Ultrasound-guided puncture of a Dandy-Walker cyst via the lateral and III ventricles

Abstract

Since the Dandy-Walker syndrome was first described by Dandy and Blackfan, Taggart and Walker, the many variants of posterior fossa anomalies, the appropriate management of these malformations and the clinical outcome have been the subjects of controversy. Surgery of the posterior fossa with membrane excision was initially the preferred method of treatment. Unfortunately, there was a high rate of complications, and many of the patients treated in this way still needed a shunting system. Ventricular-peritoneal and/or cysto-peritoneal shunting is commonly used to treat symptomatic posterior fossa cysts of Dandy-Walker malformations and hydrocephalus. Cysto-peritoneal shunt implantation only was associated with a high rate of complications, and most patients so treated needed a ventriculo-peritoneal shunt in addition. According to the literature, combined ventriculo-peritoneal and cysto-peritoneal shunting is needed for satisfactory decompression of Dandy-Walker cyst and hydrocephalus in between 16% and 92% of cases. We report on a young patient with a Dandy-Walker malformation who needed drainage of the posterior fossa and a ventricular shunt. We decided to drain the cyst and the supratentorial ventricles via a single, especially prepared, catheter with many perforations. The catheter was inserted under ultrasound guidance. The tube was inserted from the left lateral ventricle through the foramen of Monro into the III ventricle and downwards into the cyst. Intraoperatively, an immediate decrease in the size of the cyst and the supratentorial ventricles was observed. Postoperative MRI confirmed the exact position of the catheter and sufficient drainage of the posterior fossa cyst and the ventricles. Six months later the girl was seen in our outpatient department. Clinical examination showed no neurological deficit, and MRI demonstrated sufficient drainage of the ventricles and the Dandy-Walker malformation, and in addition hypoplasia of the corpus callosum.

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

“…To avoid catheter migration out of the cyst with the growing size of the head, which would make possibly more difficult shunt revision necessary, the surgeon selected a catheter which was longer than needed for the mere connection of the ventricle and cyst. Cedzich et al [30] had the same idea of connecting the posterior fossa cyst with the supratentorial ventricular system to allow monocompartmental shunt placement. In contrast to our technique, they perforated the dorsal third ventricular wall to gain access to the posterior fossa cyst.…”

“…In contrast to our technique, they perforated the dorsal third ventricular wall to gain access to the posterior fossa cyst. In our patient, there was no straight trajectory through the foramen of Monro into the posterior fossa cyst, which excluded the use of this surgical technique [30]. Furthermore, dorsal third ventricular wall perforation was considered to be more risky than the occipitobasal transtentorial approach.…”

Endoscopic, Single-Catheter Treatment of Dandy-Walker Syndrome Hydrocephalus: Technical Case Report and Review of Treatment Options

“…While open cyst fenestration has gained recent proponents [12], ventriculoperitoneal (VPS) and/or cystoperitoneal shunting (CPS) remain the mainstays of treatment [3,4,5,6,7,8,9,10,11]. According to the literature, combined VPS and CPS is needed for satisfactory decompression of the Dandy-Walker cyst and hydrocephalus in 16 and 92% of all cases [13]. …”

“…Cedzich et al [13] described the drainage of both the supratentorial ventricles and posterior fossa cyst via a single ventricular catheter placed under ultrasound guidance via a frontal burr hole. The authors reported excellent drainage of both compartments with this single shunting system, thereby minimizing the potential malfunction risk while maintaining transtentorial pressure equilibrium.…”

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

“…A multiperforated single catheter was placed under ultrasonic guidance via a frontal burr hole into both compartments through the dorsal third ventricular wall. 6) Good results were obtained with readily available equipment, but the inability to visualize the intraventricular systems carries the risk of injury to intraventricular vessels. Nonetheless, placement of the modified single catheter was reportedly safe and effective.…”