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ORIGINAL ARTICLE

Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography Siddharth Vankipuram 1 & Chhitij Srivastava 1 & B. K Ojha 1 & Anil Chandra 1 & Sunil K. Singh 1 & Somil Jaiswal 1 & Manish Jaiswal 1 Received: 5 January 2020 / Accepted: 6 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Objective The authors performed a retrospective review of children diagnosed with multiloculated hydrocephalus (MLH) in our institute. The goal was to analyze the different diagnostic and therapeutic modalities used with special emphasis on CT ventriculography (CTV). Methods Male and female patients below the age of 18 years diagnosed with MLH were included. Cases of uniloculated hydrocephalus like entrapped temporal horn or isolated fourth ventricle were excluded. We used iohexol for CTV and gadodiamide for MR ventriculography. Neuroendoscopic procedures performed were endoscopic fenestration, endoscopic third ventriculostomy (ETV), endoscopic septostomy, endoscopic aqueductoplasty, or a combination of the above. The cohort was divided into two groups (endoscopic or shunt) based on initial surgical intervention. Results A total of 52 patients were included, with 43 boys and 9 girls. The average age of presentation was 7.7 months. The most common predisposing factor for MLH was neonatal meningitis seen in 30 patients. Mean duration of follow-up was 39 months. CTV was used in 26 patients and MR ventriculography in three patients. In one patient, the diagnosis of MLH was ruled out after ventriculography. Patients who underwent ETV only had the best outcome with 71.4% success rate. At the end of follow-up, 14 patients (27%) were shunt independent. Conclusions The present study indicates that CTV helps to accurately define the anatomy of the ventricles and determine the site of physiological CSF obstruction. This helps in therapeutic planning and in avoiding misdiagnoses. Further, neuroendoscopy has the potential to lead to shunt independence in some patients.

* Siddharth Vankipuram [email protected] Chhitij Srivastava [email protected] B. K Ojha [email protected] Anil Chandra [email protected] Sunil K. Singh [email protected] Somil Jaiswal [email protected] Manish Jaiswal [email protected] 1

Department of Neurosurgery, King Georges Medical University, 5th floor, Shatabdi Phase 2, Chowk, Lucknow 226003, India

Childs Nerv Syst

Keywords Neuroendoscopy . Endoscopic fenestration . Multiseptate hyrdrocephalus . CT ventriculogrpahy . Postinfective hydrocephalus

Abbreviations AF Anterior fontanelle b-FFE Balanced-fast field echo CSF Cerebrospinal fluid CTV Computerized tomography ventriculography CT Computerized tomography DRIVE Driven equilibrium radiofrequency reset pulse ETV Endoscopic third ventriculostomy IVH Intraventricular hemorrhage MLH Multiloculated hydrocephalus MRI Magnetic resonance imaging MRV Magnetic resonance ventriculography SSFP Steady-state free precession VP Ventriculoperitoneal shunt

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