[Tactics of surgical intervention in multileveled obstructive hydrocephalus in children]

Ninety-three obstruction areas were revealed in 23 operated children aged 1.5 to 16 years who had multileveled obstructive hydrocephalus. Fifty-four endoscopic manipulations were performed. These included perforation of the bottom of the third ventricle in 9 children, resection of the cystic wall in 33, that of membranous commissures in 2, and interventriculostomy in 10. Open cystectomy was made in 1 case. Compensation of hydrocephalus was achieved in 16 (64%) children; there was no need for revision of the preinserted and nonfunctioning shunt in 5 cases. Internal drainage operations were ineffective in 7 cases (remaining liquor hyporesorption in 3 cases and uncoupling of ventricles and subarachnoidal spaces in 4), in this connection, VP shunts were implanted or the preinserted ones were preserved. In 3 (13%) children, complications (moderate ventricular hemorrhages (n=2) and an exacerbation of aseptic ventriculitis (n=1)) were successfully abolished. Four children underwent resurgery due to closure of the preapplied cystic stoma. There were no fatal outcomes. Thus, neuroendoscopic interventions are the most effective treatment for multileveled obstructive hydrocephalus. Of priority is the creation of liquor outflow from a larger cavity that induces severe compression of cerebral structures or dislocation occlusion and from the ventricular system cavities located more orally. The need for implantation of intra- and extracranial drainages emerges only when occlusion cannot be endoscopically eliminated.