gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Surgical management of trapped 4th ventricles in posthemorrhagic hydrocephalus – an institutional experience

Meeting Abstract

  • Sevgi Sarikaya-Seiwert - Neurochirurgische Klinik , Heinrich-Heine-Universität , Düsseldorf , Deutschland
  • Thomas Beez - Düsseldorf , Deutschland
  • Janina Klasen-Sansone - Düsseldorf , Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.14.03

doi: 10.3205/17dgnc255, urn:nbn:de:0183-17dgnc2557

Published: June 9, 2017

© 2017 Sarikaya-Seiwert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Intraventricular hemorrhage (IVH) is a common complication of premature neonates with small birth weight, which often leads to hydrocephalus and treatment with ventriculoperitoneal (VP) shunting procedures. Trapped fourth ventricle (TFV) can be a devastating consequence of the subsequent occlusion of the cerebral aqueduct and foramina of Luschka and Magendie.

Methods: We retrospectively reviewed the charts of 65 patients with posthemorrhagic hydrocephalus treated with VP shunt and secondary endoscopic procedure between 2011 and 2016. The patients ranged in gestational age from 24.0 to 31.0 weeks, with an average age at first shunting procedure of 6.3 weeks. A radiographic (mean 2.2 years) and clinical (mean 2.2 years) long-term follow-up was achieved.

Results: In all cases the posthemorrhagic hydrocephalus were managed with supracerebelar VP shunt insertion. 18 (27.8%) patients showed TFV following VP shunting for IVH due to prematurity. 10 (15.4%) of these patients developed symptoms of posterior fossa compression. 8 (12.3%) were treated surgically with endoscopic fenestration of he 4th ventricle into the lateral ventricle in addition to the VP shunt. The remaining 2 patients were treated with an additional shunt tube insertion in the 4th ventricle connected to the VP shunt. All of these patients showed signs of radiographic improvement with stable or improved clinical examinations during postoperative follow-up. One of the patients with additional shunt tube in the 4th ventricle needed an early revision due to a broken tube in the connection area with the VP shunt.

Conclusion: The frequency of TFV among premature IVH patients is relatively high. Most patients with TFV are asymptomatic at presentation and can be managed without surgery. Symptomatic patients may be treated surgically for decompression of the fourth ventricle. An endoscopic procedure to avoid an additional shunt tube should be preferred whenever possible.