Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Paolo Frassanito Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy; and

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Georgios Markogiannakis Department of Neurosurgery, Red Cross Hospital, Athens, Greece

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Rina Di Bonaventura Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy; and

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Luca Massimi Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy; and

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Gianpiero Tamburrini Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy; and

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Massimo Caldarelli Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy; and

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Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

ABBREVIATION

DTH = descending transtentorial herniation; VP = ventriculoperitoneal.
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  • 1

    Beier AD, & Dirks PB: Pediatric brainstem hemorrhages after traumatic brain injury. J Neurosurg Pediatr 14:421424, 2014

  • 2

    Chi NF, , Wang SJ, , Lirng JF, & Fuh JL: Transtentorial herniation with cerebral infarction and Duret haemorrhage in a patient with spontaneous intracranial hypotension. Cephalalgia 27:279282, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cinalli G, , Spennato P, , Savarese L, , Ruggiero C, , Aliberti F, & Cuomo 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 104:1 Suppl 2127, 2006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Dollo C, , Kanner A, , Siomin V, , Ben-Sira L, , Sivan J, & Constantini S: Outlet fenestration for isolated fourth ventricle with and without an internal shunt. Childs Nerv Syst 17:483486, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Feldmann E, , Gandy SE, , Becker R, , Zimmerman R, , Thaler HT, & Posner JB, et al.: MRI demonstrates descending transtentorial herniation. Neurology 38:697701, 1988

  • 6

    Fritsch MJ, , Kienke S, , Manwaring KH, & Mehdorn HM: Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children. Neurosurgery 55:372377, discussion 377379, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

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

  • 8

    Fujimoto Y, , Aguiar PH, , Freitas AB, , de Andrade AF, & Marino Júnior R: Recovery from Duret hemorrhage: a rare complication after craniotomy—case report. Neurol Med Chir (Tokyo) 40:508510, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Gallo P, , Szathmari A, , Simon E, , Ricci-Franchi AC, , Rousselle C, & Hermier M, et al.: 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 60:271277, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Harter DH: Management strategies for treatment of the trapped fourth ventricle. Childs Nerv Syst 20:710716, 2004

  • 11

    Ishizaka S, , Shimizu T, & Ryu N: Dramatic recovery after severe descending transtentorial herniation-induced Duret haemorrhage: a case report and review of literature. Brain Inj 28:374377, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    James HE: Spectrum of the syndrome of the isolated fourth ventricle in posthemorrhagic hydrocephalus of the premature infant. Pediatr Neurosurg 16:305308, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Kamijo Y, , Soma K, , Kishita R, & Hamanaka S: Duret hemorrhage is not always suggestive of poor prognosis: a case of acute severe hyponatremia. Am J Emerg Med 23:908910, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Marupaka SK, & Sood B: Atypical Duret haemorrhages seen on computed tomography. Emerg Med Australas 20:180182, 2008

  • 15

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

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Oyelese AA, , Steinberg GK, , Huhn SL, & Wijman CA: Paradoxical cerebral herniation secondary to lumbar puncture after decompressive craniectomy for a large space-occupying hemispheric stroke: case report. Neurosurgery 57:E594, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Parizel PM, , Makkat S, , Jorens PG, , Ozsarlak O, , Cras P, & Van Goethem JW, et al.: Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage). Intensive Care Med 28:8588, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Samadani U, , Huang JH, , Baranov D, , Zager EL, & Grady MS: Intracranial hypotension after intraoperative lumbar cerebro-spinal fluid drainage. Neurosurgery 52:148152, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

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

  • 20

    Schulz M, , Goelz L, , Spors B, , Haberl H, & Thomale UW: Endoscopic treatment of isolated fourth ventricle: clinical and radiological outcome. Neurosurgery 70:847859, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Sharma RR, , Pawar SJ, , Devadas RV, & Dev EJ: CT stereotaxy guided lateral trans-cerebellar programmable fourth ventriculo-peritoneal shunting for symptomatic trapped fourth ventricle. Clin Neurol Neurosurg 103:143146, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Shin M, , Morita A, , Asano S, , Ueki K, & Kirino T: Neuroendo-scopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement. Case report. J Neurosurg 92:10361039, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Stiver SI, , Gean AD, & Manley GT: Survival with good outcome after cerebral herniation and Duret hemorrhage caused by traumatic brain injury. J Neurosurg 110:12421246, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

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

  • 25

    Torres-Corzo J, , Rodriguez-Della Vecchia R, & Rangel-Castilla L: Trapped fourth ventricle treated with shunt placement in the fourth ventricle by direct visualization with flexible neuroendoscope. Minim Invasive Neurosurg 47:8689, 2004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Udayakumaran S, , Ben Sira L, & Constantini S: Chronic uncal herniation secondary to posterior fossa shunting: case report and literature review. Childs Nerv Syst 26:267271, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    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 7:5263, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Udayakumaran S, & Panikar D: Postulating the concept of compensated trapped fourth ventricle: a case-based demonstration with long-term clinicoradiological follow-up. Childs Nerv Syst 28:661664, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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