Neuroradiological findings in multiloculated hydrocephalus (original) (raw)
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Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography
Child's Nervous System, 2020
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.
Obstructive Infantile Hydrocephalus Secondary to Meningoventriculitis: A Case Report
Journal of Nepal Medical Association
Obstructive infantile hydrocephalus may arise due to anatomic or functional obstruction of cerebrospinal fluid flow. Obstruction of the aqueduct of sylvius (aqueductal stenosis) causes dilation of the lateral and third ventricles, while the size of the fourth ventricle remains relatively normal. Obstructive infantile hydrocephalus with meningoventriculitis is a rare phenomenon, and literature with only 2 other children with similar findings have been reported. We hereby report a case of a 16-week-old infant who developed Escherichia coli meningoventriculitis, later complicated by the development of hydrocephalus, challenging the management. The diagnosis was based on the magnetic resonance imaging of the brain, which showed hydrocephalus, and the cerebrospinal fluid culture showing Escherichia coli meningoventriculitis. The case was managed with serial ventricular drainage along with antibiotics followed by staged ventriculoperitoneal shunting. Serial measurement of head circumferen...
A Case of Multiloculated Hydrocephalus
Journal of Pediatric Neurosciences, 2020
Multiloculated hydrocephalus (MLH) is a disease in which no single treatment has shown to be superior to others. The authors report a pediatric case of postmeningitic MLH diagnosed at the age of 3 months. It was treated with antibiotics and right ventriculoperitoneal (VP) shunt. At 10 months of age, the patient again presented with gross MLH and non-functioning shunt tube. Patient underwent endoscopic fenestration of the multiple cysts along with endoscopic-guided left VP shunt. At 1 year of age, the patient again presented with MLH with large right-sided cyst. Patient again underwent right VP shunt. The child improved in postoperative period and hence discharged. Pediatric MLH is a neurosurgical challenge. The prognosis is guarded and it is not possible to assure the parents regarding the cure of the disease. Decision of treatment options is difficult since there is no end to the treatment of many such cases. Neuroendoscopy has a definite role in MLH.
A 1 Year Child with Hydrocephalus: A Case Report
Journal of Pharmaceutical Research International
Introduction: Hydrocephalus is the accumulation of fluid in the cavities deep within the brain. The extra fluids cause the ventricles to expand, putting pressure on the brain. The brain and spinal column are bathed in cerebrospinal fluid, which usually flows into the ventricles. Excessive cerebrospinal fluid pressure caused by hydrocephalus, on the other hand, can harm brain tissues and result in a variety of cognitive impairments. Case Presentation: Here we have selected a case of hydrocephalus. In this case, when the complete history has been taken it found that patient having a history of NICU admission for prematurity and Low Birth Weight for 40 days. During history collection, it found that the child was all right until 4 months of age after which she started to notice that the child's head circumference was increasing at an abnormal rate and has now been brought to AVBRH for further management. After all investigation in MRI brain reveals extensive dilatation of ventricula...
Child's Nervous System, 2012
Purpose Evidence-based guidelines do not indicate when ventricular reservoirs should be placed in children with neonatal hydrocephalus, and delayed intervention is common. We hypothesize that delayed ventricular drainage has adverse effects on structural development and functional outcomes. Methods Using a well-established animal model of kaolininduced obstructive hydrocephalus, we evaluated neurologic deficit after early (~1 week post-kaolin) or late (~2 weeks post-kaolin) placement of ventricular reservoirs which were tapped according to strict neurologic criteria. Results Progressive ventriculomegaly was similar in earlyand late-reservoir implantation groups. The average neurologic deficit scores (NDSs) over the experimental period were 0 (n06), 2.74 (n05), and 2.01 (n03) for the control, early-, and late-reservoir groups, respectively. At reservoir placement, early-group animals displayed enlarged ventricles without neurologic deficits (mean NDS00.17), while the late group displayed ventriculomegaly with clinical signs of hydrocephalus (mean NDS03.13). The correlation between ventriculomegaly severity and NDS in the early group was strongly positive in the acute (before surgery to 3 weeks post-reservoir placement) (R 2 00.65) and chronic (6 to 12 weeks post-reservoir placement) (R 2 00.65) phases, while the late group was less correlated (acute R 2 00.51; chronic R 2 00.19). Conclusions Current practice favors delaying reservoir implantation until signs of elevated intracranial pressure and neurologic deficit appear. Our results demonstrate that animals in early and late groups undergo the same course of ventriculomegaly. The findings also show that tapping reservoirs in these neonatal hydrocephalic animals based on neurologic deficit does not halt progressive ventricular enlargement and that neurologic deficit correlates strongly with ventricular enlargement.