Pathophysiology and treatment of multiloculated hydrocephalus

Abstract

The presence of compartmentalization inside the ventricular system makes the management of hydrocephalus very challenging. Although several therapeutical options include multiple shunts insertion, stereotactic aspiration, puncture of membrane with multiperforated catheter, and microsurgical or endoscopic fenestration, multiloculated hydrocephalus still remains associated with poor outcome. On the basis of the site of obstruction(s) and the subsequent accumulation of fluid, the anatomic and radiographic appearance of multiloculated hydrocephalus is variable and can be classified as follows: (1) Multiple intraventricular septations; (2) Isolated lateral ventricle/Unilateral hydrocephalus; (3) Entrapped temporal horn; (4) Isolated fourth ventricle; and (5) Expanding cavum septi pellucidi (CSP)/ cavum Vergae (CV). In this chapter, we discuss patients affected by loculated hydrocephalus (uni- or multi-) that are joined by the same etiological and pathogenetic entity (ventriculitis), despite different radiographic forms. The only exceptions are patients with unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro and patients with expanding cavum septum pellucidum that have different etiology, but are traditionally included in the discussion of multiloculated hydrocephalus.