Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
School of Medicine, Mansoura University, Mansoura, Egypt.
Childs Nerv Syst. 2020 Dec;36(12):2961-2969. doi: 10.1007/s00381-020-04656-w. Epub 2020 May 7.
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.
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.
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.
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.
第四脑室（TFV）嵌顿是脑积水儿童中一个明确的问题。大多数患有出血后脑积水（PHH）的患者受到影响。我们试图找出易患因素并描述临床表现，以便早期诊断 TFV 并进行管理。
我们回顾了 1991 年至 2018 年的数据库，其中包括所有需要手术治疗 TFV 的患者。我们分析了早产、脑积水的原因、植入的瓣膜类型、修订手术、TFV 的治疗方式以及他们的临床检查和 MRI 成像。
我们发现 21 例患者。大多数患者患有 PHH（16/21）、肿瘤（2/21）、脑膜炎后脑积水（2/21）和先天性脑积水（1/21）。17 例患者为早产儿。7 例患者在 MRI 中出现慢性过度引流伴狭缝脑室。13 例患者出现表示脑干功能障碍的症状；在 3 例患者中，TFV 无症状，在 5 例患者中，由于文档缺失，我们没有有关出现症状的信息。18/21 例患者选择了额外的第四脑室导管进行治疗。1 例患者接受了颅颈减压术。最后 2 例患者进行了内镜导水管成形术和支架置入术。
在小儿神经外科实践中，诊断有症状的 TFV 及其治疗是一个挑战。PHH 和早产是发生这种并发症的危险因素。第四脑室分流和内镜导水管成形术加支架置入术都能有效地治疗 TFV。由于其高失败率，不推荐进行显微第四脑室造口术。早期发现和干预可能有助于避免致命并发症并改善神经功能。
