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Alves CAPF, Sidpra J, Manteghinejad A, Sudhakar S, Massey FV, Aldinger KA, Haldipur P, Lucato LT, Ferraciolli SF, Teixeira SR, Öztekin Ö, Bhattacharya D, Taranath A, Prabhu SP, Mirsky DM, Andronikou S, Millen KJ, Barkovich AJ, Boltshauser E, Dobyns WB, Barkovich MJ, Whitehead MT, Mankad K. Dandy-Walker Phenotype with Brainstem Involvement: 2 Distinct Subgroups with Different Prognosis. AJNR Am J Neuroradiol 2023; 44:1201-1207. [PMID: 37591769 PMCID: PMC10549954 DOI: 10.3174/ajnr.a7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND PURPOSE Although cardinal imaging features for the diagnostic criteria of the Dandy-Walker phenotype have been recently defined, there is a large range of unreported malformations among these patients. The brainstem, in particular, deserves careful attention because malformations in this region have potentially important implications for clinical outcomes. In this article, we offer detailed information on the association of brainstem dysgenesis in a large, multicentric cohort of patients with the Dandy-Walker phenotype, defining different subtypes of involvement and their potential clinical impact. MATERIALS AND METHODS In this established multicenter cohort of 329 patients with the Dandy-Walker phenotype, we include and retrospectively review the MR imaging studies and clinical records of 73 subjects with additional brainstem malformations. Detailed evaluation of the different patterns of brainstem involvement and their potential clinical implications, along with comparisons between posterior fossa measurements for the diagnosis of the Dandy-Walker phenotype, was performed among the different subgroups of patients with brainstem involvement. RESULTS There were 2 major forms of brainstem involvement in patients with Dandy-Walker phenotype including the following: 1) the mild form with anteroposterior disproportions of the brainstem structures "only" (57/73; 78%), most frequently with pontine hypoplasia (44/57; 77%), and 2) the severe form with patients with tegmental dysplasia with folding, bumps, and/or clefts (16/73; 22%). Patients with severe forms of brainstem malformation had significantly increased rates of massive ventriculomegaly, additional malformations involving the corpus callosum and gray matter, and interhemispheric cysts. Clinically, patients with the severe form had significantly increased rates of bulbar dysfunction, seizures, and mortality. CONCLUSIONS Additional brainstem malformations in patients with the Dandy-Walker phenotype can be divided into 2 major subgroups: mild and severe. The severe form, though less prevalent, has characteristic imaging features, including tegmental folding, bumps, and clefts, and is directly associated with a more severe clinical presentation and increased mortality.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - J Sidpra
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - A Manteghinejad
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - S Sudhakar
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - F V Massey
- Unit of Functional Neurosurgery (F.V.M.), National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K A Aldinger
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - P Haldipur
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - L T Lucato
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S F Ferraciolli
- Department of Radiology, Division of Neuroradiology (L.T.L., S.F.F.), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - S R Teixeira
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - Ö Öztekin
- Department of Neuroradiology (Ö.Ö.), Bakırçay University, Çiğli Education and Research Hospital, İzmir, Turkey
| | - D Bhattacharya
- Department of Neuroradiology (D.B.), Royal Victoria Hospital, Belfast, UK
| | - A Taranath
- Department of Medical Imaging (A.T.), Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - S P Prabhu
- Department of Radiology, Neuroradiology Division (S.P.P.), Boston Children's Hospital, Boston, Massachusetts
| | - D M Mirsky
- Department of Radiology, Neuroradiology Division (D.M.M.), Children's Hospital Colorado, Aurora, Colorado
| | - S Andronikou
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K J Millen
- Center for Integrative Brain Research (K.A.A., P.H., K.J.M.), Seattle Children's Research Institute, Seattle, Washington
- Departments of Pediatrics and Neurology (K.A.A., P.H., K.J.M.), University of Washington, Seattle, Washington
| | - A J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - E Boltshauser
- Department of Pediatric Neurology (E.B.), University Children's Hospital, Zürich, Switzerland
| | - W B Dobyns
- Department of Genetics and Metabolism (W.B.D.), University of Minnesota, Minneaplis, Minnesota
| | - M J Barkovich
- Department of Neuroradiology (A.J.B., M.J.B.), University of California, San Francisco, San Francisco, California
| | - M T Whitehead
- From the Division of Neuroradiology (C.A.P.F.A., A.M., S.R.T., S.A., M.T.W.), Department of Radiology, Children's Hospital of Philadelphia, Philadephia, Pennsylvania
| | - K Mankad
- Unit of Neuroradiology (J.S., S.S., K.M.), Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
- Developmental Biology & Cancer Section (J.S., K.M.), University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Di Nora A, Costanza G, Pizzo F, Di Mari A, Sapuppo A, Basile A, Fiumara A, Pavone P. Dandy-Walker malformation and variants: clinical features and associated anomalies in 28 affected children-a single retrospective study and a review of the literature. Acta Neurol Belg 2022:10.1007/s13760-022-02059-z. [PMID: 36068432 DOI: 10.1007/s13760-022-02059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics, the neuroimaging features and associated anomalies observed in children affected by Dandy-Walker malformations (DWM) and variants (DWV) in a single tertiary hospital in Catania and compare our data to their existent in the literature. METHODS A retrospective case series using the medical records has been performed on 28 children diagnosed with DWM and DWV admitted to a single tertiary section of Pediatric Neurology, Department of Catania, Italy from January 2005 to January 2021. We reviewed the neuroimaging using the new diagnostic criteria of Klein et al. RESULTS: Associated anomalies were frequently reported. Among these, hydrocephalus was found in 13/28 (48%), and hydrocephalus plus corpus callosum anomalies in three children (10%). We described corpus callosum, cardiac and genitourinary anomalies in 2/28 (7%), 3/28 (10%), and 3/28 (10%), respectively. The most common clinical features were the developmental delay and epilepsy observed in 19/28 (67%) and in 9/28 (32%) of the cases. The first exam at the diagnosis was MRI in 17/28 patients, followed by transfontanellar ultrasound in 5/28, computed tomography in 4/28 and prenatal ultrasound in 2/28. To note, a child with DWM was affected by Down syndrome and one by congenital disorders of N-linked glycosylation (CDG-IId). CONCLUSIONS Children with DWV were more commonly observed than children with DWM. Hydrocephalus is an anomaly, frequently and equally reported in both DWM and DMV. Perinatal complications were frequent adverse events with severe respiratory distress and need for cardiopulmonary resuscitation. Cognitive involvement and epilepsy were the most common comorbidities. Single DWV is associated with a better developmental outcome.
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Affiliation(s)
- A Di Nora
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy.
| | - G Costanza
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy
| | - F Pizzo
- Department of Clinical and Experimental Medicine, University of Catania Postgraduate Training Program in Pediatrics, Catania, Italy
| | - A Di Mari
- Department of Radiology, University of Catania Postgraduate Training Program in Radiology, Catania, Italy
| | - A Sapuppo
- Department of Pediatric Neurology, University of Catania, Catania, Italy
| | - A Basile
- Radiology Unit, Policlinico G.Rodolico, Catania, Italy, University of Catania, 95123, Catania, Italy
| | - A Fiumara
- Department of Pediatric Neurology, University of Catania, Catania, Italy
| | - P Pavone
- Department of Pediatric Neurology, University of Catania, Catania, Italy
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Gutierrez F, Ballestero M, Herrera D, Gonzalez C, Cardona A, Mora L. Occipital encephalocele associated with Dandy-Walker malformation: a case-based review. Childs Nerv Syst 2022; 38:1683-1688. [PMID: 35588332 DOI: 10.1007/s00381-022-05551-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/08/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Occipital encephalocele is a brain malformation that has been remotely associated with Dandy-Walker; only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary of the state of the art in this association. METHODS AND RESULTS The pertinent literature has been reviewed, and an exemplary case has been reported (an 11-month-old female with Dandy-Walker malformation and occipital encephalocele). So far, 33 cases have been described, with a mean age at surgery of 5, 1 day). The majority of the cases tend to present with hydrocephalus. There are no specific surgery approaches or global consensus about this association. The management possibly relies on surgery with shunt or encephalocele excision but without a dedicated protocol yet. CONCLUSIONS The clinical research on occipital encephalocele in association with Dandy-Walker malformation is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management protocol.
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Affiliation(s)
- Felipe Gutierrez
- Department of Neurosurgery, School of Medicine, University of Antioquia, Medellin, Colombia.
| | - Matheus Ballestero
- Division of Neurosurgery, Department of Medicine, Federal University of São Carlos, UFSCAR, Sao Carlos, Brazil
| | - David Herrera
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Catalina Gonzalez
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Alejandra Cardona
- School of Medicine, Pontifical Bolivarian University, Medellin, Colombia
| | - Laura Mora
- School of Medicine, Metropolitan University of Colombia, Barranquilla, Colombia
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Mittra S, Prajapati HP, Kumar R. Craniomegaly in Neonate and Infants Requiring Neurosurgical Intervention: An Experience at Tertiary Care Center. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1735377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes.
Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants.
Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India.
Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up.
Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients.
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Affiliation(s)
- Sangh Mittra
- Department of Gynaecology, Veerangana Avanti Bai Mahila Chikitsalaya, Lucknow, Uttar Pradesh, India
| | - Hanuman Prasad Prajapati
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India
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Ulrich J, Caird J, Crimmins D. Predicting outcomes in Dandy-Walker malformation: a retrospective cohort study. J Neurosurg Pediatr 2021:1-6. [PMID: 34507295 DOI: 10.3171/2021.5.peds21140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dandy-Walker malformation (DWM) is a disorder that most neurologists and neurosurgeons will manage at some point during their careers. It is characterized by partial or complete dysgenesis of the cerebellar vermis. Outcomes are highly variable and range from functionally normal to severely disabled. Predicting these outcomes has classically been focused on the radiological findings that constitute DWM. Other anomalies that can be commonly found in these patients are potentially more indicative of outcome than the tenet markers of DWM. Furthermore, hydrocephalus is an ever-present danger in these patients, many of whom will be admitted to the hospital due to this condition. This study aims to identify these items as potential predictors of outcome. METHODS All referrals from antenatal anatomy scans between 1992 and 2013 that were suspicious for DWM were reviewed. Neurosurgery archives were reviewed for outpatient letters and other correspondence. The number of DWM diagnoses was quantified. Outcomes were judged based on patient status, ranging from death to attending normal school. The presence of any other anomalies was quantified and measured against patient outcomes. RESULTS Cyst size and the presence of another CNS anomaly were shown to portend worse outcomes. Non-CNS anomalies and hydrocephalus were not predictive of worse outcomes. Furthermore, of all the treatments assessed, ventriculoperitoneal shunts were shown to be the most effective in this data set. CONCLUSIONS Results from this study suggest a pivot in how prognoses in DWM should be established and how parents should be counseled, along with a view of hydrocephalus and its treatment that challenges the current literature.
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Affiliation(s)
- James Ulrich
- 1Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - John Caird
- 2Department of Neurosurgery, Temple Street Children's University Hospital, Dublin; and
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Yengo-Kahn AM, Wellons JC, Hankinson TC, Hauptman JS, Jackson EM, Jensen H, Krieger MD, Kulkarni AV, Limbrick DD, McDonald PJ, Naftel RP, Pindrik JA, Pollack IF, Reeder R, Riva-Cambrin J, Rozzelle CJ, Tamber MS, Whitehead WE, Kestle JRW. Treatment strategies for hydrocephalus related to Dandy-Walker syndrome: evaluating procedure selection and success within the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2021; 28:93-101. [PMID: 33930865 DOI: 10.3171/2020.11.peds20806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Treating Dandy-Walker syndrome-related hydrocephalus (DWSH) involves either a CSF shunt-based or endoscopic third ventriculostomy (ETV)-based procedure. However, comparative investigations are lacking. This study aimed to compare shunt-based and ETV-based treatment strategies utilizing archival data from the Hydrocephalus Clinical Research Network (HCRN) registry. METHODS A retrospective review of prospectively collected and maintained data on children with DWSH, available from the HCRN registry (14 sites, 2008-2018), was performed. The primary outcome was revision-free survival of the initial surgical intervention. The primary exposure was either shunt-based (i.e., cystoperitoneal shunt [CPS], ventriculoperitoneal shunt [VPS], and/or dual-compartment) or ETV-based (i.e., ETV alone or with choroid plexus cauterization [CPC]) initial surgical treatment. Primary analysis included multivariable Cox proportional hazards models. RESULTS Of 8400 HCRN patients, 151 (1.8%) had DWSH. Among these, the 102 patients who underwent shunt placement (79 VPSs, 16 CPSs, 3 other, and 4 multiple proximal catheter) were younger (6.6 vs 18.8 months, p < 0.001) and more frequently had 1 or more comorbidities (37.3% vs 14.3%, p = 0.005) than the 49 ETV-treated children (28 ETV-CPC). Fifty percent of the shunt-based and 51% of the ETV-based treatments failed. Notably, 100% (4/4) of the dual-compartment shunts failed. Adjusting for age, baseline ventricular size, and comorbidities, ETV-based treatment was not significantly associated with earlier failure compared with shunt-based treatment (HR for failure 1.32, 95% CI 0.77-2.26; p = 0.321). Complication rates were low: 4.9% and 6.1% (p = 0.715) for shunt- and ETV-based procedures, respectively. There was no difference in survival between ETV-CPC- and ETV-based treatment when adjusting for age (HR for failure 0.86, 95% CI 0.29-2.55, p = 0.783). CONCLUSIONS In this North American, multicenter, prospective database review, shunt-based and ETV-based primary treatment strategies of DWSH appear similarly durable. Pediatric neurosurgeons can reasonably consider ETV-based initial treatment given the similar durability and the low complication rate. However, given the observational nature of this study, the treating surgeon might need to consider subgroups that were too small for a separate analysis. Very young children with comorbidities were more commonly treated with shunts, and older children with fewer comorbidities were offered ETV-based treatment. Future studies may determine preoperative characteristics associated with ETV treatment success in this population.
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Affiliation(s)
- Aaron M Yengo-Kahn
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - John C Wellons
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - Todd C Hankinson
- 3Department of Neurosurgery, Children's Hospital Colorado, Colorado Springs, Colorado
| | - Jason S Hauptman
- 4Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Eric M Jackson
- 5Department of Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland
| | | | - Mark D Krieger
- 7Department of Neurosurgery, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Abhaya V Kulkarni
- 8Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David D Limbrick
- 9Department of Neurosurgery, Washington University School of Medicine in St. Louis, Missouri
| | - Patrick J McDonald
- 10Division of Neurosurgery, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert P Naftel
- 1Department of Neurosurgery, Vanderbilt University Medical Center; and
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, Tennessee
| | - Jonathan A Pindrik
- 11Department of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ian F Pollack
- 12Department of Neurosurgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
| | | | - Jay Riva-Cambrin
- 13Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Curtis J Rozzelle
- 14Division of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Alabama; and
| | - Mandeep S Tamber
- 10Division of Neurosurgery, British Columbia Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
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Syringomyelia caused by an arachnoid web in a patient with shunted Dandy-Walker malformation. Childs Nerv Syst 2017; 33:665-670. [PMID: 27822765 DOI: 10.1007/s00381-016-3293-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Dandy-Walker malformation (DWM) is a congenital brain anomaly characterized by dysgenesis of the cerebellar vermis and the presence of a posterior fossa cyst. The association of syringomyelia with DWM is extremely rare. CASE REPORT A 10-year-old patient who was diagnosed with DWM in infancy presented with progressive scoliosis and fecal incontinence. He had been treated with cystoventriculoperitoneal shunting with a Y-connection during infancy, which was followed by a revision 6 years later. During the revision surgery, intraventricular bleeding occurred and was managed conservatively. Imaging studies for the current visit revealed syringomyelia along the cervicothoracic spinal cord and a membranous structure around the cervicomedullary junction. Phase-contrast cine magnetic resonance imaging (MRI) revealed disturbed cerebrospinal fluid (CSF) flow across the membrane. We excised the arachnoid web that was tethering the brainstem and blocking CSF flow. Postoperatively, the patient experienced symptom relief, and the follow-up imaging study demonstrated a dramatic decrease in the size of the syringomyelia. DISCUSSION We suggest that syrinx formation in this patient was possibly caused by disturbed CSF flow and tethering of the brainstem. CONCLUSION We experienced an unusual case of DWM with syringomyelia which was caused by an arachnoid web blocking CSF flow and tethering the brainstem. The arachnoid web seems to be formed by previous bleeding which occurred at the time of shunt revision. After excision of the arachnoid web, the patient showed good outcome.
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Barkovich AJ. Developmental disorders of the midbrain and hindbrain. Front Neuroanat 2012; 6:7. [PMID: 22408608 PMCID: PMC3294267 DOI: 10.3389/fnana.2012.00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/20/2012] [Indexed: 11/16/2022] Open
Abstract
Malformations of the midbrain (MB) and hindbrain (HB) have become topics of considerable interest in the neurology and neuroscience literature in recent years. The combined advances of imaging and molecular biology have improved analyses of structures in these areas of the central nervous system, while advances in genetics have made it clear that malformations of these structures are often associated with dysfunction or malformation of other organ systems. This review focuses upon the importance of communication between clinical researchers and basic scientists in the advancement of knowledge of this group of disorders. Disorders of anteroposterior (AP) patterning, cerebellar hypoplasias, disorders associated with defects of the pial limiting membrane (cobblestone cortex), disorders of the Reelin pathway, and disorders of the primary cilium/basal body organelle (molar tooth malformations) are the main focus of the review.
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Affiliation(s)
- A. James Barkovich
- Department of Radiology and Biomolecular Imaging, Neuroradiology Section, University of California at San Francisco, San FranciscoCA, USA
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Correa GG, Amaral LF, Vedolin LM. Neuroimaging of Dandy-Walker malformation: new concepts. Top Magn Reson Imaging 2011; 22:303-312. [PMID: 24132069 DOI: 10.1097/rmr.0b013e3182a2ca77] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dandy-Walker malformation (DWM) is the most common human cerebellar malformation, characterized by hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and an enlarged posterior fossa with upward displacement of the lateral sinuses, tentorium, and torcular. Although its pathogenesis is not completely understood, there are several genetic loci related to DWM as well as syndromic malformations and congenital infections. Dandy-Walker malformation is associated with other central nervous system abnormalities, including dysgenesis of corpus callosum, ectopic brain tissue, holoprosencephaly, and neural tube defects. Hydrocephalus plays an important role in the development of symptoms and neurological outcome in patients with DWM, and the aim of surgical treatment is usually the control of hydrocephalus and the posterior fossa cyst. Imaging modalities, especially magnetic resonance imaging, are crucial for the diagnosis of DWM and distinguishing this disorder from other cystic posterior fossa lesions. Persistent Blake's cyst is seen as a retrocerebellar fluid collection with cerebrospinal fluid signal intensity and a median line communication with the fourth ventricle, commonly associated with hydrocephalus. Mega cisterna magna presents as an extraaxial fluid collection posteroinferior to an intact cerebellum. Retrocerebellar arachnoid cysts frequently compress the cerebellar hemispheres and the fourth ventricle. Patients with DWM show an enlarged posterior fossa filled with a cystic structure that communicates freely with the fourth ventricle and hypoplastic vermis. Comprehension of hindbrain embryology is of utmost importance for understanding the cerebellar malformations, including DWM, and other related entities.
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Affiliation(s)
- Gustavo Gumz Correa
- From the *Hospital Moinhos de Vento, Porto Alegre; and †Medimagem, Hospital Beneficiência Portuguesa, São Paulo, Brazil
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Spennato P, Mirone G, Nastro A, Buonocore MC, Ruggiero C, Trischitta V, Aliberti F, Cinalli G. Hydrocephalus in Dandy-Walker malformation. Childs Nerv Syst 2011; 27:1665-81. [PMID: 21928031 DOI: 10.1007/s00381-011-1544-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Even if the first description of Dandy-Walker dates back 1887, difficulty in the establishment of correct diagnosis, especially concerning differential diagnosis with other types of posterior fossa CSF collection, still persists. Further confusion is added by the inclusion, in some classification, of different malformations with different prognosis and therapeutic strategy under the same label of "Dandy-Walker". METHODS An extensive literature review concerning embryologic, etiologic, pathogenetic, clinical and neuroradiological aspects has been performed. Therapeutic options, prognosis and intellectual outcome are also reviewed. CONCLUSION The correct interpretation of the modern neuroradiologic techniques, including CSF flow MR imaging, may help in identifying a "real" Dandy-Walker malformation. Among therapeutical strategies, single shunting (ventriculo-peritoneal or cyst-peritoneal shunts) appears effective in the control of both ventricle and cyst size. Endoscopic third ventriculostomy may be considered an acceptable alternative, especially in older children, with the aim to reduce the shunt-related problems. Prognosis and intellectual outcome mostly depend on the presence of associated malformations, the degree of vermian malformation and the adequate control of hydrocephalus.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono Children's Hospital, Via Mario Fiore n. 6, 80129 Naples, Italy
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Warf BC, Dewan M, Mugamba J. Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and choroid plexus cauterization. J Neurosurg Pediatr 2011; 8:377-83. [PMID: 21961544 DOI: 10.3171/2011.7.peds1198] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECT Dandy-Walker complex (DWC) is a continuum of congenital anomalies comprising Dandy-Walker malformation (DWM), Dandy-Walker variant (DWV), Blake pouch cyst, and mega cisterna magna (MCM). Hydrocephalus is variably associated with each of these, and DWC-associated hydrocephalus has mostly been treated by shunting, often with 2-compartment shunting. There are few reports of management by endoscopic third ventriculostomy (ETV). This study is the largest series of DWC or DWM-associated hydrocephalus treated by ETV, and the first report of treatment by combined ETV and choroid plexus cauterization (ETV/CPC) in young infants with this association. METHODS A retrospective review of the CURE Children's Hospital of Uganda clinical database between 2004 and 2010 identified 45 patients with DWC confirmed by CT scanning (25 with DWM, 17 with DWV, and 3 with MCM) who were treated for hydrocephalus by ETV/CPC. Three were excluded because of other potential causes of hydrocephalus (2 postinfectious and 1 posthemorrhagic). RESULTS The median age at treatment was 5 months (88% of patients were younger than 12 months). There was a 2.4:1 male predominance among patients with DWV. An ETV/CPC (ETV only in one) was successful with no further operations in 74% (mean and median follow-up 24.2 and 20 months, respectively [range 6-65 months]). The rate of success was 74% for DWM, 73% for DWV, and 100% for MCM; 95% had an open aqueduct, and none required posterior fossa shunting. CONCLUSIONS Endoscopic treatment of DWC-associated hydrocephalus should be strongly considered as the primary management in place of the historical standard of creating shunt dependence.
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Affiliation(s)
- Benjamin C Warf
- Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
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MORIGAKI R, POOH KH, NAKAGAWA Y. Endoscopic Transaqueductal Placement of a Single-Catheter Cyst-Ventriculoperitoneal Shunt in a Neonate With Dandy-Walker Malformation-Associated Hydrocephalus -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:256-9. [DOI: 10.2176/nmc.51.256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ryoma MORIGAKI
- Department of Neurosurgery, National Hospital Organization, Kagawa Children's Hospital
| | - Kyong-Hon POOH
- Department of Neurosurgery, National Hospital Organization, Kagawa Children's Hospital
| | - Yoshinobu NAKAGAWA
- Department of Neurosurgery, National Hospital Organization, Kagawa Children's Hospital
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Abstract
Dandy-Walker malformation is a congenital disorder that involves the cerebellum and fourth ventricle. Regarding treatment, there is still controversy over the optimum surgical management. In the current study, we present 19 consecutive cases of Dandy-Walker malformation diagnosed between January 1992 and January 2008 that were treated in our institute. All patients presented with hydrocephalus at the time of diagnosis and were treated surgically. Combined drainage of the ventricular system and posterior fossa cyst, using a 3-way connector was performed in 5 patients. Posterior fossa cyst drainage alone was performed in 10 patients and the remaining 4 patients were treated by ventricular drainage alone. All patients improved after treatment. Dandy-Walker malformation is a developmental abnormality of the central nervous system associated with various brain and extracranial abnormalities. Surgical treatment remains controversial, whereas prognosis varies greatly according to the severity of syndrome and associated comorbidities.
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Affiliation(s)
- George A Alexiou
- Department of Neurosurgery, Children's Hospital Agia Sofia, Athens, Greece.
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Sasaki-Adams D, Elbabaa SK, Jewells V, Carter L, Campbell JW, Ritter AM. The Dandy-Walker variant: a case series of 24 pediatric patients and evaluation of associated anomalies, incidence of hydrocephalus, and developmental outcomes. J Neurosurg Pediatr 2008; 2:194-9. [PMID: 18759601 DOI: 10.3171/ped/2008/2/9/194] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The Dandy-Walker complex is a continuum of aberrant development of the posterior fossa that has been associated with multiple congenital anomalies, radiographic abnormalities, and developmental delay. The Dandy-Walker variant (DWV) is a unique entity believed to represent a milder form of the complex, and is characterized by a specific constellation of radiographic findings. In this retrospective case series, the authors report the association of the DWV with other congenital anomalies, the associated radiographic findings linked with DWV, and the developmental outcome in this population. METHODS The charts and radiographs of 10 male and 14 female patients treated between 2000 and 2006 were examined. The patients' mean gestational age was 35.6 weeks (range 23-41 weeks), and the mean follow-up period was 5.1 years (range 1 month-15 years). RESULTS Three patients died. Associated anomalies included cardiac (41.7%), neurological (33.3%), gastrointestinal (20.8%), orthopedic (12.5%), and genitourinary (12.5%) abnormalities. Less common were pulmonary and psychiatric findings. Developmental delay was identified in 11 of the 21 patients for whom follow-up was available. Five of 6 patients with isolated DWV had a normal developmental course. Radiographic findings associated with DWV included corpus callosum dysgenesis in 20.8%, ventricular enlargement in 29%, and vermian rotation in 8.3%. Shunts were placed in 4 of 7 patients with ventriculomegaly. Using the two-tailed Pearson correlation, the authors determined that developmental outcome was solely affected by neurological deficits and that ventricular enlargement predicted the need for shunt placement. CONCLUSIONS The DWV was associated with both extra- and intracranial anomalies. Associated radiographic abnormalities including ventriculomegaly were observed. Hydrocephalus requiring cerebrospinal fluid diversion may be indicated. Isolated DWV was associated with a good developmental outcome.
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Affiliation(s)
- Deanna Sasaki-Adams
- Division of Neurosurgery, Department of General Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
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Mohanty A, Biswas A, Satish S, Praharaj SS, Sastry KVR. Treatment options for Dandy-Walker malformation. J Neurosurg 2007; 105:348-56. [PMID: 17328256 DOI: 10.3171/ped.2006.105.5.348] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECT The aim of this study was to assess the efficacy of various treatment options available for children with Dandy-Walker malformation (DWM) and to evaluate the role of endoscopic procedures in the treatment of this disorder. METHODS The authors conducted a retrospective review of 72 children who underwent surgical treatment for DWM during a 16-year period. All patients underwent computed tomography scanning, and 26 underwent magnetic resonance (MR) imaging. The initial surgical treatment included ventriculoperitoneal (VP) shunt placement in 21 patients, cystoperitoneal (CP) shunt placement in 24, and combined VP and CP shunt insertion in three. Twenty-one patients underwent endoscopic procedures (endoscopic third ventriculostomy [ETV] alone in 16 patients, ETV with aqueductal stent placement in three, and ETV with fenestration of the occluding membrane in two). Three patients underwent membrane excision via a posterior fossa craniectomy. In the 26 patients who had undergone preoperative MR imaging, aqueductal patency was noted in 23 and aqueductal obstruction in three. These three patients underwent placement of a stent from the third ventricle to the posterior fossa cyst in addition to the ETV procedure. During the follow-up period, 12 patients with a CP shunt and four with a VP shunt experienced shunt malfunctions that required revision. Four patients with a CP shunt also required placement of a VP shunt. In addition, five of the 21 ETVs failed, requiring VP shunt insertion. A reduction in ventricle size noted on postoperative images occurred more frequently in patients with a VP shunt, whereas a reduction in cyst size was more appreciable in patients with a CP shunt. Successful ETV resulted in a slight decrease in ventricle size and varying degrees of reduction in cyst size. CONCLUSIONS Endoscopic procedures may be considered an acceptable alternative in children with DWM. The authors propose a treatment protocol based on preoperative MR imaging findings of associated aqueductal stenosis.
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Affiliation(s)
- Aaron Mohanty
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
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16
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Abstract
The aim of this review is to summarize our knowledge about Dandy-Walker malformation (DWM) and introduce recent notions about its prognosis. DWM is a malformation associating hypoplasia of the vermis, pseudocystic fourth ventricle, upward displacement of the tentorium, torcular and lateral sinuses and anterio-posterior enlargement of the posterior fossa. It is frequently associated with genetic anomalies, brain malformations (anomalies of gyration, grey matter heterotopias, meningoceles, corpus callosum agenesis...) or systemic malformations (heart, orthopedic, intestinal, urogenital and facial anomalies). It is also part of many syndromes. Its rarity, the difficulty of its diagnosis, the fact that the malformation is mainly known through hospitalized patients, mainly from neurosurgical departments, have made its definition variable and prevents us from having an accurate knowledge of its natural history and prognosis. Hydrocephalus, so frequent in neurosurgical series that some have included it in the definition, is actually rare as has been seen in prenatal series. Treatment, when necessary, is still controversial, the main options remaining cyst fenestration, ventriculo- and/or cystoperitoneal shunts and more recently endoscopic third ventriculostomy. The prognosis, commonly said to be unpredictable, is actually foreseeable after scrutinous observation of the brain anatomy, and mainly of the vermis. A cerebellar vermis with three groups of lobes and two main fissures, as identified on MRI T2 sagittal views, not only has the greatest chance to not be associated with other malformation but also to have a favorable neurocognitive outcome. On the contrary, a deeply dysgenetic vermis with only two or one recognizable lobes is not only constantly associated with other brain malformation but also with poor prognosis. This is a recent advance that may be important for those involved in prenatal counselling.
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Affiliation(s)
- O Klein
- Unité de Neurochirurgie Pédiatrique, Département de Neurochirurgie, Hôpital Central, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex.
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Abstract
MR imaging of the fetal brain is rapidly being embraced in clinical practice. Fetal MR imaging is proving to be a powerful modality with which to evaluate the fetal brain and is a valuable complement to prenatal ultrasound. Structural abnormalities, such as cerebral malformations and destructive lesions, can be sonographically occult on prenatal ultrasound yet detectable by fetal MR imaging. Moreover, fetal MR imaging offers the promise of contributing to our understanding of normal as well as abnormal brain development with continued advances in MR imaging techniques, such as diffusion-weighted and parallel imaging.
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Affiliation(s)
- Orit A Glenn
- Neuroradiology Section, Department of Radiology, University of California at San Francisco, CA 94143-0628, USA.
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Richter EO, Pincus DW. Development of syringohydromyelia associated with Dandy-Walker malformation: treatment with cystoperitoneal shunt placement. Case report. J Neurosurg 2006; 104:206-9. [PMID: 16572641 DOI: 10.3171/ped.2006.104.3.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dandy-Walker malformation (DWM) is a well-described clinical entity, which includes vermian agenesis, posterior fossa cysts, and frequently, hydrocephalus. The authors report the clinical course and present the radiographic findings pertaining to a 1-month-old girl with DWM who was treated initially with a ventriculoperitoneal shunt and endoscopic fenestration of a posterior fossa cyst. After decompression for hydrocephalus, an increased mass effect at the foramen magnum from her posterior fossa cyst was demonstrated, as well as subsequent development of syringohydromyelia from C-4 to T-7. She was treated with a cystoperitoneal shunt. At the 6-month follow-up examination, the child (15 months of age) had achieved gains in developmental milestones, and complete resolution of the syrinx was established through MR imaging. This is the fourth nonautopsy pediatric case of DWM-associated syringohydromyelia reported in the literature and the third in a child to demonstrate impaction of the posterior fossa cyst at the foramen magnum leading to syrinx formation with subsequent treatment and resolution. Spinal imaging may be useful in the evaluation of patients with DWM who do not experience expected improvement after shunt procedures.
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Affiliation(s)
- Erich O Richter
- Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA
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Sikorski CW, Curry DJ. Endoscopic, single-catheter treatment of Dandy-Walker syndrome hydrocephalus: technical case report and review of treatment options. Pediatr Neurosurg 2005; 41:264-8. [PMID: 16195680 DOI: 10.1159/000087486] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 04/10/2005] [Indexed: 12/11/2022]
Abstract
Optimal treatment for hydrocephalus related to Dandy-Walker syndrome (DWS) remains elusive. Patients with DWS-related hydrocephalus often require combinations of shunting systems to effectively drain both the supratentorial ventricles and posterior fossa cyst. We describe an endoscopic technique, whereby a frontally placed, single-catheter shunting system effectively drained the supratentorial and infratentorial compartments. This reduces the complexity and potential risk associated with the combined shunting systems required by so many with DWS-related hydrocephalus.
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Affiliation(s)
- Christian W Sikorski
- University of Chicago Children's Hospital, Section of Pediatric Neurosurgery, Chicago, IL 60637, USA
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Spennato P, O'Brien DF, Fraher JP, Mallucci CL. Bilateral abducent and facial nerve palsies following fourth ventricle shunting: two case reports. Childs Nerv Syst 2005; 21:309-16. [PMID: 15666179 DOI: 10.1007/s00381-004-1046-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Indexed: 10/25/2022]
Abstract
CASE REPORTS Treatment of isolated fourth ventricle syndrome is difficult and there is no widely agreed method. Fourth ventriculo-peritoneal shunting is the most commonly utilized procedure for the management of this syndrome. Complications from shunting are common and are usually related to malfunction, infection, dislocation and overdrainage. We present two unusual cases in which both patients developed bilateral abducens and facial nerve palsies following shunting of an isolated fourth ventricle. Magnetic resonance imaging (MRI) in both cases revealed collapse of the fourth ventricles with downward displacement of the brain stem. In the first case the trans-tentorial pressure difference was equilibrated with the aid of a "Y" connector between the supratentorial and infratentorial shunts, with full recovery of the neurological deficits; in the second case this approach failed and following a complicated neurosurgical course successful endoscopic aqueductal stenting was performed. DISCUSSION Pathogenesis of cranial nerve palsies following fourth ventricle shunting and the rationale of treatment are discussed and the literature is reviewed.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosurgery, Second University Hospital of Naples, Italy
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Mohanty A. Endoscopic third ventriculostomy with cystoventricular stent placement in the management of dandy-walker malformation: technical case report of three patients. Neurosurgery 2004; 53:1223-8; discussion 1228-9. [PMID: 14580292 DOI: 10.1227/01.neu.0000088810.75724.0e] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Accepted: 06/23/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Dandy-Walker malformation has conventionally been managed with placement of cystoperitoneal or ventriculoperitoneal shunts. However, associated aqueductal obstruction requires simultaneous drainage of both the supratentorial and infratentorial compartments. CLINICAL PRESENTATION Three children with Dandy-Walker malformation and aqueductal obstruction were managed with endoscopic third ventriculostomy and placement of a stent from the third ventricle to the posterior fossa cyst. INTERVENTION After an endoscopic third ventriculostomy was performed, the stent was placed from the third ventricle to the posterior fossa cyst through the thinnest part of the posteroinferior wall of the aqueduct. There was no operative morbidity. In one patient, the stent was malpositioned, requiring a repositioning. The endoscopic third ventriculostomy was successful in two patients, whereas it failed in one, requiring a ventriculoperitoneal shunt placement. CONCLUSION Cystoventricular stent placement with endoscopic third ventriculostomy is a promising alternative in patients with Dandy-Walker malformation with aqueductal obstruction.
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Affiliation(s)
- Aaron Mohanty
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Coakley FV, Glenn OA, Qayyum A, Barkovich AJ, Goldstein R, Filly RA. Fetal MRI:A Developing Technique for the Developing Patient. AJR Am J Roentgenol 2004; 182:243-52. [PMID: 14684546 DOI: 10.2214/ajr.182.1.1820243] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Fergus V Coakley
- Department of Radiology, University of California San Francisco, 505 Parnassus Ave., San Francisco, CA 94143-0628, USA
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Boddaert N, Klein O, Ferguson N, Sonigo P, Parisot D, Hertz-Pannier L, Baraton J, Emond S, Simon I, Chigot V, Schmit P, Pierre-Kahn A, Brunelle F. Intellectual prognosis of the Dandy-Walker malformation in children: the importance of vermian lobulation. Neuroradiology 2003; 45:320-4. [PMID: 12682795 DOI: 10.1007/s00234-003-0980-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2002] [Accepted: 01/21/2003] [Indexed: 10/20/2022]
Abstract
Half of patients with the Dandy-Walker malformation (DWM) have normal intellectual development. We aimed to identify feature on MRI associated with good intellectual prognosis. We reviewed 20 patients with DWM diagnosed on MRI, mean age 14.6+/-9.9 years. We assessed their intellectual development and related it to the MRI features. We found two groups with a statistically different intellectual outcome. All 14 patients with normal intellectual development had a normal lobulation of the vermis, without supratentorial anomalies. Of the six patients with mental retardation, three had an abnormal vermis, together with dysgenesis of the corpus callosum. In the other three, there were normal vermian anatomy with associated anomalies. Normal lobulation of the vermis, in the absence of any supratentorial anomaly, appears to be a good prognostic factor in DWM. Preservation of cerebrocerebellar pathways and neonatal plasticity could explain the normal intellectual development. These findings might be useful in prenatal diagnosis.
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Affiliation(s)
- N Boddaert
- Paediatric Radiology Department, Hopital Necker Enfants-Malades, 149 rue de Sèvres, 75015 Paris, France.
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Affiliation(s)
- A G Kulkarni
- Department of Medicine, Krishna Institute of Medical Science, Maharashtra State, India
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Liu JC, Ciacci JD, George TM. Brainstem tethering in Dandy-Walker syndrome: a complication of cystoperitoneal shunting. Case report. J Neurosurg 1995; 83:1072-4. [PMID: 7490623 DOI: 10.3171/jns.1995.83.6.1072] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Treatment of the Dandy-Walker syndrome has included placement of a ventriculoperitoneal shunt alone or in combination with a posterior fossa cystoperitoneal shunt. Complications in shunting are common and are usually related to malfunction or infection. The authors present a case in which the patient developed headaches and focal cranial nerve deficits following infection caused by a cystoperitoneal shunt. Magnetic resonance imaging showed tethering of the brainstem. A posterior fossa craniotomy with microsurgical untethering and cyst fenestration achieved two goals: improvement of the focal cranial nerve deficits and elimination of the cystoperitoneal shunt.
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Affiliation(s)
- J C Liu
- Division of Pediatric Neurosurgery, Children's Memorial Hospital, Chicago, Illinois, USA
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Engelhard HH, Meyer JR. Adult-onset presentation of Dandy-Walker variant in siblings. SURGICAL NEUROLOGY 1995; 44:43-7. [PMID: 7482253 DOI: 10.1016/0090-3019(95)00127-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Dandy-Walker syndrome and Dandy-Walker variant usually present as isolated cases of hydrocephalus in pediatric patients. METHODS AND RESULTS THis paper consists of a case report of the adult onset of symptoms in two sisters having Dandy-Walker variant. Such an occurrence has never before been reported in the medical literature. Both patients presented with headaches and progressive neurologic deficit. On computed tomography (CT scan) of the head, both were found to have hydrocephalus, with hypoplasia of the inferior vermis. Both patients were treated successfully with ventriculoperitoneal shunting. A third sister, with a similar history, elected not to undergo CT scanning or surgical treatment. CONCLUSIONS Variants of the Dandy-Walker syndrome may occasionally present clinically in the adult age group. Such an occurrence in siblings is consistent with an underlying genetic etiology.
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Affiliation(s)
- H H Engelhard
- Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA
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