Neuroendoscopic approach to complex hydrocephalus. Personal experience and preliminary report

Neuroendoscopic premammilary third-ventriculocisternostomy in non-communicating hydrocephalus represents, to date, the less invasive and effective procedure, whereas the neuroendoscopic approach to complex-hydrocephalus is limited to several small anecdotal series.

Among 57 pediatric patients affected by obstructive hydrocephalus, ranging in age from prenatal diagnosis to 3 years (mean 1.2 year+/-11 months) and recruited over a 2-year period, we identified 11 cases with presurgical neuroradiological complex-hydrocephalus, at admission to our Department. In two cases Magnetic Resonance imaging showed bilateral atresic foramen of Monro and corpus callosum agenesya. In these cases an extracranial cerebrospinal fluid shunt device was implanted. The authors report retrospectively, the personal experience on a series of 9 pediatric patients with complex-hydrocephalus, such as multishunted (4 cases), multiloculated hydrocephalus (3 cases), and multiple ventricular cysts plus hydrocephalus (2 cases), in which a neuroendoscopic approach was performed. At admission, symptoms and signs of an increased intracranial pressure were presents in all cases. Follow-up ranged from 3 months to 2 years. In 8 cases third ventriculostomy was successfully performed whereas, in one case, the endoscopic procedure, in a patient younger than 1 month, was aborted and an extracranial cerebrospinal fluid device was implanted.

In the postoperative period and during follow-up, a symptomatic relief and clinical improvement of preoperative signs and symptoms of increased intracranial pressure was seen in all cases. Nevertheless, in two patients psychomotor retardation worsened, respectively 6 and 7 months after the endoscopic procedure and then, an additional extracranial cerebrospinal fluid shunt device was implanted.

In our selected cases of complex-hydrocephalus, the neuroendoscopic approach did not fail to determine clinical improvement after the first procedure, in spite of increased technical difficulties and minimum decreases of ventricular volume in postoperative images.