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Pediatric patients with multiloculated hydrocephalus represent a neurosurgical challenge. While multiloculated hydrocephalus is a relatively rare occurrence, patients with this pathology may require multiple surgeries and complicated shunt designs. Additionally, their neurological outcome tends to be poorer than hydrocephalic patients without loculations. This chapter describes risk factors for multiloculated hydrocephalus such as neonatal infection and intraventricular hemorrhage. Diagnostic criteria and methods for imaging multiloculated hydrocephalus are also discussed. Several common treatments are discussed including shunting, craniotomy for fenestration of loculations, and neuroendoscopic fenestration of loculations. Finally, possible methods for the prevention of multiloculated hydrocephalus are discussed.

Basic neurosurgical procedures used to treat neurological conditions and emergencies include creating a burr hole, doing a craniotomy for access to the brain, laminectomy for access to the spinal cord, and placing a cerebral shunt. A burr hole is a small opening in the skull that is drilled to reach the dura mater. A craniotomy is a surgical procedure that requires removal of a piece of the skull to access the brain. Removal of the lamina of the spine (laminectomy) is done to gain access to the spinal cord. And finally, a cerebral shunt is used to transport fluids, most commonly cerebrospinal fluid (CSF), from the brain to another body cavity in order to decrease intracranial pressure (ICP). Steps involved in performing these basic neurosurgical procedures are described in this chapter.