| Title: | Trapped fourth ventricle-treatment options and the role of open posterior fenestration in the surgical management |
| Author(s): | Tyagi G; Singh P; Bhat DI; Shukla D; Pruthi N; Devi BI; |
| Address: | "Department of Neurosurgery, II Floor, Faculty Block, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, India. Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Department of Neurosurgery, Aster RV Hospital, Bengaluru, India. Department of Neurosurgery, II Floor, Faculty Block, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, India. bidevidr@gmail.com" |
| DOI: | 10.1007/s00701-020-04352-3 |
| ISSN/ISBN: | 0942-0940 (Electronic) 0001-6268 (Linking) |
| Abstract: | "BACKGROUND: Trapped fourth ventricle (TFV) is a rare and difficult to treat condition. Most patients have a past inciting event (infection, IVH, trauma) and history of prior CSF diversion. The symptoms are due to the mass effect on brainstem and cerebellum. Rarely, TFV can also be associated with syrinx formation due to a dissociated craniospinal CSF flow near the fourth ventricle outlets. We present our experience and outcomes of open posterior fenestration in 11 cases, along with an overview of the surgical management of TFV. METHODS: Between 2011 and 2018, 11 patients of TFV were operated by the posterior approach fenestration of the fourth ventricle outlets and arachnoid dissection. The clinical and radiological findings of the patients were retrieved from the hospital database. The surgical technique is described in detail. The patients' neurological status and imaging findings in the follow-up were recorded and compared. RESULTS: The average age of the patients was 23.55 years. The most common presenting symptoms were headache (9/11) and gait imbalance (7), with TB meningitis being the commonest etiology. Ten patients had a history of prior CSF diversion with two presenting with shunt malfunction. Mean follow-up duration was 33.33 months. The improvement in neurological status was observed in 9/11 patients, 2 remained status quo. On follow-up imaging, 8/11 (72.72%) patients had a decrease in the size of TFV while syrinx improved in 3/5 (60%). CONCLUSION: Multiple surgical approaches have been described for TFV. Endoscopic fourth ventriculostomy with aqueductoplasty is gaining popularity in the past two decades. However, an open posterior fenestration of the midline fourth ventricle outlet (magendieplasty) along with sharp arachnoid dissection (adhesiolysis) along the cerebello-medullary cisterns and paracervical gutters is relatively simple and provides physiological fourth ventricular CSF outflow. This is especially useful in TFV with syrinx as the craniospinal CSF circulation is established" |
| Keywords: | "Adolescent Adult Arachnoid/surgery Female Fourth Ventricle/*surgery Humans Male Otologic Surgical Procedures/adverse effects/*methods Postoperative Complications/epidemiology Tuberculosis, Meningeal/complications Ventriculostomy/adverse effects/*methods F;Neuroscience;" |
| Notes: | "MedlineTyagi, Gaurav Singh, Prashant Bhat, Dhanajaya I Shukla, Dhaval Pruthi, Nupur Devi, Bhagavatula Indira eng Case Reports Review Austria 2020/04/28 Acta Neurochir (Wien). 2020 Oct; 162(10):2441-2449. doi: 10.1007/s00701-020-04352-3. Epub 2020 Apr 26" |
