title: CT stereotaxy guided lateral trans-cerebellar programmable fourth ventriculo-peritoneal shunting for symptomatic trapped fourth ventricle.
abstract: A trapped fourth ventricle is a rare clinico-radiological entity producing symptoms suggestive of a progressive posterior fossa mass lesion. It is mainly reported in children as a late complication of lateral ventricular shunting to relieve infantile post-meningitic or post-hemorrhagic hydrocephalus. Optional treatment of the trapped fourth ventricle remains controversial. Placement of fourth ventricular shunting via a conventional midline approach can be fraught with complications in about 40% of the patients. Authors report a successful CT Stereotaxy guided high pressure (80 mm H(2)O) programmable fourth ventriculo-peritoneal shunting via a lateral trans-cerebellar approach in a 14-year-old girl with a trapped fourth ventricle, which occurred as a late complication of ventriculo-peritoneal shunting in her infancy. Her preoperative symptoms of raised intracranial pressure, bobble-head doll syndrome and bilateral abducens palsies completely improved following the surgery. Lateral trans-cerebellar stereotactic placement of the fourth ventricular catheter and the use of high-pressure (low flow) programmable shunt (to avoid complications associated with over drainage) are beneficial in some patients with trapped fourth ventricle.
authors.affiliation: The National Neurosurgical Centre, Khoula Hospital, PO Box 397, Al-Harthy Complex, 118, Muscat, Oman. rrsharma@omantel.net.com
authors.forename: R R
authors.initials: RR
authors.lastname: Sharma
authors.forename: S J
authors.initials: SJ
authors.lastname: Pawar
authors.forename: R V
authors.initials: RV
authors.lastname: Devadas
authors.forename: E J
authors.initials: EJ
authors.lastname: Dev
mesh_terms: D020434:Abducens Nerve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D002531:Cerebellum / Q000000981:diagnostic imaging* / Q000601:surgery*; D014695:Cerebral Ventriculography; D005260:Female; D020546:Fourth Ventricle / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D012086:Reoperation; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*