Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Pomeraniec, I. Jonathan; Ksendzovsky, Alexander; Ellis, Scott; Roberts, Susan A.; Jane, John A.

doi:10.3171/2015.10.peds15398

Cited by 25 publications

(25 citation statements)

References 38 publications

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“…We could not mention the number of patients diagnosed with TFV who were managed conservatively which is considered a limitation of our study as we included only the patients who were treated surgically. Pomeraniec et al [3] described similar results in a smaller cohort of 8 consecutive cases involving pediatric patients with TFV following VP shunting for IVH due to prematurity between 2003 and 2012. The frequency of TFV following VP shunting for neonatal PHH was found to be 15.4%.…”

Section: Discussionmentioning

confidence: 59%

“…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 hydrocephalus (PHH) may result from an inflammatory response (e.g., ependymitis, arachnoiditis) with attendant occlusion of the cerebral aqueduct of Sylvius and foramina of Luschka and Magendie or scarring and obstruction of the surface absorptive mechanisms [2,3]. Isolation of the fourth ventricle likely occurs from obstruction of the cerebral aqueduct of Sylvius and the fourth ventricle outflow tracts.…”

Section: Introductionmentioning

confidence: 99%

“…This period is very variable and ranges in the literature from 4 weeks to 12 years [4,5]. Delayed diagnosis of TFV can lead to severe neurological dysfunction and/or death [3,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Conservative management without surgery has been shown to be effective for patients with unequivocal clinical and radiographic stability [3,7]. The literature remains limited regarding the frequency, natural and surgical histories, and long-term clinical and radiographic outcomes of TFV [1,3,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

“…This period is very variable and ranges in the literature from 4 weeks to 12 years [4,5]. Delayed diagnosis of TFV can lead to severe neurological dysfunction and/or death [3,6,7].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

et al. 2020

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“…Others hypothesized that differential pressure between the ventricles and the subarachnoid spaces would allow CSF to pass from the ventricles to the subarachnoid space, and thus, result in CSF accumulation in the resection cavity or in the subdural space [ 29 , 30 ]. Trapped ventricles occur typically as a complication of intraventricular hemorrhage [ 31 – 33 ]. Entry of blood in the ventricles during the surgery may result in adhesions and scarring of the ventricular wall, finally sealing off the posterior horn.…”

Section: Discussionmentioning

confidence: 99%

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Hong

Polemikos

Heissler

et al. 2018

Fluids Barriers CNS

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BackgroundCerebrospinal fluid (CSF) circulation disturbances may occur during the course of disease in patients with glioblastoma. Ventriculoperitoneal shunting has generally been recommended to improve symptoms in glioblastoma patients. Shunt implantation for patients with glioblastoma, however, presents as a complex situation and produces different problems to shunting in other contexts. Information on complications of shunting glioma patients has rarely been the subject of investigation. In this retrospective study, we analysed restropectively the course and outcome of glioblastoma-related CSF circulation disturbances after shunt management in a consecutive series of patients within a period of over a decade.MethodsThirty of 723 patients with histopathologically-confirmed glioblastoma diagnosed from 2002 to 2016 at the Department of Neurosurgery, Hannover Medical School, underwent shunting for CSF circulation disorders. Treatment history of glioblastoma and all procedures associated with shunt implementation were analyzed. Data on follow-up, time to progression and survival rates were obtained by review of hospital charts and supplemented by phone interviews with the patients, their relations or the primary physicians.ResultsMean age at the time of diagnosis of glioblastoma was 43 years. Five types of CSF circulation disturbances were identified: obstructive hydrocephalus (n = 9), communicating hydrocephalus (n = 15), external hydrocephalus (n = 3), trapped lateral ventricle (n = 1), and expanding fluid collection in the resection cavity (n = 2). All patients showed clinical deterioration. Procedures for CSF diversion were ventriculoperitoneal shunt (n = 21), subduroperitoneal shunt (n = 3), and cystoperitoneal shunt (n = 2). In patients with lower Karnofsky Performance Score (KPS) (< 60), there was a significant improvement of median KPS after shunt implantation (p = 0.019). Shunt revision was necessary in 9 patients (single revision, n = 6; multiple revisions, n = 3) due to catheter obstruction, catheter dislocation, valve defect, and infection. Twenty-eight patients died due to disease progression during a median follow-up time of 88 months. The median overall survival time after diagnosis of glioblastoma was 10.18 months.ConclusionsCSF shunting in glioblastoma patients encounters more challenge and is associated with increased risk of complications, but these can be usually managed by revision surgeries. CSF shunting improves neurological function temporarily, enhances quality of life in most patients although it is not known if survival rate is improved.

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A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

石田¹,

Murayama

Kobayashi

2022

PCN Reports

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Background Idiopathic normal pressure hydrocephalus (iNPH) is a common form of dementia that causes gait disturbance, cognitive impairment, and urinary incontinence. iNPH is a “treatable dementia” that can be treated with shunt surgery, but this can be ineffective in some cases and can be accompanied by complications. As a result, many patients with iNPH do not undergo surgery. However, there is insufficient evidence on effective treatments other than surgical therapy. Case Presentation A 75‐year‐old woman presented to our hospital with a chief complaint of cognitive decline. She showed reduced motivation and inactivity. Brain magnetic resonance imaging showed a high score on the Evans Index (maximum width between bilateral lateral ventricular anterior horns/maximum intracranial cavity in the same slice). The subarachnoid space was enlarged at and below the Sylvian fissure, and narrowed at the higher arcuate region. She was diagnosed with iNPH. However, no shunt surgery was performed; 11 months later, she had a generalized convulsive seizure with loss of consciousness. An electroencephalogram showed generalized epileptic discharges. The possibility of surgery for her iNPH was ruled out. Levetiracetam prevented seizure recurrence and cognitive functions such as spontaneity and motivation were improved. Conclusion It is often assumed that surgery is the only effective treatment for patients with iNPH. However, as in the present case, symptomatic epileptic seizures may be a factor in dementia. Even in the absence of surgical treatment, we should examine the cause of dementia in patients with iNPH and consider pharmacological treatment, including antiepileptic drugs.

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Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus

Cited by 25 publications

References 38 publications

Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy

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