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Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography

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Abstract

Objective

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).

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

AF:

Anterior fontanelle

b-FFE:

Balanced-fast field echo

CSF:

Cerebrospinal fluid

CTV:

Computerized tomography ventriculography

CT:

Computerized tomography

DRIVE:

Driven equilibrium radiofrequency reset pulse

ETV:

Endoscopic third ventriculostomy

IVH:

Intraventricular hemorrhage

MLH:

Multiloculated hydrocephalus

MRI:

Magnetic resonance imaging

MRV:

Magnetic resonance ventriculography

SSFP:

Steady-state free precession

VP:

Ventriculoperitoneal shunt

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Authors and Affiliations

  1. Department of Neurosurgery, King Georges Medical University, 5th floor, Shatabdi Phase 2, Chowk, Lucknow, 226003, India

    Siddharth Vankipuram, Chhitij Srivastava, B. K Ojha, Anil Chandra, Sunil K. Singh, Somil Jaiswal & Manish Jaiswal

Authors
  1. Siddharth Vankipuram
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  2. Chhitij Srivastava
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  3. B. K Ojha
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  4. Anil Chandra
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  5. Sunil K. Singh
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  6. Somil Jaiswal
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  7. Manish Jaiswal
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Siddharth Vankipuram, Chhitij Srivastava, B.K Ojha, Somil Jaiswal, Anil Chandra, Manish Jaiswal, and Sunil K Singh. The first draft of the manuscript was written by Siddharth Vankipuram, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Siddharth Vankipuram.

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Vankipuram, S., Srivastava, C., Ojha, B.K. et al. Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography. Childs Nerv Syst 36, 2741–2748 (2020). https://doi.org/10.1007/s00381-020-04572-z

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  • DOI: https://doi.org/10.1007/s00381-020-04572-z

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