Date of Award

January 2012

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Dennis D. Spencer

Second Advisor

Angeliki Louvi

Subject Area(s)

Medicine, Neurosciences, Surgery

Abstract

NEUROENDOSCOPIC MANAGEMENT OF DANDY-WALKER COMPLEX-ASSOCIATED HYDROCEPHALUS.

Michael C. Dewan and Benjamin C. Warf. Department of Neurosurgery, Children's Hospital Boston and Harvard Medical School, Boston, MA. (Sponsored by Dennis D. Spencer, Department of Neurosurgery, Yale School of Medicine).

The Dandy-Walker complex (DWC) is variably associated with hydrocephalus, which can be surgically relieved via CSF diversion by means of a shunt or a third ventriculostomy. The purpose of this study is to evaluate the efficacy of combined endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) in the treatment of patients with hydrocephalus related to DWC.

A retrospective review of the clinical database of Cure Children's Hospital of Uganda identified 45 patients with DWC-associated hydrocephalus (25 with Dandy-Walker malformation [DWM], 17 with Dandy-Walker variant [DWV], and 3 with mega cisterna magna [MCM]), of which 42 were treated with ETV/CPC.

Seventy-four percent of patients were treated successfully with ETV/CPC (mean and median follow-up periods of 24.2 and 20 months, respectively). The median age at treatment was 5 months, and 88% were treated at 12 months or younger. The success rate was 74% for DWM, 73% for DWV, and 100% for MCM. An open aqueduct was observed in 95% of patients, and none required posterior fossa shunting.

The results of this study suggest that endoscopic management, rather than shunt diversion, should be strongly considered as the primary treatment modality for DWC-associated hydrocephalus.

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