Download PDF
Minim Invasive Neurosurg 2011; 54(03): 138-141
DOI: 10.1055/s-0031-1283169
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Neuroendoscopy Combined with Intraoperative Low-Field Magnetic Imaging for Treatment of Multiloculated Hydrocephalus in a 7-Month-Old Infant: Technical Case Report

P. Tabakow
1   Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
,
M. Czyz
1   Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
,
W. Jarmundowicz
1   Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
,
W. Zub
1   Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
› Author Affiliations
Further Information

Publication History

Publication Date:
23 August 2011 (online)

    Permissions and Reprints

Abstract

Background:

Treatment of multiloculated hydrocephalus in children remains a difficult neurosurgical problem because of the high recurrence rate. Endoscopic septostomy with subsequent ventriculoperitoneal shunting is one of the most widely accepted therapeutic methods. Intraventricular endoscopic surgery combined with intraoperative magnetic resonance (MR) has been used very seldom in infants.

Case Report:

A 7-month-old infant presented with a history of postnatal hydrocephalus from the germinal matrix and intraventricular hemorrhage, treated with a ventriculoperitoneal shunt. Treatment was complicated by bacterial meningitis. On admission the child presented with symptoms of elevated intracranial pressure, an MR investigation gave evidence of multiloculated hydrocephalus. The patient underwent endoscopic pellucidotomy, followed by fenestration of the septa inside the third ventricle, third ventriculostomy and aqueductoplasty. Endoscopic navigation was supported by serial intraoperative non-contrast T1-weighted MR (0.15 T, Polestar N20, Medtronic) images. They also served for confirmation of the patency of performed fenestrations and for the planning of further steps of the operation.

Conclusion:

Intraoperative low-field MR imaging provided an excellent tool for correct navigation of the endoscope inside the pathological ventricular compartments and for intraoperative assessment of surgical goals.

Key words

endoscopy - hydrocephalus - ventriculostomy - MRI - intraoperative imaging
 

  • References

  • 1 Eller TW, Pasternak JF. Isolated ventricles following intraventricular hemorrhage. J Neurosurg 1985; 62: 357-362
    CrossrefPubMedGoogle Scholar
  • 2 Kalsbeck JE, DeSousa AL, Kleiman MB et al. Compartmentalization of the cerebral ventricles as a sequela of neonatalmeningitis. J Neurosurg 1980; 52: 547-552
    CrossrefPubMedGoogle Scholar
  • 3 Lewis AI, Keiper GL, Crone KR. Endoscopic treatment of loculated hydrocephalus. J Neurosurg 1995; 82: 780-785
    CrossrefPubMedGoogle Scholar
  • 4 Samdani AF, Schulder M, Catrambone JE et al. Use of compact intraoperative low-field magnetic imager in pediatric neurosurgery. Childs Nerv Syst 2005; 21: 108-113
    CrossrefPubMedGoogle Scholar
  • 5 Balmer B, Bernays RL, Kollias SS et al. Interventional MR-guided neuroendoscopy: a new therapeutic option for children. J Pediatr Surg 2002; 37: 668-672
    CrossrefPubMedGoogle Scholar
  • 6 Black P, Moriarty T, Alexander III E et al. Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. Neurosurgery 1997; 41: 831-845
    CrossrefPubMedGoogle Scholar
  • 7 Fritsch MJ, Mehdorn M. Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age. Pediatr Neurosurg 2002; 36: 183-188
    CrossrefPubMedGoogle Scholar