Endoscopic third ventriculostomy with cystoventricular stent placement in the management of dandy-walker malformation: technical case report of three patients.
OBJECTIVE
Dandy-Walker malformation has conventionally been managed with placement of cystoperitoneal or ventriculoperitoneal shunts. However, associated aqueductal obstruction requires simultaneous drainage of both the supratentorial and infratentorial compartments.


METHODS
Three children with Dandy-Walker malformation and aqueductal obstruction were managed with endoscopic third ventriculostomy and placement of a stent from the third ventricle to the posterior fossa cyst.


METHODS
After an endoscopic third ventriculostomy was performed, the stent was placed from the third ventricle to the posterior fossa cyst through the thinnest part of the posteroinferior wall of the aqueduct. There was no operative morbidity. In one patient, the stent was malpositioned, requiring a repositioning. The endoscopic third ventriculostomy was successful in two patients, whereas it failed in one, requiring a ventriculoperitoneal shunt placement.


CONCLUSIONS
Cystoventricular stent placement with endoscopic third ventriculostomy is a promising alternative in patients with Dandy-Walker malformation with aqueductal obstruction.
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India. aamohanty@yahoo.com
Aaron
A
Mohanty
D002535:Cerebral Aqueduct / Q000601:surgery*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003616:Dandy-Walker Syndrome / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D015607:Stents; D020542:Third Ventricle / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*