Vankipuram Siddharth, Srivastava Chhitij, Ojha B K, Chandra Anil, Singh Sunil K, Jaiswal Somil, Jaiswal Manish
Department of Neurosurgery, King Georges Medical University, 5th floor, Shatabdi Phase 2, Chowk, Lucknow, 226003, India.
Childs Nerv Syst. 2020 Nov;36(11):2741-2748. doi: 10.1007/s00381-020-04572-z. Epub 2020 Mar 18.
The authors performed a retrospective review of children diagnosed with multiloculated hydrocephalus (MLH) in our institute. The goal was to analyze the different diagnostic and therapeutic modalities used with special emphasis on CT ventriculography (CTV).
Male and female patients below the age of 18 years diagnosed with MLH were included. Cases of uniloculated hydrocephalus like entrapped temporal horn or isolated fourth ventricle were excluded. We used iohexol for CTV and gadodiamide for MR ventriculography. Neuroendoscopic procedures performed were endoscopic fenestration, endoscopic third ventriculostomy (ETV), endoscopic septostomy, endoscopic aqueductoplasty, or a combination of the above. The cohort was divided into two groups (endoscopic or shunt) based on initial surgical intervention.
A total of 52 patients were included, with 43 boys and 9 girls. The average age of presentation was 7.7 months. The most common predisposing factor for MLH was neonatal meningitis seen in 30 patients. Mean duration of follow-up was 39 months. CTV was used in 26 patients and MR ventriculography in three patients. In one patient, the diagnosis of MLH was ruled out after ventriculography. Patients who underwent ETV only had the best outcome with 71.4% success rate. At the end of follow-up, 14 patients (27%) were shunt independent.
The present study indicates that CTV helps to accurately define the anatomy of the ventricles and determine the site of physiological CSF obstruction. This helps in therapeutic planning and in avoiding misdiagnoses. Further, neuroendoscopy has the potential to lead to shunt independence in some patients.
作者对我院诊断为多房性脑积水（MLH）的儿童进行了回顾性研究。目的是分析所采用的不同诊断和治疗方式，特别强调CT脑室造影（CTV）。
纳入18岁以下诊断为MLH的男性和女性患者。排除单房性脑积水病例，如被困颞角或孤立第四脑室。我们使用碘海醇进行CTV，钆喷酸葡胺进行磁共振脑室造影。所进行的神经内镜手术包括内镜开窗术、内镜第三脑室造瘘术（ETV）、内镜隔膜造口术、内镜导水管成形术或上述方法的联合应用。根据初始手术干预将队列分为两组（内镜组或分流组）。
共纳入52例患者，其中男孩43例，女孩9例。平均就诊年龄为7.7个月。MLH最常见的诱发因素是新生儿脑膜炎，30例患者中可见。平均随访时间为39个月。26例患者使用了CTV，3例患者使用了磁共振脑室造影。1例患者在脑室造影后排除了MLH诊断。仅接受ETV的患者预后最佳，成功率为71.4%。随访结束时，14例患者（27%）无需分流。
本研究表明，CTV有助于准确界定脑室解剖结构并确定生理性脑脊液梗阻部位。这有助于治疗方案的制定并避免误诊。此外，神经内镜在一些患者中有实现无需分流的潜力。
