Zoran Milenkovic J, Biljana Stevanovic S, Ivana Markovic P
Department of Surgery, General Hospital "Sava Surgery" Bulevar Zorana Djindjica, Serbia.
Surg Neurol Int. 2011;2:141. doi: 10.4103/2152-7806.85982. Epub 2011 Oct 12.
Congenital unilateral hydrocephalus is an uncommon entity occurring almost exclusively in children. Atresia, stenosis, membranous occlusion and even functional obstruction of the foramen of Monro have been described to be the main cause of this type of hydrocephalus. There are two options available in the surgical management of unilateral hydrocephalus: one is the placement of shunt CSF diversion from the dilated ventricle and the other is fenestration of the occluded foramen of Monro or septum pellucidum by endoscopy or by stereotactic method. Migration of the ventriculoperitoneal (VP) shunt in or out of ventricles is not so uncommon, but the relocation of the ventricular tip of a catheter from the ventricle into the quadrigeminal cisterns and superior vermis in association with ventriculostomy is extremely rare. Spontaneous ventriculostomy is a rare event and results from spontaneous rupture of a ventricle into the subarachnoid space.
A 5½-month-old baby with a right-sided congenital unilateral hydrocephalus underwent a VP shunt andhad experienced an uneventful outcome. Four years later on an MR imaging examination, the tip of the ventricular catheter passing through the medial wall of the ventricle and the quadrigeminal cistern was found to be situated in the superior vermis. During the follow-up period, there were no neurological difficulties. The cognitive and motor skill development corresponded well with the child's age. It transpired that the hydrocephalic ventricle reduced its size dramatically to normal.
We have described the extremely rare site of the relocation of the ventricular catheter after the treatment of the congenital unilateral hydrocephalus by VP shunting. Spontaneous ventriculostomy as a rare phenomenon may be the explanation of the relocation of the ventricular catheter.
先天性单侧脑积水是一种罕见病症，几乎仅发生于儿童。已报道室间孔闭锁、狭窄、膜性阻塞甚至功能性梗阻是此类脑积水的主要病因。单侧脑积水的手术治疗有两种选择：一种是从扩张的脑室进行分流脑脊液引流，另一种是通过内镜或立体定向方法对闭塞的室间孔或透明隔进行造瘘。脑室腹腔（VP）分流管在脑室内外移位并非罕见，但与脑室造瘘相关的导管脑室端从脑室移位至四叠体池和上蚓部极为罕见。自发性脑室造瘘是一种罕见事件，由脑室自发破裂进入蛛网膜下腔所致。
一名5个半月大的右侧先天性单侧脑积水婴儿接受了VP分流术，术后恢复顺利。4年后的磁共振成像检查发现，穿过脑室内侧壁和四叠体池的脑室导管尖端位于上蚓部。在随访期间，未出现神经功能障碍。认知和运动技能发育与患儿年龄相符。结果发现，脑积水脑室大小显著缩小至正常。
我们描述了先天性单侧脑积水经VP分流治疗后脑室导管移位至极其罕见的部位。自发性脑室造瘘作为一种罕见现象可能是脑室导管移位的原因。
