gms | German Medical Science

Objective: Treatment of isolated 4^th ventricle should be considered when clinical symptoms or a significant mass effect occur. Clinical and radiographic outcome after endoscopic stent placement into the 4^th ventricle is reported.

Methods: 19 patients (age: 1 month – 20 years; median 17.5 months) in whom 22 endoscopic procedures were performed, either as aqueductoplasty in cases of infratentorial manifestation or as interventriculostomy when the 4^th ventricular membrane extended supratentorially. All patients received a stent connected to the CSF diverting shunt. In the follow-up, surgical complications, radiological outcome and clinical outcome of the presenting symptoms are evaluated.

Results: All 19 patients had a mean follow-up of 26.9 ± 18.2 months. No immediate neurological complications were observed. 27.3% of patients experienced complete resolution of presenting symptoms, whereas 68.3% demonstrated partial resolution. Symptoms with short duration (< 4 weeks) resolved completely, while long-asting symptoms improved only partially. Short-term shunt complications (n = 2, insufficient catheter placement and subdural hygroma) and long-term stent revisions (n = 3, outgrowing of the stent and externalization of the shunt) were observed. The mean 4^th ventricular volume was reduced after surgery (44.2 ± 25.8ml to 23.1 ± 21.9ml; p < 0.01). Pontine decompression from 0.9 ± 0.3cm to 1.2 ± 0.3cm in a-p diameter (p < 0.01) was achieved after surgery. That was still valid for both parameters after a radiological follow-up of 24.4 ± 14.2 months.

Conclusions: The clinical and radiological outcome after endoscopic aqueductoplasty and interventriculostomy in children with isolated 4^th ventricle indicates that the procedure is effective and safe.