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Child's Nervous System
Published in: Child's Nervous System 7/2005

01-07-2005 | Case Report

Treatment of refractory intracranial hypertension in a spina bifida patient by a concurrent ventricular and cisterna magna-to-peritoneal shunt

Authors: Trimurti D. Nadkarni, Harold L. Rekate

Published in: Child's Nervous System | Issue 7/2005

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Abstract

Case report

A 20-year-old female born with a thoracic level myelomeningocele, Chiari II malformation, and hydrocephalus treated at birth developed clinical features of increased intracranial pressure (ICP) due to shunt malfunction. The patient became comatose. Her ICP remained high despite a functioning shunt and even after the ventricular catheter was exteriorized. Diagnostic imaging consistently demonstrated slit-like ventricles, a Chiari II malformation, and a tethered spinal cord. We attributed her neurological condition either to brainstem compression or increased ICP related to venous outlet obstruction at the foramen magnum.

Outcome

The patient improved rapidly after undergoing a Chiari II decompression and placement of a shunt from the cisterna magna and upper cervical subarachnoid space to the peritoneum connected by a “Y” connector to the ventricular catheter.

Conclusion

The complex hydrocephalus was effectively treated by this concurrent ventricular and cisterna magna-to-peritoneum shunt.
Literature
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Karahalios DG, Rekate HL, Khayata MH, Apostolides PJ (1996) Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198–202PubMed
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Rekate HL (2000) Pathophysiology and management of hydrocephalus in spina bifida. In: Sarwark JF, Lubicky JP (eds) Caring for the child with spina bifida. American Academy of Orthopaedic Surgeons, Rosemont, pp 395–407
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Metadata
Title
Treatment of refractory intracranial hypertension in a spina bifida patient by a concurrent ventricular and cisterna magna-to-peritoneal shunt
Authors
Trimurti D. Nadkarni
Harold L. Rekate
Publication date
01-07-2005
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 7/2005
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-004-1057-5

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