Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting
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ORIGINAL ARTICLE
Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting Ahmed El Damaty 1
&
Ahmed Eltanahy 2,3 & Andreas Unterberg 1 & Heidi Baechli 1
Received: 9 March 2020 / Accepted: 28 April 2020 # The Author(s) 2020
Abstract Purpose Trapped fourth ventricle (TFV) is a well-identified problem in hydrocephalic children. Patients with post-hemorrhagic hydrocephalus (PHH) are mostly affected. We tried to find out predisposing factors and describe clinical findings to early diagnose TFV and manage it. Methods We reviewed our database from 1991 to 2018 and included all patients with TFV who required surgery. We analyzed prematurity, cause of hydrocephalus, type of valve implanted, revision surgeries, modality of treatment of TFV, and their clinical examination and MRI imaging. Results We found 21 patients. Most of patients suffered from PHH (16/21), tumor (2/21), post-meningitis hydrocephalus (2/21), and congenital hydrocephalus (1/21). Seventeen patients were preterm. Seven patients suffered from a chronic overdrainage with slit ventricles in MRI. Thirteen patients showed symptoms denoting brain stem dysfunction; in 3 patients, TFV was asymptomatic and in 5 patients, we did not have available information regarding presenting symptoms due to missing documentation. An extra fourth ventricular catheter was the treatment of choice in 18/21 patients. One patient was treated by cranio-cervical decompression. Endoscopic aqueductoplasty with stenting was done in last 2 cases. Conclusion Diagnosis of clinically symptomatic TFV and its treatment is a challenge in our practice of pediatric neurosurgery. PHH and prematurity are risk factors for the development of such complication. Both fourth ventricular shunting and endoscopic aqueductoplasty with stenting are effective in managing TFV. Microsurgical fourth ventriculostomy is not recommended due to its high failure rate. Early detection and intervention may help in avoiding fatal complication and improving the neurological function. Keywords Cerebrospinal fluid . Hydrocephalus . Overdrainage . Post-hemorrhagic hydrocephalus . Prematurity . Trapped fourth ventricle
Abbreviations CSF Cerebrospinal fluid CT Computed tomography GMH Germinal matrix hemorrhage IVH Intraventricular hemorrhage
MRI PHH TFV
Magnetic resonance imaging Post-hemorrhagic hydrocephalus Trapped fourth ventricle
Introduction * Ahmed El Damaty [email protected] 1
Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
2
School of Medicine, Mansoura University, Mansoura, Egypt
3
Department of Experimental Medical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
A trapped fourth ventricle (TFV) is a well-identified problem in children with hydrocephalus. The fourth ventricle can become isolated due to multiple causes, most frequently after hemorrhage, infection, or congenital anomalies [1]. Although a specific pathophysiological explanation remains unclear, post-hemorrhagic h
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