RESUMO
INTRODUCTION: We report a patient who suffered from brainstem injury following ventriculoperitoneal (VP) shunt placement in the fourth ventricle. DISCUSSION: A 20-year-old man with complex hydrocephalus and trapped fourth ventricle underwent a suboccipital placement of a VP shunt. Postprocedure patient developed double vision. Magnetic resonance imaging showed that the catheter was penetrating the dorsal brainstem at the level of the pontomedullary junction. Patient was referred to our Neuroendoscopic Clinic. Physical exam demonstrated pure right VI cranial nerve palsy. Patient underwent flexible endoscopic exploration of the ventricular system. Some of the endoscopic findings were severe aqueductal stenosis and brainstem injury from the catheter. Aqueductoplasty, transaqueductal approach into the fourth ventricle, and endoscopic repositioning of the catheter were some of the procedures performed. Patient recovered full neurological function. The combination of endoscopic exploration and shunt is a good alternative for patients with complex hydrocephalus. A transaqueductal approach to the fourth ventricle with flexible scope is an alternative for fourth ventricle pathology.
Assuntos
Tronco Encefálico/lesões , Doenças dos Nervos Cranianos/etiologia , Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Neuroendoscopia , Derivação Ventriculoperitoneal/efeitos adversos , Tronco Encefálico/patologia , Tronco Encefálico/cirurgia , Doenças dos Nervos Cranianos/complicações , Diplopia/etiologia , Diplopia/patologia , Quarto Ventrículo/patologia , Humanos , Hidrocefalia/patologia , Imageamento por Ressonância Magnética , Masculino , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos , Adulto JovemRESUMO
Shunt placement was the most common procedure used for ventricular dilatation, but in many neurosurgical centers it has been substituted by flexible neuroendoscope; however, none of them had solved the problem of the trapped and dilated fourth ventricle. The combination of the ventricle-peritoneal catheter placement in the center of the fourth ventricle by direct visualization with a flexible neuroendoscope using a single coronal burr-hole has solved this problem. Eleven patients with a trapped fourth ventricle, with previous third ventriculostomy and aqueductal plasty, were treated with this procedure; all patients were evaluated clinically and with computed tomography 8 to 24 months (mean, 18 months) later. Here, we describe the technical procedure.