CT stereotaxy guided lateral trans-cerebellar programmable fourth ventriculo-peritoneal shunting for symptomatic trapped fourth ventricle.

Abstract

A trapped fourth ventricle is a rare clinico-radiological entity producing symptoms suggestive of a progressive posterior fossa mass lesion. It is mainly reported in children as a late complication of lateral ventricular shunting to relieve infantile post-meningitic or post-hemorrhagic hydrocephalus. Optional treatment of the trapped fourth ventricle remains controversial. Placement of fourth ventricular shunting via a conventional midline approach can be fraught with complications in about 40% of the patients. Authors report a successful CT Stereotaxy guided high pressure (80 mm H(2)O) programmable fourth ventriculo-peritoneal shunting via a lateral trans-cerebellar approach in a 14-year-old girl with a trapped fourth ventricle, which occurred as a late complication of ventriculo-peritoneal shunting in her infancy. Her preoperative symptoms of raised intracranial pressure, bobble-head doll syndrome and bilateral abducens palsies completely improved following the surgery. Lateral trans-cerebellar stereotactic placement of the fourth ventricular catheter and the use of high-pressure (low flow) programmable shunt (to avoid complications associated with over drainage) are beneficial in some patients with trapped fourth ventricle.

• Authors: R R Sharma, S J Pawar, R V Devadas, E J Dev
• Journal: Clinical neurology and neurosurgery (Clin Neurol Neurosurg) Vol. 103 Issue 3 Pg. 143-6 (Oct 2001) ISSN: 0303-8467 [Print] Netherlands
• PMID: 11532552 (Publication Type: Case Reports, Journal Article)

Topics

• Abducens Nerve Diseases (diagnostic imaging, etiology, surgery)
• Adolescent
• Cerebellum (diagnostic imaging, surgery)
• Cerebral Ventriculography
• Female
• Fourth Ventricle (diagnostic imaging, surgery)
• Humans
• Hydrocephalus (surgery)
• Intracranial Hypertension (diagnostic imaging, etiology, surgery)
• Postoperative Complications
• Reoperation
• Stereotaxic Techniques
• Tomography, X-Ray Computed
• Ventriculoperitoneal Shunt (adverse effects, methods)