Abstract
Purpose
Loculated hydrocephalus is a condition in which discrete fluid-filled compartments form in or in relation to the ventricular system of the brain. Both uni- and multiloculated variants exist, with marked differences in outcome. However, several competing and seemingly interchangeable nomenclatures exist, and none address the pathophysiological basis of the condition. To clarify current treatment options, we carried out a review of the literature.
Methods
A protocol describing search strategy and inclusion criteria was prepared in advance, and a search of MEDLINE, the Cochrane Database of Systematic Reviews, and the U.S. NIH ClinicalTrials.gov database was carried out with the search terms: “multicystic,” “multiloculated,” “multicompartment,” “uniloculated,” and “loculated.” All were used in conjunction with the search term “hydrocephalus.”
Results
A single study with a control group was found. Remaining reports are purely case series. Research efforts are hampered by unclear and seemingly interchangeable nomenclatures, which makes comparison between studies difficult. There is a paucity of studies of high methodological quality concerning choice of treatment. At the case series level, evidence is in favor of the neuroendoscopic approach.
Conclusions
In order to ensure a consistent nomenclature as well as to guide future research, we propose a new system of classification for loculated hydrocephalus. It acknowledges the differences between uniloculated and multiloculated hydrocephalus, and goes beyond a pure anatomical model. For future research, it enables us to clearly characterize subgroups, which is essential if we are to advance our understanding and level of care for this challenging group of patients.
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References
Cushing H (1908) Surgery of the head. In: Keen WW (ed) Surgery, its principles and practice, vol. III. Saunders, Philadelphia, pp 17–276
Salmon JH (1970) Isolated unilateral hydrocephalus following ventriculoatrial shunt. J Neurosurg 32:219–226
Rhoton AL, Gomez MR (1972) Conversion of multilocular hydrocephalus to unilocular. Case report. J Neurosurg 36:348–350
Albanese V, Tomasello F, Sampaolo S (1981) Multiloculated hydrocephalus in infants. Neurosurgery 8:641–646
Kalsbeck JE, DeSousa AL, Kleiman MB, Goodman JM, Franken EA (1980) Compartmentalization of the cerebral ventricles as a sequela of neonatal meningitis. J Neurosurg 52:547–552
Schultz P, Leeds NE (1973) Intraventricular septations complicating neonatal meningitis. J Neurosurg 38:620–626
Eller TW, Pasternak JF (1985) Isolated ventricles following intraventricular hemorrhage. J Neurosurg 62:357–362
Jamjoom AB, Mohammed AA, al-Boukai A, Jamjoom ZA, Rahman N, Jamjoom HT (1996) Multiloculated hydrocephalus related to cerebrospinal fluid shunt infection. Acta Neurochir (Wien) 138:714–719
Kurup A, Tee WS, Loo LH, Lin R (2001) Infection of central nervous system by motile Enterococcus: first case report. J Clin Microbiol 39:820–822
Valenzuela S, Trellez A (1999) Pediatric neuroendoscopy in Chile. Analysis of the first 100 cases. Child Nerv Syst 15:457–460
Oi S, Abbott R (2004) Loculated ventricles and isolated compartments in hydrocephalus: their pathophysiology and the efficacy of neuroendoscopic surgery. Neurosurg Clin N Am 15:77–87
El-Ghandour NMF (2008) Endoscopic cyst fenestration in the treatment of multiloculated hydrocephalus in children. J Neurosurg Pediatr 1:217–222
Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJL, Muraszko KM, Maher CO (2010) Prevalence and natural history of arachnoid cysts in children. J Neurosurg Pediatr 5:578–585
Fritsch MJ, Mehdorn M (2002) Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age. Pediatr Neurosurg 36:183–188
Lewis AI, Keiper GL, Crone KR (1995) Endoscopic treatment of loculated hydrocephalus. J Neurosurg 82:780–785
Oi S, Hidaka M, Honda Y, Togo K, Shinoda M, Shimoda M, Tsugane R, Sato O (1999) Neuroendoscopic surgery for specific forms of hydrocephalus. Child Nerv Syst 15:56–68
Spennato P, Cinalli G, Ruggiero C, Aliberti F, Trischitta V, Cianciulli E, Maggi G (2007) Neuroendoscopic treatment of multiloculated hydrocephalus in children. J Neurosurg 106:29–35
Gangemi M, Maiuri F, Donati P, Sigona L, Iaconetta G, de Divitiis E (1998) Neuroendoscopy. Personal experience, indications and limits. J Neurosurg Sci 42:1–10
Nowosławska E, Polis L, Kaniewska D, Mikołajczyk W, Krawczyk J, Szymański W, Zakrzewski K, Podciechowska J (2003) Effectiveness of neuroendoscopic procedures in the treatment of complex compartmentalized hydrocephalus in children. Child Nerv Syst 19:659–665
Sagan LM, Kojder I, Madany L, Gizewska M (2006) Endoscope-guided placement of the ventriculoperitoneal shunt: technique and applications. Ann Acad Med Stetin 52:85–89
Guerreiro MM, Facure NO, Silva EA (1988) Multiloculated hydrocephalus: report of 2 cases. Arq Neuropsiquiatr 46:312–315
Spennato P, Cinalli G, Carannante G, Ruggiero C, Basso D, de Caro ML (2004) Multiloculated hydrocephalus. In: Cinalli G, Maixner W, Sainte-Rose C (eds) Pediatric hydrocephalus. Springer, Milan, pp 219–244
Nida TY, Haines SJ (1993) Multiloculated hydrocephalus: craniotomy and fenestration of intraventricular septations. J Neurosurg 78:70–76
Sandberg DI, McComb JG, Krieger MD (2005) Craniotomy for fenestration of multiloculated hydrocephalus in pediatric patients. Neurosurgery 57:100–106, discussion 100–106
Powers SK (1992) Fenestration of intraventricular cysts using a flexible, steerable endoscope. Acta Neurochir Suppl 54:42–46
Buxton N, Macarthur D, Mallucci C, Punt J, Vloeberghs M (1998) Neuroendoscopic third ventriculostomy in patients less than 1 year old. Pediatr Neurosurg 29:73–76
Zuccaro G, Ramos JG (2011) Multiloculated hydrocephalus. Child Nerv Syst 27:1609–1619
Schroeder HW, Wagner W, Tschiltschke W, Gaab MR (2001) Frameless neuronavigation in intracranial endoscopic neurosurgery. J Neurosurg 94:72–79
Schulz M, Bohner G, Knaus H, Haberl H, Thomale U-W (2010) Navigated endoscopic surgery for multiloculated hydrocephalus in children. J Neurosurg Pediatr 5:434–442
Cipri S, Gambardella G (2001) Neuroendoscopic approach to complex hydrocephalus. Personal experience and preliminary report. J Neurosurg Sci 45:92–96
Kulkarni AV, Riva-Cambrin J, Browd SR (2011) Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg Pediatr 7:143–146
Acknowledgments
The authors received research grants from The Aase og Ejnar Danielsen Fund, The Augustinus Fund, and Dagmar Marshalls Fund. We are grateful for their help and their support of this study.
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The authors declare that they have no conflict of interest.
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Andresen, M., Juhler, M. Multiloculated hydrocephalus: a review of current problems in classification and treatment. Childs Nerv Syst 28, 357–362 (2012). https://doi.org/10.1007/s00381-012-1702-3
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DOI: https://doi.org/10.1007/s00381-012-1702-3