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Endoscopic transtentorial ventriculocystostomy and cystoventriculoperitoneal shunt in a neonate with Dandy-Walker malformation and associated aqueductal obstruction.
[hydrocephalus with stenosis of the aqueduct of sylvius]
Shunting
of
the
lateral
ventricle
and
the
posterior
fossa
cyst
is
the
advocated
surgical
therapy
for
children
with
Dandy-
Walker
malformation
(
DWM
)
and
associated
aqueductal
obstruction
.
The
high
rate
of
complications
of
combined
shunting
stimulated
the
authors
to
search
for
an
alternative
surgical
solution
.
After
transtentorial
endoscopic
ventriculocystostomy
,
a
cystoventricular
catheter
,
connected
to
a
peritoneal
shunt
,
was
placed
in
a
neonate
with
DWM
and
associated
aqueductal
obstruction
.
Immediately
prior
to
ventriculocystostomy
,
the
presence
of
a
blocked
third
ventricular
outflow
was
reconfirmed
by
contrast
medium
injection
.
Neuronavigation
was
required
to
define
the
surgical
path
from
the
lateral
ventricle
through
the
tentorium
and
the
overlying
small
rim
of
brain
parenchyma
into
the
posterior
fossa
cyst
.
The
postoperative
clinical
course
was
uneventful
with
radiologically
proven
reduction
of
the
size
of
the
ventricular
system
and
the
cyst
.
Cystoventriculoperitoneal
shunt
placement
after
transtentorial
endoscopic
ventriculostomy
is
a
surgical
alternative
in
very
young
children
with
DWM
and
associated
aqueductal
obstruction
.