Multiloculated hydrocephalus: craniotomy and fenestration of intraventricular septations.

Ten pediatric patients with multiloculated hydrocephalus caused by neonatal meningitis, ventriculitis, or intraventricular hemorrhage were surgically treated over a 14-year period (January 1, 1976, to December 31, 1990). Six patients underwent craniotomy and transcallosal fenestration of intraventricular septations followed by placement of a shunt, while the other four were treated by shunting procedures alone. Craniotomy resulted in reduction of the shunt revision rate from a median of 2.75 per year prior to fenestration to 0.25 per year following fenestration, with median observation periods of 44.5 and 27 months, respectively. This was compared to a median revision rate of 0.55 per year for patients treated with shunting procedures alone. There were no deaths in either group. Although no surgical complications were encountered, one patient did require a second fenestration procedure. The important aspects of multiloculated hydrocephalus, including pathophysiology, radiographic correlates, and treatment options, are discussed. The goal of treatment is to eliminate the need for multiple shunt revisions, minimizing the accompanying morbidity and expense. It is concluded that craniotomy and transcallosal fenestration of intraventricular septations is a successful treatment of multiloculated hydrocephalus.