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 .