Endoscopic treatment of the trapped fourth ventricle

OBJECTIVE: To propose endoscopic treatment as an effective initial alternative for patients with a trapped fourth ventricle. METHODS: We reviewed the records of the last 16 consecutive patients with a symptomatic trapped fourth ventricle seen at the Arkansas Children's Hospital. The first eight patients underwent a shunt procedure; the next eight had endoscopic procedures. The shunt procedures consisted of either separate shunts or combined supra- and infratentorial shunts with shared distal catheters. The endoscopic procedures consisted of either fenestration into the lateral ventricle or aqueductal plasty with or without a stent. RESULTS: All patients underwent successful procedures with good outcomes, although the patients with shunts appeared to have a higher-than-expected rate of revision (50%). Seven revisions were performed on four patients, with a complication rate of 25%. Of the patients who had endoscopic procedures, one eventually required a shunt. The overall complication rate for patients who had endoscopic procedures was also 25%. CONCLUSION: Endoscopic treatment of the trapped fourth ventricle is effective in most cases. In view of the higher-than-expected revision rate with fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped fourth ventricle.