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

Abstract

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.

Retrocerebellar Ependymal Cyst Presenting with Obstructive Hydrocephalus in an Infant

“…18 In our case, we decided to approach the cyst first because cases of ascending transtentorial herniation have been described in patients with very bulky lesions of the posterior fossa after sudden relief of supratentorial intracranial hypertension. [33][34][35][36][37] Likewise, a slow emptying of the cyst should be performed to prevent the sudden appearance of a space between the dura mater and the brain and to prevent the rapid decrease in intracranial pressure because both events can lead to the appearance of a subdural hematoma. These collections usually appear at the initial follow-up and do not usually require surgical intervention 1,8,38,39 The clinic usually subsides completely after surgery and the recurrence rate is low.…”