Spennato Pietro, Scala Maria Rosaria, Vitulli Francesca, Parlato Raffaele Stefano, Russo Carmela, Cinalli Giuseppe
Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy.
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli Federico II, Naples, Italy.
Childs Nerv Syst. 2023 May;39(5):1341-1345. doi: 10.1007/s00381-022-05811-1. Epub 2022 Dec 27.
Dandy-Walker malformation (DWM) is a posterior fossa malformation characterized by a huge posterior fossa cyst in communication with the fourth ventricle. Hydrocephalus is associated with more than 80% of cases and is usually treated by shunting. Despite infection being a common complication of the shunt, abscess formation within the cyst was reported only once.
A neonate affected by DWM developed a posterior fossa abscess following a shunt infection. The purulent collection was refractory to standard treatment (antibiotics and burr hole drainage); therefore, an endoscopic approach was performed in order to remove the purulent collection under direct vision. This material was aspirated with the help of an endoscopic ultrasonic aspirator. The outcome was favorable, with a resolution of infection and re-implantation of the ventriculo-peritoneal shunt. Surprisingly, post-operative radiological examination showed substantial modification of the anatomy of the posterior fossa with disappearing of the Dandy-Walker cyst. To the best of our knowledge, this is the first documented report of a true Dandy-Walker malformation that modified its anatomical appearance over time.
Endoscopic aspiration of intracranial purulent collection should be considered a valid option to manage complicated cases. An endoscopic ultrasonic aspirator may make the procedure more effective and faster.
丹迪-沃克畸形(DWM)是一种后颅窝畸形,其特征为与第四脑室相通的巨大后颅窝囊肿。超过80%的病例伴有脑积水,通常采用分流术治疗。尽管感染是分流术的常见并发症,但囊肿内形成脓肿仅报道过一例。
一名患有DWM的新生儿在分流感染后发生了后颅窝脓肿。脓性积液对标准治疗(抗生素和钻孔引流)无效;因此,采用了内镜方法以便在直视下清除脓性积液。借助内镜超声吸引器抽吸该物质。结果良好,感染得到解决,脑室-腹腔分流管重新植入。令人惊讶的是,术后影像学检查显示后颅窝解剖结构有显著改变,丹迪-沃克囊肿消失。据我们所知,这是第一例记录在案的真正的丹迪-沃克畸形随时间推移其解剖外观发生改变的报告。
内镜抽吸颅内脓性积液应被视为处理复杂病例的有效选择。内镜超声吸引器可能使该操作更有效、更快速。