title: Avoiding complicated shunt systems by open fenestration of symptomatic fourth ventricular cysts associated with hydrocephalus.
abstract: Optimal treatment of the hydrocephalic patient with symptomatic Dandy-Walker malformation or trapped fourth ventricle remains controversial. We describe 6 patients with symptomatic Dandy-Walker malformation or trapped fourth ventricle and hydrocephalus that were treated with an aggressive cyst fenestration. Four of the 6 patients had previously undergone five or more failed shunt procedures. There were no complications associated with surgery, and 5 of the 6 patients (83%) have remained asymptomatic with respect to their posterior fossa cysts. One patient has required subsequent fourth ventricular shunt placement. Median follow-up was 26 months (range 12-66 months). We suggest that suboccipital craniectomy and open fenestration is a valid treatment option in hydrocephalic patients with symptomatic Dandy-Walker malformation or trapped fourth ventricle. Although the associated lateral ventriculomegaly will probably still require a ventriculoperitoneal shunt, the absence of a cystoperitoneal shunt system seems to minimize the incidence of complications and reoperation.
authors.affiliation: Pediatric Neurosurgery Service, Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Villavicencio
authors.forename: J C
authors.initials: JC
authors.lastname: Wellons
authors.forename: T M
authors.initials: TM
authors.lastname: George
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002552:Cerebral Ventricles / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D003560:Cysts / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003616:Dandy-Walker Syndrome / Q000150:complications; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications* / Q000175:diagnosis; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome