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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2020; 9(03): 219-224
DOI: 10.1055/s-0040-1710104
Techniques in Neurosurgery

Fourth Ventricular Outflow Obstruction in an Infant with Ileal Atresia and Laryngomalacia: Endoscopic Management

Forhad H. Chowdhury
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Mohammod Raziul Haque
2   Department of Neurosurgery, Dhaka Medical College Hospital, Dhaka, Bangladesh
,
Jalal Uddin Mohammod Rumi
1   Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
,
Mohammod Samsul Arifin
3   Department of Neurosurgery, Ibn Sina Specialized Hospital, Dhanmondi, Dhaka, Bangladesh
› Author Affiliations Funding None.
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Abstract

Fourth ventricle outflow obstruction (FVOO) is a rare cause of obstructive hydrocephalus. In this study, we described a case of idiopathic FVOO with ileal atresia and laryngomalacia which was managed with endoscopic third ventriculostomy (ETV) and re-endoscopy. We also described the techniques of fenestration of Liliequist membrane and partial removal of arachnoid membrane over dorsum sella (DS) to prevent closure of fenestration and recurrence of hydrocephalus. The patient was a 4-month-old infant presented with progressively increasing head size, feeding difficulty, respiratory distress, and tense fontanel. The infant had a history of laparotomy for ileal atresia. CT scan showed panventriculomegaly due to FVOO. ETV with fenestration of Liliequist membrane was done on emergency basis. After operation, the patient improved clinically and radiologically. Four weeks later, the patient returned with recurrent hydrocephalus. Endoscopic reoperation showed closure of fenestration in arachnoid membrane (Lilieqiest membrane). Endoscopic refenestration with partial excision of arachnoid on DS was done. The patient again recovered radiologically and clinically till last follow-up. In idiopathic FVOO, ETV with wide fenestration of Liliequist membrane, preferably with partial removal of arachnoid on DS, may be very useful in treating hydrocephalus (HCP) and preventing recurrent HCP even in infants.

Keywords

hydrocephalus - fourth ventricle outflow obstruction - endoscopic third ventriculostomy - re-endoscopic procedure


Publication History

Article published online:
12 June 2020

© 2020. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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