DOI: 10.33962/roneuro-2020-086 Multilocular hydrocephalus Harold Vasquez, Ezequiel García-Ballestas, Luis Rafael Moscote -Salazar, Sergio A Serrato, William A Florez, Amit Agrawal Romanian Neurosurgery (2020) XXXIV (4): pp. 509-511 DOI: 10.33962/roneuro-2020-086 www.journals.lapub.co.uk/index.php/roneurosurgery Multilocular hydrocephalus Harold Vasquez1,5, Ezequiel García-Ballestas2, Luis Rafael Moscote-Salazar3, Sergio A Serrato4, William A Florez5, Amit Agrawal6 1 Facultad de Ciencias de la Salud, Universidad del Sinu Elias Bechara Zainum, Cartagena de Indias, COLOMBIA 2 Center for Biomedical Research (CIB). Faculty of Medicine - University of Cartagena, COLOMBIA 3 Neurosurgeon. Critical Care. Center for Biomedical Research (CIB). Director of Research Line Cartagena Neurotrauma Research Group. Faculty of Medicine - University of Cartagena, COLOMBIA 4 Uros Clinic, Neiva, COLOMBIA 5 Latin-American council of neurointensivism - ClaNi, Cartagena, COLOMBIA 6 Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Madhya Pradesh, INDIA ABSTRACT Multilocular hydrocephalus is an entity that occurs relatively frequently in neurosurgical practice. We are present an editorial letter with a mini-review of the pathophysiology, surgical, and medical treatment. Multiloculated hydrocephalus (MH) has also been termed as a multiseptate hydrocephalus, polycystic hydrocephalus, interventricular septum and can be unilocular or multiloculated. 5,6,9 MH is characterized by the presence of septations or obstructions within the normal ventricular system, leading to cerebrospinal fluid (CSF) accumulation due to a lack of communication between ventricles 4,6,8,10,11. Although the etiology and pathogenesis not clearly known, the presence of septations has been considered to be caused by a fibrous adhesion within the ventricles or by inflammation leading to sub ependymal gliosis leading to glial bumps and septations leading to Ventricular obstruction4,8,9 . Many etiological factors have been shown to associate with multiloculated hydrocephalus such as many intracranial processes as infection, intracranial hemorrhage, bacterial or fungal meningitis, congenital malformations, birth trauma, tumors, intracranial surgery, among others 2, 6, 8,10,11 Histologically, ventricular septum it is origins from a glial protrusion Keywords multilocular hydrocephalus, hydrocephaly, endoscopic neurosurgery, operative approach Corresponding author: William A Florez Latin-American council of neurointensivism - ClaNi, Cartagena, Colombia william-florez@hotmail.com Copyright and usage. This is an Open Access article, distributed under the terms of the Creative Commons Attribution Non–Commercial No Derivatives License (https://creativecommons .org/licenses/by-nc-nd/4.0/) which permits non- commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of the Romanian Society of Neurosurgery must be obtained for commercial re-use or in order to create a derivative work. ISSN online 2344-4959 © Romanian Society of Neurosurgery First published December 2020 by London Academic Publishing www.lapub.co.uk http://www.lapub.co.uk/ 510 Harold Vasquez, Ezequiel García-Ballestas, Luis Rafael Moscote-Salazar et al. in ventricles4. The clinical presentation is determined by the most frequent manifestations of complicated hydrocephalus, such as: enlargement of the head, convulsions, neurological impairment, sign of the setting sun (inability to look upwards, observed with higher frequency in infants), headache or mental retardation3,7. On the other hand, in the worst scenario, many patients may have the intracranial pressure (ICP) increased, presented as a consequence of the expansion or enlargement of the ventricles (ventriculomegaly) 3,10. Computed tomography (CT) and magnetic resonance imaging (MRI) allow visualization of the multiple cavities with CSF and irregular dilations with multiple septations (Figure -1)2,4,9,10. the complications may be obtained by catheters and interventions to relief the symptoms caused by raised intracranial pressure, however, the primary goal is to establish communication between existing compartments and thereby achieve the diversion of the CSF 8,10 Treatment seeks to restore communication between isolated intraventricular compartments, in order to create a single cavity and implement a single bypass 11 .Treatment options include placement of multiple bypass systems, endoscopic fenestration of localized compartments, septostomy, third endoscopic ventriculostomy, stereotactic aspiration, or craniotomy for the microsurgical fenestration of localized compartments or combination of several surgical principles.2,3,4,10 This mentioned open surgical and endoscopic approach effective at improving adequate function of CSF derivation. Furthermore, endoscopic techniques have the advantage in decrease time of surgery, need of transfusion and length hospital stay1.The craniotomy and open surgical approach show a better success rate in severity and/or refractory chases1,2 Figure 1. CT scan (A-E), MRI (F and G) and USG images showing characteristic imaging appearance of multiloculated hydrocephalus i.e., dilated ventricle and multiple septations. REFERENCES 1. Akbari SHA, Holekamp TF, Murphy TM, Mercer D, Leonard JR, Smyth MD, et al. Surgical management of complex multiloculated hydrocephalus in infants and children. Child’s Nerv Syst. 2015;31(2):243–9. 2. Andresen M, Juhler M. Multiloculated hydrocephalus: a review of current problems in classification and treatment. Child's nervous system: ChNS : official journal of the International Society for Pediatric Neurosurgery 2012;28:357-362. 3. Chamilos C, Sgouros S. Intrauterine grade IV intraventricular hemorrhage in a full-term infant leading to hydrocephalus. 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