Intraventricular Septations

Intraventricular septations complicating meningitis, ventriculitis and brain abscess in infants and children remain extremely difficult therapeutic problem. Successful treatment in the intraventricular septations have been scarcely described in previous papers. Six cases of the intraventricular septations, which we have experienced for the past 8 years, are reviewed. Ventriculoperitoneal shunts were performed in all cases. In cases 1, 2 and 3, a solitary septum was demonstrated in the right temporal horn, enclosing a fluid-filled cavity that resembled a mass. This isolated cyst was fenestrated to another CSF cavity. In cases 4, 5 and 6, multiple septations were disclosed in both lateral ventricles. Multiple septums were opened in cases 4 and 5. Case 6 died the second day after bilateral shunting procedures. Four of the five survivors have serious neurological deficits. It makes difficult the treatment that these post-inflammatory septations compartmentalize the ventricular system, and interfere with attempted shunting procedures. Therefore, in the treatment of intraventricular septations, the opening of multiple septums or the fenestration of an isolated cavity to another CSF cavity should be performed with the combination of shunting procedures. In our series, the case with a single septum in the ventricular system, in comparison with multiple septums, was easily treated and had a good result. These intraventricular septations should be suspected with the presence of the increased intracranial pressure, the deformity of head or focal neurological signs, in spite of the treatment of post-meningitic hydrocephalus. The early diagnosis by angiogram or ventriculogram leads a proper treatment and a good result.