Multiloculated hydrocephalus.

OBJECTIVE

The study aims to assess the treatment of progressive multiloculated hydrocephalus. In a retrospective study, the authors reviewed their experience with different treatment modalities.

METHODS

We have retrospectively evaluated 93 patients with progressive multiloculated hydrocephalus operated between 1988 and 2010. They represented around 2% (93/4,565) of all patients surgically treated for nontumoral hydrocephalus during this period of time at our institution.

RESULTS

Ventricular septal fenestration was carried out by craniotomy in 27 patients, endoscopic septum pellucidum fenestration in 19, endoscopic ventricular septal fenestration in 18, choroid plexectomy-fulguration in 14 (8 endoscopically and 6 by craniotomy), and third ventriculostomy in 2. Hydrocephalus was resolved in 21 patients with shunting, placing two ventricular catheters as the only procedure. Out of the 72 remaining patients, 34 underwent only one treatment, 30 two treatments, and 8 three or more procedures. The majority of patients ultimately required CSF shunt placement with only one ventricular catheter.

CONCLUSIONS

(1) Multiloculated hydrocephalus is a severe disease in which no single treatment has clearly been shown to be superior. (2) The goal of treatment is to restore communication between isolated intraventricular compartments in order to create the possibility of the implantation of a simple shunt with only one intraventricular catheter. More than improving the quality of life the patient, the objective is to reduce the number of surgical procedures. (3) Given the complexity of multiloculated hydrocephalus, each patient must be studied individually, and no procedure proposed by the literature should be ruled out, no matter how old fashioned may appear.