Endoscopic Fenestration of Multiloculated Post-Infectious Hydrocephalus

Abstract
Background: Loculated hydrocephalus is a condition of multiple cerebrospinal fluid filled loculi with or without communication with the ventricular system, and with tendency to enlarge and causing added problems to the patients. Endoscopic fenestration of the loculi should be considered the initial management for multiloculated hydrocephalus. It carries less morbidity and mortality compared to other methods of treatment with much better outcome. Multiloculated hydro-cephalus caused by CNS infection is a special entity which is not well studied separately in the literature and it carries less favorable prognosis than other types caused by other etiologies.
Aim of Study: This study evaluated surgical results of post-infectious multiloculated hydrocephalus treated by en-doscopic fenestration.
Patients and Methods: This is a retrospective study case series of 20 patients with multiloculated hydrocephalus due to previous attack of meningitis or shunt infection. All patients were treated surgically using endoscopic fenestration. Patients were followed after surgery for a period of time ranged from 6 to 30 months average 22 months during the period from June 2013 to December 2016.
Twenty patients with multiloculated hydrocephalus due to either known previous attack of meningitis in 13 patients (65%) or as a sequele of repeated shunt infection in 7 patients (35%) were included. All patients underwent endoscopic fenestration of the loculi with either shunt revision or placement of new shunt. All patients had recent brain CT scan and MRI scans preoperatively. Follow-up scans were evaluated regarding change in cysts size, disappearance of mass effect and resto-ration of the architecture of the brain sulci denoting improve-ment of hydrocephalus.
Results: Post-operative improvement in hydrocephalus occurred in 14 patients(70%), while 3 patients (15%) showed no improvement. Surgery has been terminated in 3 patients (15%) overall patients needed shunt revisions were 14 (70%). At the end of our follow-up period 9 patients (45%) needed endoscopic fenestration one time again, 6 patients (30%) needed 2 surgeries for endoscopic fenestration after the initial one with insertion of another shunt. 3 patients (15%) repeated endoscopic fenestration for 3 times after the initial one with placement of another shunt. Only 2 patients (10%) continue without the need for any further surgeries.
Conclusion: Multiloculated hydrocephalus is a serious problem caused by different etiologies. Endoscopic fenestration considered the 1st choice for solving this problem because of sound efficacy and less morbidity related to the procedure. Multiloculation caused by CNS infection has less favorable outcome than that caused by other etiologies.