Introduction: Loculated hydrocephalus occurs when discrete fluid-filled compartments form in relation to the ventricles. Treatment options include microsurgical fenestration, endoscopic third ventriculostomy, septostomy, endoscopic fenestration, use of multi-catheter shunt systems and others. The NICO Myriad device can be used in the treatment of complicated hydrocephalus. The device combines variable aspiration and mechanical cutting, allowing for fenestratration of adhesions present in multi-loculated hydrocephalus.
Methods: We retrospectively reviewed the charts of children undergoing endoscopic approaches to mutli-loculated hydrocephalus. We sought to identify those children who underwent NICO Myriad-assisted surgical approach and assess outcomes.
Results: From 2006 to 2012, 54 children underwent a total of 74 endoscopic-assisted procedures for management of loculated hydrocephalus at Children’s Hospital of Pittsburgh. Of this cohort, we identified two children who underwent NICO Myriad-assisted surgical intervention. The first child is an 11yo female with hydrocephalus secondary to germinal matrix hemorrhage with a complex shunt system. She presented in shunt failure; shunt dye studies revealed mutliloculated hydrocephalus with many compartments. She underwent wide fenestration of her cystic compartments via endoscopic-assisted use of NICO Myriad and replacement of 2 ventricular catheters. She is 2-years post-fenestration without recurrence of decompensated hydrocephalus. The second child is a 17yo female with hydrocephalus secondary to a tectal glioma and resultant aqueductal stenosis. Endoscopic evaluation of her ventricular system revealed dense arachnoid membranes. The NICO Myriad was used to fenestrate the adhesions and to enlarge the ostomy in the floor of the third ventricle. The patient is now one year post-surgery without recurrence of hydrocephalus.
Conclusions: We present a novel endoscopic approach to the treatment of surgically complex multi-loculated hydrocephalus utilizing the NICO Myriad system, not previously described. When used in an endoscopic-assisted approach to this difficult hydrocephalus clinical picture, this tool may safely and effectively augment treatment.
Patient Care: Mutliloculated hydrocephalus consists of multiple compartments and CSF spaces that may not drain with conventional shunting techniques; this tool may help in our ability to communicate the multiple compartments and allowing for CSF diversion.
Learning Objectives: At the conclusion of this presentation, participants should recognize the potential utility of the NICO Myriad device as a tool to augment the surgical approach to loculated hydrocepahalus