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Updated: Oct 20, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Endoscopic treatment of complex multiloculated hydrocephalus in children, steps that may help to decrease revision
Sherif Elsayed Elkheshin1, Mohamed Bebars1
1Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt.
Insights
A modified endoscopic surgery for multiloculated hydrocephalus (MLH) showed better outcomes, reducing complications and redo surgeries. Further trials are recommended to confirm the efficacy of this improved technique for managing complex hydrocephalus.
Area of Science:
- Neurosurgery
- Minimally Invasive Procedures
- Pediatric Neurosurgery
Background:
- Multiloculated hydrocephalus (MLH) presents challenges due to intraventricular septations and isolated compartments, leading to increased intracranial pressure.
- Current surgical options for MLH require continuous evaluation for optimal treatment strategies.
- Endoscopic techniques offer potential for addressing complex ventricular anatomy in MLH.
Purpose of the Study:
- To evaluate the efficacy of endoscopic septal fenestration and pellucidotomy combined with shunt refashioning and advancement for MLH.
- To compare a standard endoscopic technique with a modified approach incorporating additional side ports for shunt hardware.
Main Methods:
- Retrospective analysis of 55 patients with symptomatic complex MLH undergoing endoscopic surgery.
- Patients were divided into a standard technique group (Group A) and a modified technique group (Group B) with added shunt side ports.
- Data collected included clinical manifestations, operative details, remission rates, complications, and need for additional shunt hardware or redo surgery.
Main Results:
- The modified technique (Group B) demonstrated a trend towards higher clinical improvement rates compared to the standard technique (Group A).
- Group B showed a lower rate of complications (20% vs. 36%) and redo surgery (20% vs. 44%) than Group A, though not statistically significant (P > 0.05).
- The need for insertion of two shunts was similar between groups (16.7% vs. 20%).
Conclusions:
- The modified endoscopic technique for MLH appears associated with improved outcomes, particularly regarding single shunt use and reduced need for reoperation.
- Randomized clinical trials are recommended to definitively ascertain the efficacy of the modified technique compared to the standard approach.
- Further research is warranted to optimize surgical management strategies for complex multiloculated hydrocephalus.
Background:
Multiloculated hydrocephalus (MLH) is associated with increased intracranial pressure, with intraventricular septations, loculations, and isolation of parts of the ventricular system. Search continues for ideal surgical remedy capable of addressing the dimensions of the problem. We aimed to evaluate endoscopic septal fenestration and pellucidotomy combined with proximal shunt tube refashioning and further advancement into isolated loculations of the ventricular system containing choroid plexus.
Methods:
This retrospective study was conducted on 55 patients with symptomatic complex MLH who underwent endoscopic surgery. The collected data included patients' age, gender, presenting manifestations, operative details, rate of remission of preoperative clinical and imaging signs, postoperative complications, redo surgery, or extra shunt hardware insertion. Patients were divided into Group A (underwent the standard technique of endoscopic multiseptal wide fenestration and final ventriculoperitoneal shunt insertion) and Group B (modified technique by adding extra side ports along the proximal shunt hardware).
Results:
Groups A and B included 25 and 30 patients, respectively. The percentage of patients showing improvement of almost all manifestations was higher in Group B compared to Group A, with no significant difference (P > 0.05). Group B had lower rate of complications (20% vs. 36%, P = 0.231), insertion of two shunts (16.7% vs. 20%, P = 1.000), and redo surgery (20% vs. 44%, P = 0.097).
Conclusion:
The modified technique was associated with better outcomes in terms of the use of single shunt and redo surgery. Launching randomized clinical trials to compare the two techniques are recommended to ascertain the efficacy of the modified technique.
