A Precursor to Multiloculated Hydrocephalus: Case Report and Review of Literature

Background: Multiloculated hydrocephalus (MH) is a challenging pathology for pediatric neurosurgeons, arising from various etiologies including intraventricular hemorrhage, infection, and overshunting. Although previous publications have discussed the potential etiology of this pathological process, including fibroglial webbing, no clear precursor has been proven. We present a case of MH developing after both intraventricular hemorrhage and intraventricular infection, with visualization of the precursor via endoscopy and a confirmed glial scar on pathological examination. Case Description: Our patient is an preterm-born (at 24 weeks of gestation) male with a grade III intraventricular hemorrhage treated with reservoir placement and serial taps. He did not develop posthemorrhagic hydrocephalus but presented back at approximately 4 months of age with Escherichia coli meningitis that necessitated multiple interventions for intraventricular abscesses, including an endoscopic exploration. He ultimately developed MH requiring placement of a ventriculoperitoneal shunt. Conclusions: MH is a complex pathology with multiple risk factors. To date, only theories regarding the etiology have been proposed. Our case represents the first known direct visualization of intraventricular fibroglial webbing with magnetic resonance imaging correlation. Improved understanding of the pathophysiology of this entity may improve our ability to treat this pathology before loculations develop.