Ultrasound-guided puncture of a Dandy-Walker cyst via the lateral and III ventricles

Since the Dandy-Walker syndrome was first described by Dandy and Blackfan, Taggart and Walker, the many variants of posterior fossa anomalies, the app ropriate management of these malformations and the clinical outcome have be en the subjects of controversy. Surgery of the posterior fossa with membran e excision was initially the preferred method of treatment. Unfortunately, there was a high rate of complications, and many of the patients treated in this way still needed a shunting system. Ventricular-peritoneal and/or cys to-peritoneal shunting is commonly used to treat symptomatic posterior foss a cysts of Dandy-Walker malformations and hydrocephalus. Cysto-peritoneal s hunt implantation only was associated with a high rate of complications, an d most patients so treated needed a ventriculo-peritoneal shunt in addition . According to the literature, combined ventriculo-peritoneal and cysto-per itoneal shunting is needed for satisfactory decompression of Dandy-Walker c yst and hydrocephalus in between 16% and 92% of cases. We report on a young patient with a Dandy-Walk-er malformation who needed drainage of the poste rior fossa and a ventricular shunt. We decided to drain the cyst and the su pratentorial ventricles via a single, especially prepared, catheter with ma ny perforations. The catheter wets inserted under ultrasound guidance. The tube was inserted from the left lateral ventricle through the foramen of Mo nro into the III ventricle and downwards into the cyst. Intraoperatively, a n immediate decrease in the size of the cyst and the supratentorial ventric les was observed. Postoperative MRI confirmed the exact position of the cat heter and sufficient drainage of the posterior fossa cyst and the ventricle s. Six months later the girl was seen in our outpatient department. Clinica l examination showed no neurological deficit, and MRI demonstrated sufficie nt drainage of the ventricles and the Dandy-Walker malformation, and in add ition hypo plasia of the corpus callosum.