J Korean Neurotraumatol Soc.  2009 Dec;5(2):109-114. 10.13004/jknts.2009.5.2.109.

Navigation Assisted Lateral Transcerebellar Ventriculoperitoneal Shunt for Treatment of Trapped 4th Ventricle Hydrocephalus Patient

• Chong K
• Kim JH
• Kim JH
• Park YK
• Chung HS
• Kwon TH

• KMID: 1427369
• DOI: http://doi.org/10.13004/jknts.2009.5.2.109

Abstract

Trapped 4th ventricle hydrocephalus (TFVH) is occasionally presented as a series of sequel which came after inflammatory condition of central nervous system (CNS). Treatment of TFVH with intervention may aid preservation of life and neurological function. This is a report of TFVH patient who underwent improvement of neurology without complication, after navigation assisted lateral transcerebellar ventriculo-peritoneal (V-P) shunt system application. A Thirty-four years-old, female came to hospital with gait disturbance and dizziness. She had history of V-P shunt operation at lateral ventricle because of hydrocephalus due to listeria meningitis. General work-up and imaging study performed, and no other specific new finding except enlargement of 4th ventricle. The cause of dizziness and syncope was deduced as TFVH. With Stealth navigation system's assistance, lateral transcerebellar (LTC) V-P shunt had planned. With navigation system's guidance, proximal catheter insertion was performed with confirmation of clear cerebrospinal fluid (CSF) drainage. Then, using 3-way connector, proximal catheters located at lateral and 4th ventricle was connected to form a one way out system. Two proximal catheters and one valve system finally set. Patient's symptoms and hydrocephalus were gradually improved with shunt pressure management without specific complications. Complication of brainstem penetration with LTC V-P shunt for the treatment of TFVH may be reduced with navigation assistance technique. So, we are expecting more easy concern of LTC approach for the treatment of TFVH, by this technique.

Keyword

Hydrocephalus; Fourth ventricle; Ventriculoperitoneal shunt; Stereotactic technique

MeSH Terms

Brain Stem
Catheters
Central Nervous System
Dizziness
Drainage
Female
Fourth Ventricle
Gait
Humans
Hydrocephalus
Lateral Ventricles
Meningitis, Listeria
Neurology
Porphyrins
Stereotaxic Techniques
Syncope
Ventriculoperitoneal Shunt
Porphyrins

Figure

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  FIGURE 1 Initial magnetic resonance imaging before 1st ventriculoperitoneal shunt operation. There were no specific intracranial findings, except subgaleal hematoma at right parietal area, extracranial. The patient had minimal head trauma history, at about 1 month before imaging study.

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  FIGURE 2 Diffusion magnetic resonance image after seizure and mental change. Diffuse enlargements of both lateral ventricle and 3rd ventricle enlargement were identified, which were compatible with acute hydrocephalus.

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  FIGURE 3 Computed tomography scan after 1st external ventricular drainage procedure. Hydrocephalus was improved with procedure.

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  FIGURE 4 Computed tomography scan after 1st ventriculoperitoneal shunt operation at right lateral ventricle. Hydrocephalus' improvement was maintained after operation.

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  FIGURE 5 Imaging study at 2nd admission. A: Computed tomography scan. 4th ventricle enlargement was obviously identified. B: Magnetic resonance imaging after modulation of shunt system's valve pressure. The size of both lateral ventricles was improved, but 4th ventricle was still enlarged with T2 FLAIR's high signal change around 4th ventricle. FLAIR: fluid-attenuated inversion recovery.

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  FIGURE 6 Skull simple X-ray after 2nd shunt operation. Using 3-way connector, proximal catheters located at lateral and 4th ventricle was connected to form a one way out system. Two proximal catheters and one valve system finally set.

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  FIGURE 7 Post 2nd shunt operation computed tomography scan. The trapped 4th ventricle was improved without penetration of brain stem, and hydrocephalus was successfully improved. A: 6 weeks later. B: 8 weeks later.

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