Turner Michael S, Nguyen Ha Son, Payner Troy D, Cohen-Gadol Aaron A
Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University, Indianapolis 46202, Indiana.
J Neurosurg Pediatr. 2011 Jul;8(1):15-21. doi: 10.3171/2011.4.PEDS10541.
Posterior fossa cysts are usually divided into Dandy-Walker malformations, arachnoid cysts, and isolated and/or trapped fourth ventricles. Shunt placement is a mainstay treatment for decompression of these fluid collections when their expansion becomes symptomatic. Although several techniques to drain symptomatic posterior fossa cysts have been described, each method carries its own advantages and disadvantages. This article describes an alternative technique.
In 10 patients, the authors used an alternative technique involving stereotactic and endoscopic methods to place a catheter in symptomatic posterior fossa cysts across the tentorium. Discussion of these cases is included, along with a review of various approaches to shunt placement in this region and recommendations regarding the proposed technique.
No patient suffered intracranial hemorrhage related to the procedure and catheter implantation. All 3 patients who underwent placement of a new transtentorial cystoperitoneal shunt and a new ventriculoperitoneal shunt did not suffer any postoperative complication; a decrease in the size of their posterior fossa cysts was evident on CT scans obtained during the 1st postoperative day. Follow-up CT scans demonstrated either stable findings or further interval decrease in the size of their cysts. In 1 patient, the postoperative head CT demonstrated that the transtentorial catheter terminated posterior to the right parietal occipital region without entering the retrocerebellar cyst. This patient underwent a repeat operation for proximal shunt revision, resulting in an acceptable catheter implantation. The patient in Case 8 suffered from a shunt infection and subsequently underwent hardware removal and aqueductoplasty with stent placement. The patient in Case 9 demonstrated a slight increase in fourth ventricle size and was returned to the operating room. Exploration revealed a kink in the tubing connecting the distal limb of the Y connector to the valve. The Y connector was replaced with a T connector, and 1 week later, CT scans exhibited interval decompression of the ventricles. This patient later presented with cranial wound breakdown and an exposed shunt. His shunt hardware was removed and he was treated with antibiotics. He later underwent reimplantation of a lateral ventricular and transtentorial shunt and suffered no other complications during a 3-year follow-up period.
The introduction of endoscopic and stereotactic techniques has expanded the available treatment possibilities for posterior fossa cysts.
后颅窝囊肿通常分为丹迪-沃克畸形、蛛网膜囊肿以及孤立和/或被困第四脑室。当这些液体积聚扩张出现症状时，分流管置入是对其进行减压的主要治疗方法。尽管已经描述了几种引流有症状后颅窝囊肿的技术，但每种方法都有其自身的优缺点。本文描述了一种替代技术。
作者对10例患者采用了一种涉及立体定向和内镜方法的替代技术，通过小脑幕将导管置入有症状的后颅窝囊肿。文中包括了对这些病例的讨论，以及对该区域分流管置入的各种方法的综述和对所提出技术的建议。
没有患者因该操作和导管植入发生颅内出血。所有3例行新的经小脑幕囊肿-腹腔分流术和新的脑室-腹腔分流术的患者均未出现任何术后并发症；术后第1天的CT扫描显示后颅窝囊肿大小明显减小。随访CT扫描显示囊肿大小要么稳定，要么进一步缩小。1例患者术后头颅CT显示经小脑幕导管终止于右顶枕区后方，未进入小脑后囊肿。该患者接受了近端分流管修复的再次手术，导管植入情况可接受。病例8的患者发生了分流管感染，随后接受了硬件移除和带支架的导水管成形术。病例9的患者第四脑室大小略有增加，返回手术室。探查发现连接Y形连接器远端肢体与阀门的管道有扭结。将Y形连接器换成T形连接器，1周后，CT扫描显示脑室有阶段性减压。该患者后来出现颅骨伤口裂开和分流管外露。移除了他的分流管硬件并给予抗生素治疗。他后来接受了侧脑室和经小脑幕分流管的重新植入，在3年的随访期内未出现其他并发症。
内镜和立体定向技术的引入扩大了后颅窝囊肿的可用治疗可能性。
