W, , Tschiltschke W, & Gaab MR: Frameless neuronavigation in intracranial endoscopic neurosurgery. J Neurosurg 94:7279, 2001

    • Search Google Scholar
    • Export Citation
  • 31

    Shah SS, , Hall M, , Slonim AD, , Hornig GW, , Berry JG, & Sharma V: A multicenter study of factors influencing cerebrospinal fluid shunt survival in infants and children. Neurosurgery 62:10951103, 2008

    • Search Google Scholar
    • Export Citation
  • 32

    Spennato P, , Cinalli G, , Ruggiero C, , Aliberti F, , Trischitta V, & Cianciulli E, et al.: Neuroendoscopic treatment of multiloculated hydrocephalus in children. J Neurosurg 106:1 Suppl 2935, 2007

    • Search Google Scholar
    • Export Citation
  • 33

    Stein SC, & Guo W: Have we made progress in preventing shunt failure? A critical analysis. J Neurosurg Pediatr 1:4047, 2008

  • 34

    Stein SC, & Guo W: A mathematical model of survival in a newly inserted ventricular shunt. J Neurosurg 107:6 Suppl 448454, 2007

  • 35

    Tuli S, , Drake J, , Lawless J, , Wigg M, & Lamberti-Pasculli M: Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg 92:3138, 2000

    • Search Google Scholar
    • Export Citation
  • 36

    Tuli S, , O'Hayon B, , Drake J, , Clarke M, & Kestle J: Change in ventricular size and effect of ventricular catheter placement in pediatric patients with shunted hydrocephalus. Neurosurgery 45:13291335, 1999

    • Search Google Scholar
    • Export Citation
  • 37

    Wagner W, & Koch D: Mechanisms of failure after endoscopic third ventriculostomy in young infants. J Neurosurg 103:1 Suppl 4349, 2005

  • 38

    Wu Y, , Green NL, , Wrensch MR, , Zhao S, & Gupta N: Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 61:557563, 2007

    • Search Google Scholar
    • Export Citation
  • 39

    Yamini B, , Goumnerova LC, & Frim DM: Endoscopic approach to noncommunicating fluid spaces in the shunted patient. Pediatr Neurosurg 31:237241, 1999

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 593 203 45
Full Text Views 154 17 1
PDF Downloads 106 17 2
EPUB Downloads 0 0 0