Comparison of treatment modalities regarding the entity of the trapped fourth ventricle: A 20-year retrospective analysis of our clinical experience
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Introduction: The entity of the trapped fourth ventricle represents a clinical challenge, as it is a rare entity associated with a wide spectrum of underlying pathologic conditions and the proposed treatment options are restricted and frequently associated with complications and unfavorable long-term outcome. The majority of the affected individuals report a medical history of previous ventriculo-peritoneal shunt infection, as well as a precipitating factor for the entrapment (central nervous system infection, intraventricular hemorrhage, trauma). They come to clinical attention due to symptomatology attributed to mass effect that is exerted by the ballooned fourth ventricle on the brainstem and cerebellum.
Materials and Methods: We present our results, extracted from data derived from our medical center 20 years surgical experience and relevant outcomes in 120 pediatric patients diagnosed and managed with entrapped fourth ventricle. They were treated either with fourth ventricle-peritoneal shunt insertion or with an endoscopic approach. The relative efficacy of both techniques was recorded one year and five years after the initial operation and the data underwent statistical analysis. All patients who failed the initial therapeutic option were managed again with the aforementioned techniques, and their long-term results were recorded.
Conclusions: We recorded that after one year of follow-up, there were no significant differences in outcome when these two techniques were compared. However, when the results of five-year follow-up were compared between two groups, there was superiority, regarding the functional outcome, of the procedure involving the insertion of a fourth ventricular-peritoneal shunt. The outcome of patients that underwent a salvage procedure of any type did not seem to be different after a one-year follow-up period, being unable to verify the superiority of one technique over the other. However, there seems to be a superiority of the shunt procedure over the endoscopic technique regarding the functional outcome of these patients, five years after their second operation. Nevertheless, these results are only indicative and our data are insufficient to establish a statistical level of significance, probably due to the restricted number of patients that were incorporated in our survey.
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2. Harter D. Management strategies for treatment of the trapped fourth ventricle. Childs Nerv Syst 2004;20(10):710–716.
3. Udayakumaran S, Biyani N, Rosenbaum DP, Ben-Sira L, Constantini S, Beni-Adani L. Posterior fossa craniotomy for trapped fourth ventricle in shunt-treated hydrocephalic children: long-term outcome. J Neurosurg Pediatr 2011;7(1):52–63.
4. Gallo P, Hermier M, Mottolese C, Ricci-Franchi A-C, Rousselle C, Simon E, Szathmari A. The endoscopic trans-fourth ventricle aqueductoplasty and stent placement for the treatment of trapped fourth ventricle: long-term results in a series of 18 consecutive patients. Neurol India 2012; 60(3):271-277.
5. Mohanty A, Manwaring K. Isolated Fourth Ventricle: To Shunt or Stent. Oper Neurosurg (Hagerstown) 2018;(1);14(5):483-493. doi: 10.1093/ons/opx136.
6. Sagan LM, Kojder I, Poncyljusz W. Endoscopic aqueductal stent placement for the treatment of a trapped fourth ventricle. J Neurosurg 2006;(105):275-280.
7. Cinalli G, Spennato P, Savarese L, et al. Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children. J Neurosurg 2006;(104):21-27.
8. Villavicencio AT, Wellons JC, George TM 3rd. Avoiding complicated shunt systems by open fenestration of symptomatic fourth ventricular cysts associated with hydrocephalus. Pediatr Neurosurg 1998;(29):314-319.
9. Sagan LM, Kojder I, Poncyljusz W. Endoscopic aqueductal stent placement for the treatment of a trapped fourth ventricle. J Neurosurg 2006;(105):275-280.
10. Lee M, Leahu D, Weiner HL, Abbott R, Wisoff JH, Epstein FJ. Complications of fourth-ventricular shunts. Pediatr Neurosurg 1995;(22):309-314.
11. Eder HG, Leber KA, Gruber W. Complications after shunting isolated IV ventricles. Childs Nerv Syst 1997;(13):13-16.
12. Sharma RR, Pawar SJ, Devadas RV, Dev EJ. CT stereotaxy guided lateral transcerebellar programmable fourth ventriculo-peritoneal shunting for symptomatic trapped fourth ventricle. Clin Neurol Neurosurg 2001;(103):143-146.
13. Harrison HR, Reynolds AF. Trapped fourth ventricle in coccidioidal meningitis. Surg Neurol. 1982;(17):197-199.