Endoscopic Management of a Fourth Ventricular Cyst

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Medical Imaging

Background:

• Congenital hydrocephalus requires timely intervention to manage cerebrospinal fluid buildup.
• Previous shunting procedures can sometimes lead to cyst formation or complications.
• Large cysts in the fourth ventricle can obstruct cerebrospinal fluid flow, causing increased intracranial pressure.

Observation:

• A 12-year-old male with a history of shunted congenital hydrocephalus presented with symptoms of increased intracranial pressure: headache, nausea, vomiting, and lethargy.
• Brain MRI revealed a large cyst in the superior recess of the fourth ventricle, extending towards the third ventricle via the cerebral aqueduct.

Findings:

• Endoscopic dual fenestration of the cyst was successfully performed via a posterior suboccipital approach through the foramen of Magendie.
• The procedure effectively relieved the patient's symptoms without any immediate or delayed complications.

Implications:

• Endoscopic fenestration offers a minimally invasive and effective treatment for large intraventricular cysts causing hydrocephalus.
• This approach provides a durable solution, as evidenced by the patient's 4-year symptom-free follow-up.
• Successful endoscopic management highlights its potential as an alternative to further shunting or more invasive surgeries in select pediatric cases.