title: Navigated endoscopic surgery for multiloculated hydrocephalus in children.
abstract: OBJECTIVE
  Multiloculated hydrocephalus remains a challenging condition to treat in the pediatric hydrocephalic population. In a retrospective study, the authors reviewed their experience with navigated endoscopy to treat multiloculated hydrocephalus in children.
  
  
  METHODS
  Between April 2004 and September 2008, navigated endoscopic procedures were performed in 16 children with multiloculated hydrocephalus (median age 8 months, mean age 16.1 +/- 23.3 months). In all patients preoperative MR imaging was used for planning entry sites and trajectories of the endoscopic approach for cyst perforation and catheter positioning. Intraoperatively, a rigid endoscope was tracked by the navigation system. For all children the total number of operative procedures, navigated endoscopic procedures, implanted ventricular catheters, and drained compartments were recorded. In addition, postoperative complications and radiological follow-up data were analyzed.
  
  
  RESULTS
  In 16 children, a total of 91 procedures were performed to treat multiloculated hydrocephalus, including 29 navigated endoscopic surgeries. Finally, 21 navigated procedures involved 1 ventricular catheter and 8 involved 2 catheters for CSF diversion via the shunt. The average number of drained compartments in a shunt was 3.6 +/- 1.7 (range 2-9 compartments). In 9 patients (56%) a navigated endoscopic procedure constituted the last procedure within the follow-up period. One additional surgery was necessary in 3 patients (19%) after navigated endoscopy, and in 4 patients (25%) 2 further procedures were necessary after navigated endoscopy. Serial follow-up MR imaging demonstrated evidence of sufficient CSF diversion in all patients.
  
  
  CONCLUSIONS
  Navigated endoscopic surgery is a safe and effective treatment option for multiloculated hydrocephalus. The combination of the endoscopic approach and neuronavigation further refines preoperative planning and intraoperative orientation. The aim of treatment is to drain as many compartments as possible and as soon as possible, thereby establishing sufficient CSF drainage with few ventricular catheters in single shunt systems. Close clinical and radiological follow-up is mandatory because multiple revisions are likely.
authors.affiliation: Department of Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulz
authors.forename: Georg
authors.initials: G
authors.lastname: Bohner
authors.forename: Hannah
authors.initials: H
authors.lastname: Knaus
authors.forename: Hannes
authors.initials: H
authors.lastname: Haberl
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D019299:Decompression, Surgical / Q000295:instrumentation; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D038361:Neuronavigation / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D014696:Ventriculostomy / Q000295:instrumentation*