scholarly journals Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting

2020 ◽  
Vol 36 (12) ◽  
pp. 2961-2969
Author(s):  
Ahmed El Damaty ◽  
Ahmed Eltanahy ◽  
Andreas Unterberg ◽  
Heidi Baechli
Keyword(s):  
Fourth Ventricle ◽  
Rare Complication ◽  
Pediatric Neurosurgery ◽  
Clinical Findings ◽  
Ventricular Catheter ◽  
Mri Imaging ◽  
Presenting Symptoms ◽  
Trapped Fourth Ventricle ◽  
Early Diagnose ◽  
Endoscopic Aqueductoplasty

Abstract Purpose Trapped fourth ventricle (TFV) is a well-identified problem in hydrocephalic children. Patients with post-hemorrhagic hydrocephalus (PHH) are mostly affected. We tried to find out predisposing factors and describe clinical findings to early diagnose TFV and manage it. Methods We reviewed our database from 1991 to 2018 and included all patients with TFV who required surgery. We analyzed prematurity, cause of hydrocephalus, type of valve implanted, revision surgeries, modality of treatment of TFV, and their clinical examination and MRI imaging. Results We found 21 patients. Most of patients suffered from PHH (16/21), tumor (2/21), post-meningitis hydrocephalus (2/21), and congenital hydrocephalus (1/21). Seventeen patients were preterm. Seven patients suffered from a chronic overdrainage with slit ventricles in MRI. Thirteen patients showed symptoms denoting brain stem dysfunction; in 3 patients, TFV was asymptomatic and in 5 patients, we did not have available information regarding presenting symptoms due to missing documentation. An extra fourth ventricular catheter was the treatment of choice in 18/21 patients. One patient was treated by cranio-cervical decompression. Endoscopic aqueductoplasty with stenting was done in last 2 cases. Conclusion Diagnosis of clinically symptomatic TFV and its treatment is a challenge in our practice of pediatric neurosurgery. PHH and prematurity are risk factors for the development of such complication. Both fourth ventricular shunting and endoscopic aqueductoplasty with stenting are effective in managing TFV. Microsurgical fourth ventriculostomy is not recommended due to its high failure rate. Early detection and intervention may help in avoiding fatal complication and improving the neurological function.

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

2015 ◽  
Vol 16 (5) ◽  
pp. 540-544 ◽  
Author(s):  
Paolo Frassanito ◽  
Georgios Markogiannakis ◽  
Rina Di Bonaventura ◽  
Luca Massimi ◽  
Gianpiero Tamburrini ◽  
...  
Keyword(s):  
Case Report ◽  
Fourth Ventricle ◽  
Rare Complication ◽  
Exceptional Case ◽  
Mass Lesion ◽  
Transtentorial Herniation ◽  
Csf Shunting ◽  
Trapped Fourth Ventricle ◽  
Supratentorial Mass

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.

Neuroendoscopic aqueductal stent placement procedure for isolated fourth ventricle after ventricular shunt placement

2000 ◽  
Vol 92 (6) ◽  
pp. 1036-1039 ◽  
Author(s):  
Masahiro Shin ◽  
Akio Morita ◽  
Shuichiro Asano ◽  
Keisuke Ueki ◽  
Takaaki Kirino
Keyword(s):  
Stent Placement ◽  
Surgical Procedure ◽  
Fourth Ventricle ◽  
Rare Complication ◽  
Ventricular Catheter ◽  
Foramen Of Monro ◽  
Content Type ◽  
Shunt Placement ◽  
Progressive Cerebellar Ataxia ◽  
Isolated Fourth Ventricle

✓ Isolated fourth ventricle (IFV) is a rare complication in patients who undergo shunt placement, and it is not easily corrected by surgical procedures. The authors report a case of IFV that was successfully treated with an aqueductal stent placed under direct visualization by using a neuroendoscope. This 36-year-old suffered meningitis after partial resection of a brainstem pilocytic astrocytoma, and subsequently developed hydrocephalus for which a ventriculoperitoneal shunt was placed. Nine months later, the patient presented with progressive cerebellar ataxia, and magnetic resonance imaging revealed slitlike supratentorial ventricles and a markedly enlarged fourth ventricle, which were compatible with the diagnosis of IFV. The surgical procedure described was performed under visualization through a styletlike slim optic fiberscope inserted into a ventricular catheter. The catheter, with the endoscope inside it, was passed through the foramen of Monro and then through the aqueduct to reach the enlarged fourth ventricle, where membranous occlusion of the foramen of Magendie was clearly visualized. The tip of the catheter was placed in the fastigium of the fourth ventricle. After the procedure, the size of the fourth ventricle was reduced and the patient's symptoms improved. Thus, it is concluded that endoscopic aqueductal stent placement is a simple and safe surgical procedure for treatment of IFV.

Paradoxical ventriculomegaly due to low-pressure hydrocephalus, a rare complication of the treatment of a trapped fourth ventricle: Case report

2017 ◽  
Vol 39 ◽  
pp. 101-103 ◽  
Author(s):  
Neelan J. Marianayagam ◽  
Netanel Ben Shalom ◽  
Saeed Yassin ◽  
Shalom Michowiz ◽  
Sagi Harnof ◽  
...  
Keyword(s):  
Case Report ◽  
Fourth Ventricle ◽  
Rare Complication ◽  
Low Pressure ◽  
Trapped Fourth Ventricle

The marionette technique for treatment of isolated fourth ventricle

2013 ◽  
Vol 12 (4) ◽  
pp. 339-343 ◽  
Author(s):  
Pierluigi Longatti ◽  
Elisabetta Marton ◽  
Salima Magrini
Keyword(s):  
Surgical Treatment ◽  
Fourth Ventricle ◽  
Third Ventricle ◽  
Operating Rooms ◽  
Simple Method ◽  
Less Invasive ◽  
Isolated Fourth Ventricle ◽  
Ventricular Catheters ◽  
Endoscopic Aqueductoplasty

Isolated fourth ventricle is not uncommon in complex posthemorrhagic or postinfectious hydrocephalus. When the condition is symptomatic, the current surgical treatment is endoscopic aqueductoplasty, followed by endoscope-assisted placement of a catheter in the fourth ventricle. The authors suggest a very simple method of steering the tip of standard ventricular catheters by using materials commonly available in all operating rooms. The main advantage of this method is that it permits less invasive transaqueductal drainage of trapped fourth ventricles, especially in cases of narrow third ventricle, because the scope and catheter are introduced in sequence and not in a double-barreled fashion. Two illustrative cases are reported.

scholarly journals Primary Gastrointestinal Kaposi’s Sarcoma in a Patient with Human Immunodeficiency Virus

2018 ◽  
Vol 11 (3) ◽  
pp. 638-647 ◽  
Author(s):  
Martin Ignacio Zapata Laguado ◽  
Jorge Enrique Aponte Monsalve ◽  
Jorge Hernan Santos ◽  
Javier Preciado ◽  
Andres Mosquera Zamudio ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Kaposi's Sarcoma ◽  
Gastrointestinal Endoscopy ◽  
Rare Complication ◽  
Kaposi’S Sarcoma ◽  
Skin Lesions ◽  
Clinical Findings ◽  
Upper Gastrointestinal Endoscopy ◽  
Immunodeficiency Virus ◽  
Upper Gastrointestinal

Gastrointestinal bleeding in HIV patients secondary to coinfection by HHV8 and development of Kaposi’s sarcoma (KS) is a rare complication even if no skin lesions are detected on physical examination. This article indicates which patients might develop this type of clinical sign and also tries to recall that absence of skin lesions never rules out the presence of KS, especially if gastrointestinal involvement is documented. Gastrointestinal bleeding in terms of hematemesis has rarely been reported in the literature. We review some important clinical findings, diagnosis, and treatment approach. We present the case of an HIV patient who presented to the emergency department with hematemesis and gastrointestinal signs of KS on upper gastrointestinal endoscopy without any dermatological involvement.

scholarly journals Fuchs’ Heterochromic Iridocyclitis in an Italian Tertiary Referral Centre: Epidemiology, Clinical Features, and Prognosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Massimo Accorinti ◽  
Giovanni Spinucci ◽  
Maria Pia Pirraglia ◽  
Simone Bruschi ◽  
Francesca Romana Pesci ◽  
...  
Keyword(s):  
Significant Risk ◽  
Significant Risk Factor ◽  
Clinical Findings ◽  
Tertiary Referral Centre ◽  
Blurred Vision ◽  
Visual Prognosis ◽  
Presenting Symptoms ◽  
Significant Incidence ◽  
Keratic Precipitates

Purpose. To study epidemiology, clinical findings and visual prognosis of patients with Fuchs’ Heterochromic Iridocyclitis (FHI).Methods. A retrospective analysis was performed on 158 patients with FHI. Thirty-five patients were observed only once; the remaining 123 had a mean follow-up of 30.7 months (50 of them had a mean follow-up of 63.5 months) and in those we assessed complications, medical and surgical treatment, and long-term visual prognosis.Results. Average age at uveitis diagnosis was 27.2 years and 18.3% of patients were children. Blurred vision (54.5%) and floaters (40.5%) were the most frequent presenting symptoms. Small to medium-sized keratic precipitates (95.6%), iris atrophy (86.8%), and vitreous opacities (91.2%) were the most common signs; the prevalence of cataract and IOP increase was 63.5% and 20.1%, respectively, and their incidence was 0.1 and 0.06 eye/year. Significant risk factor for visual loss was IOP increase at presentation (p=0.02). At final examination 98% of the eye had a visual acuity ≥ 0.6, and topical (p<0.001) and systemic (p<0.001) corticosteroids therapy were used less frequently than before referral.Conclusions. FHI has a good visual prognosis, despite the significant incidence of cataract and glaucoma. A correct and prompt diagnosis might avoid unnecessary therapies and provide excellent visual outcomes.

Posterior fossa craniotomy for trapped fourth ventricle in shunt-treated hydrocephalic children: long-term outcome

2011 ◽  
Vol 7 (1) ◽  
pp. 52-63 ◽  
Author(s):  
Suhas Udayakumaran ◽  
Naresh Biyani ◽  
David P. Rosenbaum ◽  
Liat Ben-Sira ◽  
Shlomi Constantini ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Late Complication ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Posthemorrhagic Hydrocephalus ◽  
Spinal Subarachnoid Space ◽  
Trapped Fourth Ventricle

Object Trapped fourth ventricle (TFV) is a rare late complication of postinfectious or posthemorrhagic hydrocephalus. This entity is distinct from a large fourth ventricle because TFV entails pressure in the fourth ventricle and posterior fossa due to abnormal inflow and outflow of CSF, causing significant symptoms and signs. As TFV is mostly found in children who were born prematurely and have cerebral palsy, diagnosis and treatment options are a true challenge. Methods Between February 1998 and February 2007, 12 children were treated for TFV in Dana Children's Hospital by posterior fossa craniotomy/craniectomy and opening of the TFV into the spinal subarachnoid space. The authors performed a retrospective analysis of relevant data, including pre- and postoperative clinical characteristics, surgical management, and outcome. Results Thirteen fenestrations of trapped fourth ventricles (FTFVs) were performed in 12 patients. In 6 patients with prominent arachnoid thickening, a stent was left from the opened fourth ventricle into the spinal subarachnoid space. One patient underwent a second FTFV 21 months after the initial procedure. No perioperative complications were encountered. All 12 patients (100%) showed clinical improvement after FTFV. Radiological improvement was seen in only 9 (75%) of the 12 cases. The follow-up period ranged from 2 to 9.5 years (mean 6.11 ± 2.3 years) after FTFV. Conclusions Fenestration of a TFV via craniotomy is a safe and effective option with a very good long-term outcome and low rate of morbidity.

Vocal Fold Immobility Following Vaccination

2020 ◽  
pp. 000348942096563
Author(s):  
Guy Talmor ◽  
Brandon Nguyen ◽  
Corina Din-Lovinescu ◽  
Boris Paskhover ◽  
Rachel Kaye
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Symptom Onset ◽  
Vocal Fold ◽  
Rare Complication ◽  
Adverse Event Reporting System ◽  
Vaccine Administration ◽  
Presenting Symptoms ◽  
Vocal Fold Immobility ◽  
The Relationship

Objective: Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. Methods: The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. Results: Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. Conclusion: Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.

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