title: Endoscopic management of complex hydrocephalus.
abstract: BACKGROUND
  The management of complex hydrocephalus is challenging. There is no consensus of the best treatment for isolated fourth ventricles, arachnoid cysts, and multiloculated hydrocephalus, although the avoidance of multiple shunts is desirable. We reviewed our experience with the use of endoscopic techniques to simplify complex multicompartmental hydrocephalus to determine its efficacy and safety.
  
  
  METHODS
  We performed a retrospective study of 114 consecutive adults and children undergoing endoscopic management of hydrocephalus by a single surgeon. The type of hydrocephalus and endoscopic procedure performed were recorded. The management algorithm for simplification of complex hydrocephalus is reviewed. All patients were followed up in the office or by telephone.
  
  
  RESULTS
  A total of 143 endoscopic procedures were performed on 114 patients with a mean age of 4.4 years (4 weeks to 32 years). The endoscopic procedures performed included cyst fenestration, septum pellucidotomy, endoscopic third ventriculostomy, aqueductal plasty with and without stent, and removal of cystercicotic cysts. Twenty-two (19.3%) patients had planned staged endoscopic procedures. Mean follow up was 65 months (range 33-122 months). Eighty-two (72%) patients were reduced to 1 shunt, shunt independence was achieved in 32 (28%) patients, and only 8 (11%) patients required shunt revision in the follow-up period.
  
  
  CONCLUSIONS
  Endoscopic simplification of complex hydrocephalus enables dependence on only a single shunt in the majority of patients, and a significant proportion achieve shunt independence. Endoscopic management should be considered before the placement of a second shunt, and some cases require staged endoscopic procedures to adequately communicate multicompartmental hydrocephalus.
authors.affiliation: Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Randwick, New South Wales, Australia. cteo@bigpond.net.au
authors.forename: Charles
authors.initials: C
authors.lastname: Teo
authors.forename: David
authors.initials: D
authors.lastname: Kadrian
authors.forename: Caroline
authors.initials: C
authors.lastname: Hayhurst
mesh_terms: D000293:Adolescent; D000328:Adult; D016080:Arachnoid Cysts / Q000601:surgery; D002535:Cerebral Aqueduct / Q000601:surgery; D002552:Cerebral Ventricles / Q000002:abnormalities; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D044583:Neuroendoscopy / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012688:Septum Pellucidum / Q000601:surgery; D056124:Slit Ventricle Syndrome / Q000150:complications / Q000601:surgery; D015607:Stents; D014696:Ventriculostomy / Q000379:methods; D055815:Young Adult