The benefits of navigated neuroendoscopy in children with multiloculated hydrocephalus

CONTEXT: Multiloculated hydrocephalus remains one of the most challenging neurosurgical problems. In this study, we use frameless navigation during endoscopic interventions to improve the efficiency of operations. SUBJECTS AND METHODS: Nine navigated endoscopic procedures were performed in 8 children with various forms of multiloculated hydrocephalus from March 2013 to June 2014. Preoperatively, the optimal entry point for fenestration of several cysts was determined on the basis of magnetic resonance data. During surgery, rigid endoscope was registered in neuronavigation system for making the connection between separated ventricles and cysts. The final stage of the operation was to conduct a stent through the working channel of the endoscope for implantation of a shunt. RESULTS: Number of compartments interconnected by an operation ranged from 3 to 5. Seven interventions were performed simultaneously with the shunt implantation. The follow-up period ranged from 9 to 15 months. The clinical improvement as a result of the operation was achieved in all children. The follow-up included clinical examination and evaluation of magnetic resonance imaging. Additional surgery was necessary in two patients: The first 5 months later, the second 1-year after endoscopic intervention. CONCLUSION: Application of frameless navigated neuroendoscopy makes this kind of operations the most efficient and safe for the patient.