Comparing fourth ventricle shunt survival after placement via stereotactic transtentorial and suboccipital approaches

Clinical article

View More View Less
  • Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Fourth ventricle hydrocephalus, or a “trapped” fourth ventricle, presents a treatment challenge in pediatric neurosurgery. Fourth ventricle hydrocephalus develops most commonly as a result of congenital anomalies, intraventricular hemorrhage, or infection. Standard management of loculated fourth ventricle hydrocephalus consists of fourth ventricle shunt placement via a suboccipital approach. An alternative approach is stereotactic-guided transtentorial fourth ventricle shunt placement via the nondominant superior parietal lobule. In this report, the authors compare shunt survival after placement via the suboccipital and stereotactic parietal transtentorial (SPT) approaches.

Methods

A retrospective chart review was performed to find all patients with a fourth ventricle shunt placed between January 1, 1998, and December 31, 2011. Time to shunt failure was quantified as the number of days from shunt placement to first shunt revision or removal. Other variables studied included patient age and sex, origin of hydrocephalus, comorbidities, number of existing supratentorial catheters at the time of fourth ventricle shunt placement (as a proxy for complexity), operating surgeon, and number of previous shunt revisions. The crossover rate from one technique to the other after shunt failure from the original approach was also investigated.

Results

In the 29 fourth ventricle shunts placed during the study period, 18 were placed via the suboccipital approach (62.1%) and 11 via the SPT approach (37.9%). There was a statistically significant difference in time to shunt failure, with the SPT shunts lasting an average of 901 days and suboccipital shunts lasting 122 days (p = 0.04). In addition, there was a significant difference in the rate of crossover from one technique to another, with 1 SPT shunt changed to a suboccipital shunt (5.6%) and 5 suboccipital shunts changed to SPT shunts (45.5%).

Conclusions

Fourth ventricle shunt placement using an SPT approach resulted in significantly longer shunt survival times and lower rates of revision than the traditional suboccipital approach, despite a higher rate of crossover from previously failed shunting procedures. Stereotactic parietal transtentorial shunt placement may be considered for patients with loculated fourth ventricle hydrocephalus, especially when shunt placement via the standard suboccipital approach fails. It is therefore reasonable to offer this procedure either as a first option for the treatment of fourth ventricle hydrocephalus or when the need for fourth ventricle shunt revision arises.

Abbreviation used in this paper:SPT = stereotactic parietal transtentorial.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Douglas L. Brockmeyer, M.D., Department of Neurosurgery, University of Utah, 175 North Medical Drive East, Salt Lake City, Utah 84132. email: douglas.brockmeyer@hsc.utah.edu.

Please include this information when citing this paper: published online April 19, 2013; DOI: 10.3171/2013.3.PEDS12442.

  • 1

    Aoki N: Sequestered fourth ventricle. J Neurosurg 81:962963, 1994

  • 2

    Cinalli G, , Spennato P, , Savarese L, , Ruggiero C, , Aliberti F, & Cuomo L, : Endoscopic aqueductoplasty and placement of a stent in the cerebral aqueduct in the management of isolated fourth ventricle in children. J Neurosurg 104:1 Suppl 2127, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Colpan ME, , Savas A, , Egemen N, & Kanpolat Y: Stereotactically-guided fourth ventriculo-peritoneal shunting for the isolated fourth ventricle. Minim Invasive Neurosurg 46:5760, 2003

    • Search Google Scholar
    • Export Citation
  • 4

    Drake JM, , Kestle JR, , Milner R, , Cinalli G, , Boop F, & Piatt J Jr, : Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294305, 1998

    • Search Google Scholar
    • Export Citation
  • 5

    Erşahin Y: Endoscopic aqueductoplasty. Childs Nerv Syst 23:143150, 2007

  • 6

    Erşahin Y: Endoscopic aqueductoplasty with and without stent. Minim Invasive Neurosurg 49:124125, 2006

  • 7

    Fritsch MJ, , Kienke S, , Manwaring KH, & Mehdorn HM: Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children. Neurosurgery 55:372379, 2004

    • Search Google Scholar
    • Export Citation
  • 8

    Fritsch MJ, , Kienke S, & Mehdorn HM: Endoscopic aqueductoplasty: stent or not to stent?. Childs Nerv Syst 20:137142, 2004

  • 9

    Gawish I, , Reisch R, & Perneczky A: Endoscopic aqueductoplasty through a tailored craniocervical approach. J Neurosurg 103:778782, 2005

  • 10

    Hamada H, , Hayashi N, , Kurimoto M, & Endo S: Endoscopic aqueductal stenting via the fourth ventricle under navigating system guidance: technical note. Neurosurgery 56:1 Suppl E206, 2005

    • Search Google Scholar
    • Export Citation
  • 11

    Lee M, , Leahu D, , Weiner HL, , Abbott R, , Wisoff JH, & Epstein FJ: Complications of fourth-ventricular shunts. Pediatr Neurosurg 22:309314, 1995

    • Search Google Scholar
    • Export Citation
  • 12

    Mohanty A: Endoscopic options in the management of isolated fourth ventricles. Case report. J Neurosurg 103:1 Suppl 7378, 2005

  • 13

    Montes JL, , Clarke DB, & Farmer JP: Stereotactic transtentorial hiatus ventriculoperitoneal shunting for the sequestered fourth ventricle. Technical note. J Neurosurg 80:759761, 1994

    • Search Google Scholar
    • Export Citation
  • 14

    Sagan LM, , Kojder I, & Poncyljusz W: Endoscopic aqueductal stent placement for the treatment of a trapped fourth ventricle. J Neurosurg 105:4 Suppl 275280, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Sandberg DI, & Souweidane MM: Endoscopic-guided proximal catheter placement in treatment of posterior fossa cysts. Pediatr Neurosurg 30:180185, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Sansone JM, & Iskandar BJ: Endoscopic cerebral aqueductoplasty: a trans-fourth ventricle approach. J Neurosurg 103:5 Suppl 388392, 2005

  • 17

    Schroeder HW, , Oertel J, & Gaab MR: Endoscopic treatment of cerebrospinal fluid pathway obstructions. Neurosurgery 60:2 Suppl 1 ONS44ONS52, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Scotti G, , Musgrave MA, , Fitz CR, & Harwood-Nash DC: The isolated fourth ventricle in children: CT and clinical review of 16 cases. AJR Am J Roentgenol 135:12331238, 1980

    • Search Google Scholar
    • Export Citation
  • 19

    Teo C, , Burson T, & Misra S: Endoscopic treatment of the trapped fourth ventricle. Neurosurgery 44:12571262, 1999

  • 20

    Upchurch K, , Raifu M, & Bergsneider M: Endoscope-assisted placement of a multiperforated shunt catheter into the fourth ventricle via a frontal transventricular approach. Neurosurg Focus 22:4 E8, 2007

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 502 254 9
Full Text Views 102 21 1
PDF Downloads 204 31 1
EPUB Downloads 0 0 0