title: Dandy-Walker Malformation: A Clinical and Surgical Outcome Analysis.
abstract: OBJECTIVE
  To determine the clinical presentations, complications and mortality in patients with Dandy-Walker Malformation (DWM) after surgery i.e., shunt with y-connector.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Neurosurgery Ward, JPMC, Karachi, from January 2009 to December 2013.
  
  
  METHODS
  Cases of DWM, with associated hydrocephalus, further confirmed on CT scan of brain, were admitted through OPD. Those who were previously operated, those with other associated co-morbid or anomalies were excluded from this study. Combined drainage of the ventricular system and posterior fossa cyst, via dual shunt i.e. cystoperitoneal and ventriculoperitoneal shunt with y-connector was performed in all patients. Complications and mortality after surgical intervention in these patients were noted upto one month after surgery. The data analysis for descriptive statistics was done on SPSS version 20.
  
  
  RESULTS
  In this study of 70 patients, majority of the patients were female aged between 1 - 2 years. Hydrocephalus was the predominant symptom as being present in all patients, followed by cerebellar signs in 60 (86%), and other in 5 (7.14%) patients. Complications of surgery were infection and shunt fracture dislocation in 7 (10%) each, malpositioning and shunt blockage in 6 (8.5%) each within one month of surgery, intracranial haemorrhage in 5 (7.14%) patients. Only one patient (1.42%) expired after surgical intervention.
  
  
  CONCLUSIONS
  In DWM, the commonest presentation is that of hydrocephalus. Shunt malfunction and infection are the commonest complication after shunting. Dual shunt with y-connector has the lowest mortality when compared with other methods for treatment of shunt with y-connector.
authors.affiliation: Department of Neurosurgery, Ward No. 18, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Iram
authors.initials: I
authors.lastname: Bokhari
authors.affiliation: Department of Neurosurgery, Ward No. 18, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Lal
authors.initials: L
authors.lastname: Rehman
authors.affiliation: Department of Neurosurgery, Ward No. 18, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: Sher
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Department of Neurosurgery, Ward No. 18, Jinnah Postgraduate Medical Centre, Karachi.
authors.forename: M Sattar
authors.initials: MS
authors.lastname: Hashim
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D002531:Cerebellum / Q000002:abnormalities*; D002675:Child, Preschool; D003616:Dandy-Walker Syndrome / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D014696:Ventriculostomy