Endoscopic Transtentorial Ventriculocystostomy and Cystoventriculoperitoneal Shunt in a Neonate with Dandy-Walker Malformation and Associated Aqueductal Obstruction

Abstract

Objective: Shunting of the lateral ventricle and the posterior fossa cyst is the advocated surgical therapy for children with Dandy-Walker malformation (DWM) and associated aqueductal obstruction. The high rate of complications of combined shunting stimulated the authors to search for an alternative surgical solution. Clinical Presentation/Intervention: After transtentorial endoscopic ventriculocystostomy, a cystoventricular catheter, connected to a peritoneal shunt, was placed in a neonate with DWM and associated aqueductal obstruction. Immediately prior to ventriculocystostomy, the presence of a blocked third ventricular outflow was reconfirmed by contrast medium injection. Neuronavigation was required to define the surgical path from the lateral ventricle through the tentorium and the overlying small rim of brain parenchyma into the posterior fossa cyst. The postoperative clinical course was uneventful with radiologically proven reduction of the size of the ventricular system and the cyst. Conclusion: Cystoventriculoperitoneal shunt placement after transtentorial endoscopic ventriculostomy is a surgical alternative in very young children with DWM and associated aqueductal obstruction.

Surgical Treatment of 13 Pediatric Patients with Dandy-Walker Syndrome

“…However, Asai et al [15] reported that C-P shunt plus V-P shunt surgery may lead to secondary aquaductus cerebri stenosis. On the other hand, endoscopic surgery is also used in treatment of patients with D-WS [22,28,29,30]. Weinzierl et al [30] reported that cystoventriculoperitoneal shunt placement after transtentorial endoscopic ventriculostomy was a surgical alternative in a neonate with D-WS associated aqueductal obstruction.…”

“…On the other hand, endoscopic surgery is also used in treatment of patients with D-WS [22,28,29,30]. Weinzierl et al [30] reported that cystoventriculoperitoneal shunt placement after transtentorial endoscopic ventriculostomy was a surgical alternative in a neonate with D-WS associated aqueductal obstruction. Sikorski and Curry [29] described an endoscopic technique for hydrocephalus related to D-WS.…”

Endoscopic Transaqueductal Placement of a Single-Catheter Cyst-Ventriculoperitoneal Shunt in a Neonate With Dandy-Walker Malformation-Associated Hydrocephalus -Case Report-

“…19,22) This maneuver minimizes the complexity associated with the placement of combined VP and CP shunts, avoids CP shunt-associated complications, and facilitates transtentorial ventricular pressure equalization. However, sophisticated instrumentation and relatively complicated maneuvers are required.…”

“…The surgical management of this disorder has shifted from craniectomy and excision or fenestration of the cyst wall to the placement of various shunts. 1,5,9,[11][12][13][14]22) Lateral ventriculoperitoneal (VP), cyst-peritoneal (CP), and combined VP and CP shunts have been placed and endoscopic third ventriculostomy (ETV) has been performed in the past decade. 14) Transaqueductal placement of a multiperforated shunt catheter has been used to treat isolated fourth ventricle, 20,21) but not hydrocephalus associated with DWM.…”

Ascending Transaqueductal Cystoventriculoperitoneal Shunting in Dandy-Walker Malformation: Technical Note

“…The evolution of the surgical procedures is not yet completed. Since the description of this entity by Dandy and Blackfan [7] and later by Taggart and Walker [8], various methods such as posterior fossa surgery with membrane excision, ventriculoperitoneal shunting (VPS), cystoperitoneal shunting (CPS) or combinations have been used [9,10]. …”