Endoscopic Management of Pediatric Complex Hydrocephalus

• Published in: World neurosurgery 2018-11, Vol.119, p.e482-e490
• Main Authors: Peraio, Simone, Amen, Mohamed Mohsen, Ali, Nabil Mansour, Zaher, Ahmed, Mohamed Taha, Ahmed Nageeb, Tamburrini, Gianpiero
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Complex hydrocephalus; Endoscopy; ETV; Female; Follow-Up Studies; Humans; Hydrocephalus - diagnostic imaging; Hydrocephalus - surgery; Infant; Infant, Newborn; Male; Multiloculated; Neuroendoscopy; Neuronavigation; Pediatric; Retrospective Studies; Shunt
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.07.187

To define the role of neuroendoscopy as an adjuvant technique for the management of pediatric complex hydrocephalus. We performed a retrospective analysis of a series of pediatric patients who had undergone surgery for complex hydrocephalus from January 2002 to March 2017 at 2 pediatric neurosurgery units in Rome, Italy and Mansoura, Egypt. The endoscopic procedures performed included cyst or membrane fenestration, septum pellucidotomy, foraminoplasty, and aqueductoplasty with or without a stent. In selected cases, endoscopic third ventriculostomy was performed as a combined procedure. The mean follow-up period was 5 years. A total of 68 patients (26 females, 42 males), with a mean age of 2 years (range, 0–18), underwent 109 endoscopic procedures. Of the 68 patients, 39 (57%) were affected by multiloculated hydrocephalus, 17 by isolated lateral ventricle (24.6%), 3 by an excluded lateral ventricle horn (4.3%), 7 by an isolated fourth ventricle (10.1%), and 1 each by an isolated third ventricle and a cavum septi pellucidi cyst. The overall postoperative complications rate was 28% (shunt infection, 16.1%; shunt malfunction, 8.8%; subdural collection, 2.9%). At the latest clinical follow-up visit, 65% of the children had only 1 shunt, 25% (n = 17) had a double ventricular catheter, and 10% (n = 7) were shunt free. We have confirmed that neuroendoscopy has a main role in the long-term management of complex hydrocephalus, significantly contributing to the reduction of the number of shunts and the shunt revision rate. Neuronavigation should be performed in all cases in which the ideal trajectory should be established. •Neuroendoscopy for management of pediatric complex hydrocephalus.•A total of 68 patients underwent 109 endoscopic procedures; the mean follow-up period was 5 years.•A reduction in the number of needed shunts in most cases was obtained.•In selected cases, the use of a permanent shunt was avoided.