Treatment of multi-loculated hydrocephalus using endoscopic cyst fenestration and endoscopic guided VP shunt insertion

  • Sirachai Piyachon
  • Nunthasiri WittayanakornEmail author
  • Lisa Kittisangvara
  • Paveen Tadadontip
Original Article



To evaluate the role of endoscopic cyst fenestration and endoscopic guided VP shunt insertion in multi-loculated hydrocephalus in children.


A retrospective analysis was performed on 20 patients with multi-loculated hydrocephalus who underwent endoscopic cyst fenestration (ECF) alone or in combination with VP shunt revision or insertion between August 2014 and December 2016 with the extended follow-up period to December 2017.


Thirty-one ECFs were performed: ECF alone, 10 operations in 8 cases, and 21 ECFs with shunt insertion in 12 cases. Eighteen of 20 patients required a VP shunt, 7 cases required multiple shunts. All patients with a previous shunt remained shunt dependent; and 6 cases with no prior shunt underwent endoscopic guided ventricular catheter insertion after ECF; only 2 cases did not require a shunt after ECF. The rate of repeated ECFs was 0.25 operations/year and the shunt revision rate was 0.11 operations/year. VP shunt or cystoperitoneal shunt without repeat ECF was used in 7 cases (35%). Mean duration between operations was 71 days in repeated ECF and 16 days in added-on shunt. The most common cause of re-operations was new formation of intraventricular fibrosis or compartmentalization causing ventricular catheter blockage.


Endoscopic cyst fenestration and endoscopic assisted VP shunt insertion minimize shunt complications in multi-loculated hydrocephalus. Shunt independence is unusual.


Complex hydrocephalus Neuroendoscopy 


Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sirachai Piyachon
    • 1
  • Nunthasiri Wittayanakorn
    • 1
    Email author
  • Lisa Kittisangvara
    • 1
  • Paveen Tadadontip
    • 1
  1. 1.Division of Neurosurgery, Department of SurgeryQueen Sirikit National Institute of Child HealthBangkokThailand

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