Complications of fourth-ventricular shunts.
Fourth-ventricular shunting is commonly used to treat symptomatic posterior fossa cysts of the Dandy-Walker malformation and trapped fourth ventricle. Although the benefits of this procedure have been widely reported, there is a paucity of data on the pitfalls of posterior fossa shunting in the neurosurgical literature. During the 4-year period from July 1989 to June 1993, we placed fourth-ventricular shunts in 12 patients. Remarkably, 5 patients suffered complications related to posterior fossa catheter placement (42% rate). Three of these patients developed new cranial nerve dysfunction caused by direct injury to the floor of the fourth ventricle, 1 patient suffered an intracystic hemorrhage and acute shunt malfunction, and 1 patient had the catheter tip in the brainstem on postoperative studies without new neurological deficit. We conclude that placement of fourth-ventricular shunts can be fraught with complications which we believe is related to technique. We propose that altering the trajectory of the ventricular catheter from our usual midline technique to a more lateral position will lessen the chances for injury to the floor of the fourth ventricle. In this manner we hope to decrease our incidence of complications for this procedure.
Lee
M
M
Division of Pediatric Neurosurgery, New York University Medical Center, New York 10016, USA.
Leahu
D
D
Weiner
H L
HL
Abbott
R
R
Wisoff
J H
JH
Epstein
F J
FJ
D000328:Adult; D001933:Brain Stem / Q000293:injuries; D002552:Cerebral Ventricles / Q000293:injuries / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002675:Child, Preschool; D020209:Cranial Nerve Injuries; D003560:Cysts / Q000601:surgery; D003616:Dandy-Walker Syndrome / Q000601:surgery*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation*