Third ventriculostomy for internal hydrocephalus complicated by unrecognized subdural hygroma and hematoma: a case report of a patient treated by Dr. Walter Dandy

Abstract

The authors review the case of a patient treated by Dr. Walter Dandy. When the patient was a young child he underwent two right transtemporal third ventriculostomies during which he sustained an unrecognized contralateral subdural hygroma and a chronic subdural hematoma with a mild infantile hemiparesis. He was able to complete high school, albeit at a slower pace than usual. As an adult he held several limited employment positions, lived at home for several decades, and was later cared for at a nursing home for a short time. The patient died when he was 66 years of age.

Technical and Clinical Evolution of Modern Neuroendoscopy

“…The disadvantage of this method consisted besides of the occasional necessity to sacrifice the optic nerve also in the frequent occurrence of hygromas (King 2003). To overcome this problem Dandy preferred since 1933 a more posterior extradural subtemporal approach (Aschoff et al 1999, Dandy 1933, King 2003. It is reported that Dandy performed also 2 endoscopic inspections in children with hydrocephalus.…”

“…This was achieved anatomically by means of an open ventriculostomy perforating the lamina terminalis from a temporopolar approach (Aschoff et al 1999;King 2003). The disadvantage of this method consisted besides of the occasional necessity to sacrifice the optic nerve also in the frequent occurrence of hygromas (King 2003). To overcome this problem Dandy preferred since 1933 a more posterior extradural subtemporal approach (Aschoff et al 1999, Dandy 1933, King 2003.…”

“…Due to their theoretical results on hydrocephalus the logical therapeutic approach for communicating hydrocephalus consisted in reduction of the CSF production by extirpation or coagulation the choroid plexus in the lateral ventricle (Dandy 1918) and for obstructive hydrocephalus in producing an artificial bypass from the ventricles into the subarachnoidal space. This was achieved anatomically by means of an open ventriculostomy perforating the lamina terminalis from a temporopolar approach (Aschoff et al 1999;King 2003). The disadvantage of this method consisted besides of the occasional necessity to sacrifice the optic nerve also in the frequent occurrence of hygromas (King 2003).…”