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Updated: May 28, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Management of Dandy-Walker complex-associated infant hydrocephalus by combined endoscopic third ventriculostomy and
Benjamin C Warf1, Michael Dewan, John Mugamba
1Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA. benjamin.warf@childrens.harvard.edu
Insights
Endoscopic third ventriculostomy with or without choroid plexus cauterization (ETV/CPC) offers a high success rate for treating hydrocephalus associated with Dandy-Walker complex (DWC). This endoscopic approach is a viable alternative to shunting, reducing shunt dependence in affected infants.
Area of Science:
- Pediatric Neurosurgery
- Congenital Neurological Disorders
- Hydrocephalus Management
Background:
- Dandy-Walker complex (DWC) encompasses a spectrum of congenital brain anomalies including Dandy-Walker malformation (DWM), Dandy-Walker variant (DWV), Blake pouch cyst, and mega cisterna magna (MCM).
- Hydrocephalus is a common complication of DWC, historically managed with shunting procedures, often leading to long-term shunt dependence.
- Endoscopic third ventriculostomy (ETV) has been infrequently reported for DWC-associated hydrocephalus.
Purpose of the Study:
- To evaluate the efficacy of ETV, particularly combined ETV and choroid plexus cauterization (ETV/CPC), as a primary treatment for hydrocephalus in infants with DWC.
- To report the largest series to date on ETV/CPC for DWC-associated hydrocephalus.
- To compare ETV/CPC outcomes across different subtypes of DWC.
Main Methods:
- Retrospective review of a clinical database from 2004-2010 at CURE Children's Hospital of Uganda.
- Identification of 45 pediatric patients diagnosed with DWC (DWM, DWV, MCM) and hydrocephalus, treated with ETV/CPC.
- Exclusion of three patients with alternative causes of hydrocephalus (post-infectious, post-hemorrhagic).
Main Results:
- The study included 45 patients, with a median age of 5 months at treatment; 88% were under 12 months.
- ETV/CPC achieved a 74% success rate (no further operations required) with a mean follow-up of 24.2 months.
- Success rates were 74% for DWM, 73% for DWV, and 100% for MCM, with 95% maintaining an open aqueduct and no need for posterior fossa shunting.
Conclusions:
- Endoscopic treatment, specifically ETV/CPC, should be strongly considered as the primary management for DWC-associated hydrocephalus.
- This endoscopic approach offers a successful alternative to traditional shunting, potentially avoiding shunt dependence.
- ETV/CPC demonstrates favorable outcomes across various DWC subtypes in young infants.
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.
