title: "Growing" cerebellum in an infant after shunt insertion.
abstract: BACKGROUND
  Supratentorial cortical mantle growth after shunt surgery in infants with posthemorrhagic hydrocephalus is common. However, cerebellar growth and Chiari are rare.
  
  
  METHODS
  We describe a term newborn with an intraventricular hemorrhage and posthemorrhagic hydrocephalus who underwent endoscopic third ventriculostomy followed by shunt placement at age 4 months.
  
  
  RESULTS
  After shunt placement, her head circumference growth rate rapidly decreased from the ninety-seventh percentile to the third percentile. Six months after a shunt placement, cerebellar disproportional growth was noticed. Five years after surgery, her cerebellar volume had increased by 300% whereas the cerebral hemispheres volume by 150%, and Chiari 1 appeared. She manifested early hemiparetic cerebral palsy, but, did not develop clinical evidence of increased intracranial pressure or brainstem abnormalities.
  
  
  CONCLUSIONS
  This term newborn exhibited apparent cerebellar "growth" and posterior fossa crowding after shunt surgery for posthemorrhagic hydrocephalus. Our patient's findings may have resulted from shunt-related alterations in pressure dynamics, leading to decreased head growth rate with a relatively smaller posterior fossa, in face of a normal brain growth. The timing of intraventricular hemorrhage at term, beyond the vulnerable period of cerebellar development, may have been a contributing factor to the craniocerebellar disproportion and posterior fossa crowding cerebellar development may have been relatively spared and was a contributing factor to the craniocerebellar disproportion and posterior fossa crowding.
authors.affiliation: Rappaport School of Medicine, Technion, Haifa, Israel.
authors.forename: Haggai
authors.initials: H
authors.lastname: Benvenisti
authors.affiliation: Neonatoal Neurology Service, Child Neurology and Development Unit, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sakler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Bassan
authors.affiliation: Sakler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Shelly
authors.initials: S
authors.lastname: Shiran
authors.affiliation: Sakler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Sholmi
authors.initials: S
authors.lastname: Constantini
authors.affiliation: Sakler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Pediatric Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address: jonaroth@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
mesh_terms: D002531:Cerebellum / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000601:surgery; D002547:Cerebral Palsy / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002658:Developmental Disabilities / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000503:physiopathology*; D014696:Ventriculostomy / Q000009:adverse effects*
keywords: Chiari; cerebellar growth; growing cerebellum; intraventricular hemorrhage; posthemorrhagic hydrocephalus; shunt