Medical Student Liaquat National Hospital and Medical College
Introduction: To evaluate the currently available evidence for management of multiloculated hydrocephalus and compare the clinical outcomes for various interventions used to treat hydrocephalus.
Methods: A systematic review of the English-language literature from 1992-2022 was undertaken to identify articles documenting management of patients with multiloculated hydrocephalus. We limited our search to the pediatric population. Two independent reviewers assessed the level of evidence quality using the criteria set by the North American Spine Society and disagreements were resolved by consensus.
Results: Of the 308 citations identified from Cochrane, PubMed and EMBASE, 13 met the criteria to undergo full-text review. A pooled cohort of 403 procedures were identified to treat patients who had multiloculated hydrocephalus. About 263 patients were treated endoscopically, while 140 were treated with non-endoscopic interventions (craniotomy/CSF diversion). There was an absolute risk reduction of 11.9 % with endoscopic interventions compared to later with an NNT of 8.3 (CER 79.29 vs EER 67.3%). About one-fourth of the patients had postoperative shunt infections based on data from 9 studies. A total of 8 studies advocated the use of shunt placement as a secondary procedure irrespective of the primary procedure. MLH was associated with higher prevalence of developmental delays despite treatment (72.8%).
Conclusion : Multiloculated hydrocephalus continues to pose a challenge for neurosurgeons. The currently available literature suggests that endoscopic interventions are the way forward as a primary intervention. Invasive surgical techniques are generally reserved for endoscope refractory multiloculated hydrocephalus.
