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Trapped Fourth Ventricle: Pathophysiology, History and Treatment Strategies

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 46))

Abstract

Trapped fourth ventricle is a clinic-radiological entity characterised by progressive neurological symptoms due to enlargement and dilatation of fourth ventricle secondary to obstruction to its outflow. There are several causative mechanisms for the development of trapped fourth ventricle, including previous haemorrhage, infection or inflammatory processes. However, this condition is most commonly observed in ex preterm paediatric patients shunted for a post-haemorrhagic or post-infective hydrocephalus. Until the introduction of endoscopic aqueductoplasty and stent placement, treatment of trapped fourth ventricle was associated with high rates of reoperation and complications resulting in morbidity. With the advent of new endoscopic techniques, supratentorial and infratentorial approaches for aqueductoplasty and stent insertion have revolutionised the treatment of trapped fourth ventricle. Fourth ventricular fenestration and direct shunting remain viable options in cases where aqueduct anatomy and length of obstruction is not surgically favourable for endoscopic approaches. In this book chapter, we explore the background, historical developments,$ and surgical treatment strategies in the management of this challenging condition.

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Acknowledgements

We would like to thank Mr William B. Lo, MA (Cantab), FRCS (NeuroSurg) and FEBNS for his beautiful illustration of the Dandy’s aqueduct intubation shown in Fig. 11.1.

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  1. Department of Paediatric Neurosurgery, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK

    Pasquale Gallo & Fardad T. Afshari

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  1. Pasquale Gallo
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Correspondence to Pasquale Gallo .

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  1. International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

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Gallo, P., Afshari, F.T. (2023). Trapped Fourth Ventricle: Pathophysiology, History and Treatment Strategies. In: Di Rocco, C. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 46. Springer, Cham. https://doi.org/10.1007/978-3-031-28202-7_11

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