• World Neurosurg · Aug 2024

    Ventricular Anatomical Differences-A Different Perspective on Endoscopic Treatment of Pediatric Hydrocephalus: Anomalies, Variations and Deformations.

    • Demet Evleksiz Karimzada, Can EzguMehmetMDepartment of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey., Gardashkhan Karimzada, and Yusuf Izci.
    • Department of Neurosurgery, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey. Electronic address: demetevleksz@gmail.com.
    • World Neurosurg. 2024 Aug 15.

    ObjectiveEndoscopic management of pediatric hydrocephalus is always challenging because of the different anatomical structure of the ventricles. The aim of this study is to document the endoscopic anatomy of the ventricular system and to show the variations and deformations.MethodsThe study included 84 children who underwent endoscopic surgery for the treatment of hydrocephalus in the department of neurosurgery between 2017 and 2022. All preoperative and postoperative radiological images and intraoperative video recordings were retrospectively analyzed. Anatomy of the lateral ventricles and the third ventricle, variations, and deformations were detected and evaluated in detail.ResultsThe mean age of the patients was 7.6 months. Myelomeningocele-encephalocele-associated hydrocephalus was the most common cause of hydrocephalus (38%), followed by postventriculitis in 21%, posthemorrhagic in 21%, and obstructive causes in 20% of cases, respectively. Endoscopic anomaly/variation or deformation was detected in 83% of all cases. Based on the preoperative radiological images, septum pellucidum anomaly/variation or deformation was the most common radiological finding in 64% of the cases. Lateral ventricle anomaly/variation or deformation was noted in 62% of the cases, and third ventricle anomaly/variation or deformation was observed as a radiological finding in 27% of the cases.ConclusionsThe compliance of the brain deteriorates with increasing intracranial pressure in pediatric hydrocephalus and the intraventricular anatomical structures differ from the normal anatomy. Developmental anomalies of the ventricle are also significant and since all these variations are often unpredictable on preoperative imaging, awareness of endoscopic anatomy, variations, and deformations will improve operative safety in children.Copyright © 2024 Elsevier Inc. All rights reserved.

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