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Treatment options for Dandy-Walker malformation.
[hydrocephalus with stenosis of the aqueduct of sylvius]
The
aim
of
this
study
was
to
assess
the
efficacy
of
various
treatment
options
available
for
children
with
Dandy-
Walker
malformation
(
DWM
)
and
to
evaluate
the
role
of
endoscopic
procedures
in
the
treatment
of
this
disorder
.
The
authors
conducted
a
retrospective
review
of
72
children
who
underwent
surgical
treatment
for
DWM
during
a
16
-
year
period
.
All
patients
underwent
computed
tomography
scanning
,
and
26
underwent
magnetic
resonance
(
MR
)
imaging
.
The
initial
surgical
treatment
included
ventriculoperitoneal
(
VP
)
shunt
placement
in
21
patients
,
cystoperitoneal
(
CP
)
shunt
placement
in
24
,
and
combined
VP
and
CP
shunt
insertion
in
three
.
Twenty
-
one
patients
underwent
endoscopic
procedures
(
endoscopic
third
ventriculostomy
[
ETV
]
alone
in
16
patients
,
ETV
with
aqueductal
stent
placement
in
three
,
and
ETV
with
fenestration
of
the
occluding
membrane
in
two
)
.
Three
patients
underwent
membrane
excision
via
a
posterior
fossa
craniectomy
.
In
the
26
patients
who
had
undergone
preoperative
MR
imaging
,
aqueductal
patency
was
noted
in
23
and
aqueductal
obstruction
in
three
.
These
three
patients
underwent
placement
of
a
stent
from
the
third
ventricle
to
the
posterior
fossa
cyst
in
addition
to
the
ETV
procedure
.
During
the
follow-up
period
,
12
patients
with
a
CP
shunt
and
four
with
a
VP
shunt
experienced
shunt
malfunctions
that
required
revision
.
Four
patients
with
a
CP
shunt
also
required
placement
of
a
VP
shunt
.
In
addition
,
five
of
the
21
ETVs
failed
,
requiring
VP
shunt
insertion
.
A
reduction
in
ventricle
size
noted
on
postoperative
images
occurred
more
frequently
in
patients
with
a
VP
shunt
,
whereas
a
reduction
in
cyst
size
was
more
appreciable
in
patients
with
a
CP
shunt
.
Successful
ETV
resulted
in
a
slight
decrease
in
ventricle
size
and
varying
degrees
of
reduction
in
cyst
size
.
Endoscopic
procedures
may
be
considered
an
acceptable
alternative
in
children
with
DWM
.
The
authors
propose
a
treatment
protocol
based
on
preoperative
MR
imaging
findings
of
associated
aqueductal
stenosis
.
Diseases
Validation
Diseases presenting
"associated aqueductal stenosis"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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