Skip to main content

Advertisement

SpringerLink
Log in

Radiologic and clinical outcome of isolated fourth ventricle following post-hemorrhagic hydrocephalus in children

  • Original Article
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Few studies report radiologic and clinical outcome of post-hemorrhagic isolated fourth ventricle (IFV) with focus on surgical versus conservative management in neonates and children. Our aim is to investigate differences in radiological and clinical findings of IFV between patients who had surgical intervention versus patients who were treated conservatively.

Methods

A retrospective analysis of patients diagnosed with IFV was performed. Data included demographics, clinical exam findings, surgical history, and imaging findings (dilated FV extent, supratentorial ventricle dilation, brainstem and cerebellar deformity, tectal plate elevation, basal cistern and cerebellar hemisphere effacement, posterior fossa upward/downward herniation).

Results

Sixty-four (30 females) patients were included. Prematurity was 94% with 90% being < 28 weeks of gestation. Mean age at first ventricular shunt was 3.6 (range 1–19); at diagnosis of IFV, post-lateral ventricular shunting was 26.2 (1–173) months. Conservatively treated patients were 87.5% versus 12.5% treated with FV shunt/endoscopic fenestration. Severe FV dilation (41%), severe deformity of brainstem (39%) and cerebellum (47%) were noted at initial diagnosis and stable findings (34%, 47%, and 52%, respectively) were seen at last follow-up imaging. FV dilation (p = 0.0001) and upward herniation (p = 0.01) showed significant differences between surgery versus conservative management. No other radiologic or clinical outcome parameters were different between two groups.

Conclusion

Only radiologic outcome results showed stable or normal FV dilation and stable or decreased upward herniation in the surgically treated group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ali K, Nannapaneni R, Hamandi K (2013) The isolated fourth ventricle. BMJ Case Rep 2013:bcr2013008791. https://doi.org/10.1136/bcr-2013-008791

  2. Dandy WE (1921) The diagnosis and treatment of hydrocephalus due to occlusion of the foramina of Magendie and Luschka. Surge Gynecol Obstet 32:112–124

    Google Scholar 

  3. Harter DH (2004) Management strategies for treatment of the trapped fourth ventricle. Childs Nerv Syst 20(10):710–716. https://doi.org/10.1007/s00381-004-1004-5

  4. Hawkins JC 3rd, Hoffman HJ, Humphreys RP (1978) Isolated fourth ventricle as a complication of ventricular shunting. Report of three cases. J Neurosurg 49(6):910–913. https://doi.org/10.3171/jns.1978.49.6.0910

  5. Ang BT, Steinbok P, Cochrane DD (2006) Etiological differences between the isolated lateral ventricle and the isolated fourth ventricle. Childs Nerv Syst. 22(9):1080–1085. https://doi.org/10.1007/s00381-006-0046-2

  6. Pomeraniec IJ, Ksendzovsky A, Ellis S, Roberts SE, Jane JA Jr (2016) Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus. J Neurosurg Pediatr 17(5):552–557. https://doi.org/10.3171/2015.10.PEDS15398

  7. El Damaty A, Eltanahy A, Unterberg A, Baechli H (2020) Trapped fourth ventricle: a rare complication in children after supratentorial CSF shunting. Childs Nerv Syst 36(12):2961–2969. https://doi.org/10.1007/s00381-020-04656-w

  8. Schulz M, Goelz L, Spors B, Haberl H, Thomale UW (2012) Endoscopic treatment of isolated fourth ventricle: clinical and radiological outcome. Neurosurgery 70(4):847–859. https://doi.org/10.1227/NEU.0b013e318236717f

  9. Ogiwara H, Morota N (2013) Endoscopic transaqueductal or interventricular stent placement for the treatment of isolated fourth ventricle and pre-isolated fourth ventricle. Childs Nerv Syst 29(8):1299–1303. https://doi.org/10.1007/s00381-013-2112-x

  10. Mohanty A, Manwaring K (2018) Isolated fourth ventricle: to shunt or stent. Oper Neurosurg (Hagerstown) 14(5):483–493. https://doi.org/10.1093/ons/opx136

  11. Furtado LMF, da Costa Val Filho JA, Giannetti AV (20221) Proposed radiological score for the evaluation of isolated fourth ventricle treated by endoscopic aqueductoplasty. Childs Nerv Syst 37(4):1103–1111. https://doi.org/10.1007/s00381-020-04937-4

  12. Klebe D, McBride D, Krafft PR, Flores JJ, Tang J, Zhang JH (2020) Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: established mechanisms and proposed pathways. J Neurosci Res 98(1):105–120. https://doi.org/10.1002/jnr.24394

  13. Kochanek KD, Kirmeyer SE, Martin JA, Strobino DM, Guyer B (2020) Annual summary of vital statistics. Pediatrics 2012;129(2):338–348. https://doi.org/10.1542/peds.2011-3435

  14. Ballabh P (2014) Pathogenesis and prevention of intraventricular hemorrhage. Clin Perinatol 41(1):47–67. https://doi.org/10.1016/j.clp.2013.09.007

  15. Messerschmidt A, Brugger PC, Boltshauser E et al (2005) Disruption of cerebellar development: potential complication of extreme prematurity. AJNR Am J Neuroradiol 26(7):1659–1667

    PubMed  PubMed Central  Google Scholar 

  16. Udayakumaran S, Biyani N, Rosenbaum DP, Ben-Sira L, Constantini S, Beni-Adani L (2011) Posterior fossa craniotomy for trapped fourth ventricle in shunt-treated hydrocephalic children: long-term outcome. J Neurosurg Pediatr 7(1):52–63. https://doi.org/10.3171/2010.10.PEDS10139

  17. Raouf A, Zidan I (2013) Suboccipital endoscopic management of the entrapped fourth ventricle: technical note. Acta Neurochir (Wien). 2013;155(10):1957–1963. https://doi.org/10.1007/s00701-013-1843-5

  18. Teo C, Burson T, Misra S (1999) Endoscopic treatment of the trapped fourth ventricle. Neurosurgery 44(6):1257–1262

    CAS  PubMed  Google Scholar 

  19. Patel DM, Tubbs RS, Pate G, Johnston JM Jr, Blount JP (2014) Fast-sequence MRI studies for surveillance imaging in pediatric hydrocephalus. J Neurosurg Pediatr. 2014;13(4):440–447. https://doi.org/10.3171/2014.1.PEDS13447

  20. Tekes A, Senglaub SS, Ahn ES, Huisman TAGM, Jackson EM (2018) Ultrafast brain MRI can be used for indications beyond shunted hydrocephalus in pediatric patients. AJNR Am J Neuroradiol 39(8):1515–1518. https://doi.org/10.3174/ajnr.A5724

  21. Ramgopal S, Karim SA, Subramanian S, Furtado AD, Marin JR (2020) Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. BMC Pediatr 20(1):14. https://doi.org/10.1186/s12887-020-1919-3

  22. Tekes A, Jackson EM, Ogborn J et al (2016) How to reduce head CT orders in children with hydrocephalus using the Lean Six Sigma methodology: experience at a major quaternary care academic children’s center. AJNR Am J Neuroradiol. 37(6):990–996. https://doi.org/10.3174/ajnr.A4658

Download references

Acknowledgements

We would like to thank Haleh Sangi-Haghpeykar, PhD (Edward B. Singleton Department of Radiology and Department of Obstetrics and Gynecology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX), for the excellent and professional statistical support.

Author information

Authors and Affiliations

  1. Edward B. Singleton Department of Radiology, Fannin St, Texas Children’s Hospital, Baylor College of Medicine, Suite 470, Houston, TX, USA

    Rida Salman, Thierry A. G. M. Huisman, Stephen Kralik, Avner Meoded, Nilesh K. Desai & Gunes Orman

  2. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Samuel G. McClugage

  3. Department of Surgery, Division of Pediatric Neurosurgery, Texas Children’s Hospital, 6701 Fannin Street, Suite 1230.01, Houston, TX, 77030, USA

    Samuel G. McClugage

  4. Department of Pediatric Neurology, University Children’s Hospital Zürich, Zurich, Switzerland

    Eugen Boltshauser

Authors
  1. Rida Salman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thierry A. G. M. Huisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Kralik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Avner Meoded
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nilesh K. Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samuel G. McClugage
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eugen Boltshauser
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gunes Orman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by RS and GO. The first draft of the manuscript was written by RS. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gunes Orman.

Ethics declarations

Conflict of interest

The authors have no relevant financial or nonfinancial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Salman, R., Huisman, T.A.G.M., Kralik, S. et al. Radiologic and clinical outcome of isolated fourth ventricle following post-hemorrhagic hydrocephalus in children. Childs Nerv Syst 38, 977–984 (2022). https://doi.org/10.1007/s00381-022-05494-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-022-05494-8

Keywords

Search

Navigation