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Updated: Jun 13, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Navigated endoscopic surgery for multiloculated hydrocephalus in children
Matthias Schulz1, Georg Bohner, Hannah Knaus
1Department of Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Germany.
Insights
Navigated endoscopy offers a safe and effective treatment for pediatric multiloculated hydrocephalus, improving cerebrospinal fluid (CSF) diversion. This technique enhances surgical planning and orientation, aiming to drain multiple compartments with minimal catheters.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Minimally Invasive Surgery
Background:
- Multiloculated hydrocephalus presents significant treatment challenges in pediatric patients.
- Endoscopic approaches have been explored, but refinement in planning and execution is needed.
Purpose of the Study:
- To evaluate the safety and efficacy of navigated endoscopy for treating multiloculated hydrocephalus in children.
- To assess the impact of neuronavigation on preoperative planning and intraoperative guidance.
Main Methods:
- A retrospective review of 16 pediatric patients with multiloculated hydrocephalus treated with navigated endoscopy.
- Preoperative MRI for planning, with intraoperative tracking of the endoscope using a navigation system.
- Recording of operative procedures, catheter placements, drained compartments, and postoperative outcomes.
Main Results:
- 29 navigated endoscopic procedures were performed, with an average of 3.6 drained compartments per shunt.
- In 56% of patients, navigated endoscopy was the final procedure; 19% required one additional surgery, and 25% required two.
- Postoperative imaging confirmed sufficient cerebrospinal fluid (CSF) diversion in all cases.
Conclusions:
- Navigated endoscopic surgery is a safe and effective option for pediatric multiloculated hydrocephalus.
- Neuronavigation enhances precision in preoperative planning and intraoperative orientation.
- The goal is efficient CSF diversion with minimal catheters, though close follow-up is essential due to potential revisions.
Object:
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.
