She recovered well from the surgery and did not experience any post-operative complications. Case report. Pribil S, Boone SC, Waley R. Obstructive hydrocephalus at the anterior third ventricle caused by dilated veins from an arteriovenous malformation. Unfortunately, understanding of the natural history is presently insufficient to definitively provide an exact prognosis or offer fetal therapy. .speech-bubble { Classic X-linked recessive hydrocephalus (Bickers-Adam syndrome) accounts for approximately 7 percent of male hydrocephalus. Common presenting complaints in patients, Common presenting complaints in patients with hydrocephalus due to aqueductal stenosis in a, Neurosurgical interventions including Endoscopic third, Neurosurgical interventions including Endoscopic third ventriculostomy (ETV) and Ventriculoperitoneal (VP) shunting carried out, Kafarnosky score of patients aged > 12 years who were diagnosed with hydrocephalus due, MeSH right:10px; Hydrocephalus is a condition in which cerebrospinal fluid (CSF) abnormally accumulates in the brain. Neurosurg Rev. Currently, endoscopic ventriculostomy (ETV) is recommended as treatment of choice. Bisht A, Suri A, Bansal S, Chandra PS, Kumar R, Singh M, Sharma BS. Results: display: block; 2013 Feb;79(2 Suppl):S21.e13-20. Watch this video tour to learn what to expect at your first visit to the Wood Center for Fetal Diagnosis and Treatment. Federal government websites often end in .gov or .mil. An official website of the United States government. Eighty patients (median age 12.0 years, range 0-79 years) have been treated for MRI-proven aqueductal stenosis. Associated conditions were bilateral congenital talipes equinovarus, spina bifida, Arnold Chairi malformations, meningitis and HIV. 2014 Sep;21(9):1483-9. doi: 10.1016/j.jocn.2013.12.033. border-bottom: 0; Bethesda, MD 20894, Web Policies In a descriptive cross-sectional study, 258 records of patients diagnosed with hydrocephalus were analyzed after ethical approval from Kenyatta National Hospital- University of Nairobi (KNH-UON) ethics and research committee from January 2010 to May 2016. The presenting complaints differed according to the age groups. Aqueductal stenosis is a narrowing of the aqueduct of Sylvius which blocks the flow of cerebrospinal fluid (CSF) in the ventricular system.Blockage of the aqueduct can lead to hydrocephalus, specifically as a common cause of congenital and/or obstructive hydrocephalus.. The first report of aqueductal stenosis in NF-1 was made by Pennybacker in 1940. Aqueductal stenosis is the most common cause of congenital obstructive hydrocephalus, but can also be seen in adults as an acquired abnormality. Data were divided into 2 sets based on the patient's age i.e. Whitehead WE, Jea A, Vachhrajani S, Kulkarni AV, Drake JM. We treated the patient with a ventriculoperitoneal shunt. In these cases, such as hydrancephaly and holoprosencephaly, the ventricles are not only relatively enlarged but also often distorted due to overlying parenchymal abnormalities. Hydrocephalus due to congenital stenosis of aqueduct of sylvius (HSAS) is a form of L1 syndrome, which is an inherited disorder that primarily affects the nervous system. MeSH Bethesda, MD 20894, Web Policies Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults. Careers. Our case is the first in which aqueductal stenosis caused by a developmental venous anomaly presents as congenital hydrocephalus. Traditionally, fetal hydrocephalus has been detected prenatally using sonographic measurements of the enlarged ventricles. This condition is called hydrocephalus. Hydrocephalus caused by aqueductal stenosis (AS) is a poorly characterized subtype of hydrocephalus. DVAs are usually benign lesions and considered normal variants that drain healthy brain tissue and do not need treatment because there is no risk of rupture and bleeding. Even after re-reviewing the MRI of the brain with contrast with our neuroradiologist, we found that the DVA was intraventricular (inside the posterior third ventricle) in the region of the aqueduct rather than the quadrigeminal cistern. Dandy Walker: 29%, Neonatal Hydrocephalus Four types of AQS have been defined with distinct age ranges and symptomatology: congenital type I (n = 24), chronic progressive (tectal tumor-like) type II (n = 23), acute type III (n = 10), and adult chronic (normal-pressure hydrocephalus-like) type IV (n = 23). position: relative; Ventricular shunting involves placement of a thin tube into the ventricles of the brain to drain fluid and relieve hydrocephalus. The site is secure. Although most cases of AS-induced hydrocephalus occur during childhood, rare cases have been observed in adulthood and are classified as an adult chronic subtype. Croat Med J. At 37 weeks, the maternal abdominal girth exceeded the expected range, and a second ultrasound revealed interval development of congenital hydrocephalus (Figure (Figure1).1). 26.9). Only 10 cases have been reported (Table (Table1)1) in our review of the literature. The stenosis results in a buildup of cerebrospinal fluid and a dangerous increase in intracranial pressure, which manifests itself in neurological disorders. Blockage at the aqueduct is assumed when the lateral and third ventricles are enlarged proximal to the . Giannetti AV, Rodrigues RB, Trivelato FP. Accurate diagnosis and treatment remain a cardinal to improving patient outcome. Keywords: Timmons, G.D.; Johnson, K.P., 1970: Aqueductal stenosis and hydrocephalus after mumps encephalitis In this study, we review the literature and report the first case of congenital hydrocephalus associated with aqueductal stenosis from a developmental venous anomaly. border: 12.5px solid transparent; Her pupils were equal and reactive to light; she had normal muscle tone and was moving all extremities symmetrically. These risks diminish as gestation progresses to term. Within the ventricles, the choroids plexus produces cerebral spinal fluid (CSF) starting at the sixth week of gestation. 2010 Oct;6(4):310-5 Bethesda, MD 20894, Web Policies The Kafanosky score improve from < 50 pre-op to 19 cases achieving a score of 100, six months post-op. Epub 2012 Feb 10. whether < 1 year or > 12 years. Several authors have addressed the issue of variable ETV success rates depending on age and pathogenetic factors. In some patients VP shunt was placed before ETV was done, Kafarnosky score of patients aged > 12 years who were diagnosed with hydrocephalus due to aqueductal stenosis. Obstruction by a vascular malformation at the aqueduct is a very rare cause [2,4-7], and aqueductal stenosis attributable to a developmental venous anomaly (DVA) is perhaps the most uncommon [8]. Giordano F, Spacca B, Danti A, Taverna M, Losi S, Stagi S, Genitori L. Pediatr Neurosurg. Traditionally, hydrocephalus is detected and treated after birth with a shunting procedure. Sato S, Sonoda Y, Kuroki R, Kayama T. [A rare case of aqueductal stenosis due to venous angioma]. There is no apparent risk to the mother or fetus from the radiofrequency pulses or the magnetic field. Ventricular shunting involves placement of a thin tube into the ventricles of the brain to drain fluid and relieve hydrocephalus. Disease: Hydrocephalus due to congenital stenosis of aqueduct of sylvius A very rare disorder where there is a buildup of cerebrospinal fluid inside the skull due to a narrow canal that connects the third and fourth ventricles of the brain. Retrospective analysis of neurological and radiological . It is defined by hypoplasia of the cerebellar vermis, cystic dilatation of fourth ventricle and hydrocephalus. Treatment of aqueductal stenosis (AQS) has undergone several paradigm shifts during the past decades. This does not deny the possibility of ongoing, irreversible damage in stable hydrocephalus, but recognizes that at present, there is no data to mandate preterm intervention. Out of 258 cases of hydrocephalus, 52 had aqueductal stenosis. doi: 10.1016/j.wneu.2012.02.007. } Introduction: The most useful measurement is the transverse atrial width, which is normally between 4-8 mm with a normal upper limit of 10 mm. It is related to etiology or cause and in all cases, outcomes appear to be less favorable when compared to neonatal counterparts: Fetal Hydrocephalus USA. National Library of Medicine Epub 2012 Feb 10. Epub 2016 Apr 11. 2018 Aug;55(8):6227-6236. doi: 10.1007/s12035-017-0835-5. Keywords: AQS can be divided into four distinct age groups and types in regards of clinical course and symptomatology. Aqueductal stenosis (AS) includes a large variety of etiologies: posthemorrhagic or postmeningitic obstruction, compression of the aqueduct, or presence of a third ventricle mass. Elevated Surfactant Protein Levels and Increased Flow of Cerebrospinal Fluid in Cranial Magnetic Resonance Imaging. The first case resembled late-onset idiopathic aqueductal stenosis on serial imaging. J Neurosurg Pediatr. For patients diagnosed with hydrocephalus before the legal limit of abortion, there is an urgency to complete the work-up to allow for informed parental decision-making. Morbidity and mortality data related to prematurity argue against delivery and shunting before 32 weeks. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Patients with hydrocephalus from aqueductal stenosis from venous lesions (modified from Giannetti. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. Radiological response was measured as Evan's index in follow-up MRI. Conclusion: Prenatal factors such as progression, degree of cortical mantle thinning to less than 1.5 cm and in utero duration of greater than four weeks are associated with a poor prognosis. 1962 Aug;37:345-62 In evaluating hydrocephalus, maternal gestational history is reviewed for previous outcomes, early drug exposures and unexpected illnesses. Endoscopic re-opening of third ventriculostomy: Case series and review of literature. A thorough understanding of the natural history of fetal hydrocephalus should form the basis for rational treatment and parental counseling. Depending on the AQS type, ETV cannot be unequivocally recommended. There were 25 cases < 1year and 27 cases > 12 years old who were diagnosed with hydrocephalus due to aqueductal stenosis. The obstruction may be caused by a tumor, congenital etiology, or post-inflammatory gliotic atresia, among other conditions [1-3]. Before Bookshelf Aqueductal stenosis: This is the most common cause of congenital hydrocephalus.It involves the narrowing or blockage of an area of the brain known as the Cerebral Aqueduct (Aqueduct of Sylvius) - a narrow tube between the third and fourth ventricles in the brain (see picture below). In our case and a recent report of two other cases, an MRI based on a gadolinium-enhanced T1-weighted sequence revealed the aqueductal obstruction and its causes [8]. width: 0; The most common form of isolated, obstructive hydrocephalus is so-called "aqueductal stenosis," which is the blockage of CSF passage through the aqueduct of Sylvius. The posterior fossa is distorted due to a congenital Chiari malformation and . Aqueduct stenosis is more commonly due to acquired disorders, for example, viral infections that affect both sexes. In Table 1, patients were divided into 3 age groups. transform: rotate(90deg) skew(-25deg) translateY(16.6666666667px); The https:// ensures that you are connecting to the 2016 Oct;18(4):423-429. doi: 10.3171/2016.4.PEDS163. Federal government websites often end in .gov or .mil. In our opinion, what makes our case unusual and worthy of publication is that our patient would be the youngest reported case in the literature with hydrocephalus occurring in the perinatal period from DVA. Pediatr Neurosurg. Congenital type I AQS may have a better neurological outcome with VP-shunt whereas acute type III offers excellent ETV results. In its most severe form, the syndrome is often associated with other CNS, cardiac, genitourinary, ocular and facial anomalies and is often accompanied by intellectual disabilities. The authors would like to recognize Lily Chun for her editorial assistance in the production of this manuscript. In brief, we chose to treat our patient with a VPS because of ETV's high rate of failure in the infant age group [20]. Fetal hydrocephalus is also commonly associated with congenital malformation syndromes. Aqueductal stenosis; Kenya; hydrocephalus. the display of certain parts of an article in other eReaders. .speech-bubble p a { Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. Oka K, Kumate S, Kibe M, Tomonaga M, Maehara F, Higashi Y. Aqueductal stenosis due to mesencephalic venous malformation: case report. A PS Medical low-pressure valve and distal catheter was then tunneled and passed in a typical fashion. Clinical presentation differs according to patients age. Aqueductal stenosis caused by a vein or DVA is extremely rare [3-5,10,15-17]. Epidemiology Congenital aqueductal stenosis has an estimated incidence of ~1:5000 births although . This typically causes increased pressure inside the skull.Older people. 0-30 points: 0.0 . Accessibility However, aqueductal stenosis caused by a developmental venous anomaly presenting as congenital hydrocephalus is even more rare, and, to the best of our knowledge, has not yet been reported in . A small group of fetuses will undergo rapidly progressive ventricular enlargement. The .gov means its official. Hydrocephalus can have a genetic basis. The sylvian aqueduct is the most common site of intraventricular blockage of the cerebro-spinal fluid. Pande A, Lamba N, Mammi M, Gebrehiwet P, Trenary A, Doucette J, Papatheodorou S, Bunevicius A, Smith TR, Mekary RA. Please enable it to take advantage of the complete set of features! Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients. Chiari II: 70% The brain can accommodate ventricular dilatation to a certain extent without significant neuronal damage. ETV should be considered in older children with this pathology or later shunt malfunction in this population. From the moment of referral through delivery and postnatal care, your family can expect a supportive experience when you come to us with a diagnosis of a birth defect. The finding of fetal ventriculomegaly requires a prompt, thorough evaluation that begins with a concerted effort to rule out additional anomalies. The authors declare no competing interest. Initial signs and symptoms, type of surgery, and complications were analyzed. 2016;51(1):35-41. doi: 10.1159/000441254. Aqueductal stenosis contributes a significant burden of morbidity in patients with hydrocephalus. #cookieblock__banner { 13). Blackmore CC, Mamourian AC. A cesarean section is performed at the discretion of the obstetrician when head size precludes vaginal delivery. Thank you for visiting the new GARD website. A discussion of the pros and cons of endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal shunt (VPS) to address hydrocephalus is beyond the scope of this report. Causes of Congenital Hydrocephalus. DP and SH were major contributors in writing and editing the manuscript. The functionality is limited to basic scrolling. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Clin Neurosci. Spennato P, Tazi S, Bekaert O, Cinalli G, Decq P. World Neurosurg. Before Normal cerebrospinal fluid dynamics require an open aqueduct so that fluid can flow freely . However, success rates have usually been defined as "ETV non-failure." Xanthochromic CSF was visualized from the ventricular catheter corroborating old blood that was identified on the preoperative MRI. Clinical aspects, neuroradiological appearance, and treatment of hydrocephalus secondary to . The ePub format uses eBook readers, which have several "ease of reading" features While this does not necessarily foretell a devastating outcome, it does appear to be a significant adverse predictor and consideration should be given for early delivery and early shunting. Aqueductal stenosis is one of the known causes of hydrocephalus and the most common cause of congenital (present at birth) hydrocephalus. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. Therefore, primary treatment should be targeted towards addressing hydrocephalus, if the DVAs are symptomatic. -, Zentralbl Neurochir. The cause of hydrocephalus varies depending on the type. Midbrain venous angioma with obstructive hydrocephalus. Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles. Acquired hydrocephalus can result from any lesion that obstructs the CSF pathway (see Fig. border-radius:12px; The aqueduct of Sylvius is the channel which connects the third ventricle to the fourth ventricle and is the narrowest part . The cerebral aqueduct (of Sylvius) is a narrow channel that connects two of the ventricles (fluid-filled chambers within the brain) and passes through the midbrain. Epub 2018 Feb 2. Would you like email updates of new search results? 23 However, the reports gradually increased in the era of modern imaging, but most were case reports. You may notice problems with T2-weighted images did not demonstrate any abnormal signal flow voids. liveagent.init('https://d.la3-c1-ph2.salesforceliveagent.com/chat', '5723Z00000000EH', '00Dj0000001omsQ'); 2016 May;124(5):1413-20. doi: 10.3171/2015.4.JNS15129. For additional information, or to request that your IP address be unblocked, please send an email to PMC. Aqueductal stenosis is one of the known causes of hydrocephalus and the most common cause of congenital (present at birth) hydrocephalus. . Headache was the most common presenting symptom. We did not initially suspect a venous anomaly as a possible cause for hydrocephalus, so we did not order an MRA or MRV upfront. acute type III (n = 10), and adult chronic (normal-pressure hydrocephalus-like) type IV (n = 23). } To our knowledge literature is very scarce, wherein SWI is . MR evaluation of developmental venous anomalies: medullary venous anatomy of venous angiomas. Her head circumference was 35.5 cm, which correlated to the 50th percentile. The role of mesencephalic aqueduct obstruction in hydrocephalus development: a case report. A form of L1 syndrome caused by changes in the L1CAM gene characterized by severe hydrocephalus mostly with prenatal onset, signs of intracranial hypertension, adducted thumbs, spasticity, and severe intellectual deficit. The highest incidence of late onset aqueductal stenosis was in the age group between (41-60) (44%) followed by the age group between (5-20) (36%), while the age group which showed least . Skalick P, Mldek A, Vlask A, De Lacy P, Bene V, Brad O. Neurosurg Rev. 2021 Jun;44(3):1227-1241. doi: 10.1007/s10143-020-01320-4. She opened her eyes spontaneously and cried to stimulation. -, Pediatr Neurosurg. But ultrasound evaluations alone can miss important anomalies, which will affect the outcome. As the process continues, however, irreversible brain damage inevitably occurs. David Paulson, Steven W Hwang, [], and Andrew Jea. It is important to distinguish hydrocephalus from ventricular enlargement or ventriculomegaly, which can also be caused by brain destruction and morphological maldevelopment. A number of congenital and acquired factors are known to cause aqueductal stenosis and subsequent obstructive hydrocephalus [1-3]. Spennato P, Tazi S, Bekaert O, Cinalli G, Decq P. World Neurosurg. Please enable it to take advantage of the complete set of features! Accessibility We did not feel that more invasive investigation with cerebral angiography and all its attendant risks was warranted in this case. . 2016 Jun;145:58-63. doi: 10.1016/j.clineuro.2016.04.007. Types of hydrocephalus. However, aqueductal stenosis caused by a developmental venous anomaly presenting as congenital hydrocephalus is even more rare, and, to the best of our knowledge, has not yet been reported in the literature. Currently, endoscopic ventriculostomy (ETV) is recommended as treatment of choice. A cesarean section is preferred, followed by immediate shunt insertion to eliminate vaginal and ICU flora exposure and colonization. Chronic type IV (iNPH-like) patients (age > 21) responded neurologically in 70 % after ETV and VPS, but radiological response was low (5 %). PMC A few cases in males are due to an X-linked disorder that results in aqueduct stenosis. Chiari II: 66% Accordingly, aqueductal stenosis (AS) is one of the leading causes of hydrocephalus, though the etiological relationship between AS and hydrocephalus is still far to be clear since AS may also ensue the hydrocephalus. The scope of this paper is to highlight the disease burden of hydrocephalus attributed to aqueductal stenosis which still remains unknown in our setting. Careers. The condition is characterized by aqueductal stenosis, severe intellectual disabilities and in half of the affected children, an adduction thumb deformity. whether < 1 year or > 12 years. and transmitted securely. Brugieres P, Combes C, el-Khoury C, Decq P, Heine P, Meyrignac C, Gaston A. Aqueduct stenosis due to venous ectasia with a dural arteriovenous fistula. The outcome of isolated fetal hydrocephalus, however, is variable. Almost always periaqueductal/tectal hamartomas were demonstrated in these cases, and the term "primary aqueductal stenosis" was used. Patients with a diagnosis of hydrocephalus due to aqueductal stenosis were included in this study. With this in mind, early delivery and shunting may be performed after 32 weeks for the rapidly progressive hydrocephalic fetus with documented lung maturity. Jellinger G. Anatomopathology of non-tumoral aqueductal stenosis. Childrens Hospital of Philadelphia is a charitable 501(c)(3) nonprofit organization. The diagnostic distinction can be difficult to make, particularly with ultrasound alone, but is critical because fetal ventriculomegaly from a destructive or maldevelopment process carries a poor prognosis. This figure compares the Kafanosky score pre and post operatively. Data were divided into 2 sets based on the patient's age i.e. We also closely examined the MRI of the brain with contrast with our neuroradiologist and found that the MRI did not suggest any vascular malformation. The cerebral aqueduct is the narrowest portion of the ventricular system, and aqueductal stenosis or other changes to its structure are a common cause of hydrocephalus. 2001;55(3):132136. Expanding lesions in . Macrocephaly. Hydrocephalus Causes. The authors describe 2 cases of triventricular hydrocephalus initially presenting as aqueductal stenosis that subsequently developed tumors of the pineal and tectal region. The shunt was then connected and placed in the peritoneum. With holoprosencephaly one would expect to see a monoventricle with no falx. Isolated hydrocephalus without associated malformations, detected before the legal abortion limit, may be reason enough to terminate the pregnancy for families who cannot accept the prospect of having a handicapped child. Fukuhara T, Luciano MG. Clinical features of late-onset idiopathic aqueductal stenosis. Hydrocephalus may also be present in a number of major and minor chromosomal aberrations affecting chromosome 8, 9, 13, 15, 18 or 21. A complete ultrasound examination is carried out to search for additional abnormalities. Neurological treatment success was defined by neurological improvement and, in childhood, head circumference. Prenatal ultrasound at 37 weeks gestation shows triventricular hydrocephalus, suggesting obstruction at the aqueduct of Sylvius. A shunt infection can be devastating for the neonate or premature infant, especially when it involves gram-negative organisms. Clinically, the patient recovered from the procedure and was subsequently discharged home in good condition. margin:12px; Aqueductal stenosis / tecal tumor / other: 30 points; Previous shunt. 1-3 New theories have . Rodis I, Mahr CV, Fehrenbach MK, Meixensberger J, Merkenschlager A, Bernhard MK, Schob S, Thome U, Wachowiak R, Hirsch FW, Nestler U, Preuss M. Childs Nerv Syst. By the neonatal period, approximately 300-500 cc of CSF is produced per day. sharing sensitive information, make sure youre on a federal The authors declare that they have no competing interests. Postnatal T1-weighted axial and sagittal MRI with gadolinium at three days of life demonstrates a patent aqueduct of Sylvius, but a developmental venous anomaly (white arrow) extending from the left thalamus converging on a central draining vein bridges across the proximal orifice of the aqueduct of Sylvius and obstructs the aqueduct. If the ventriculomegaly is stable, the fetus is carried to term. Neurosurgical interventions included Endoscopic Third Ventriculostomy (ETV) in 21 cases, insertion of Ventriculoperitoneal (VP) shunt and ETV were done in 3 cases while the rest had only insertion of VP shunt. Postnatal magnetic resonance imaging showed triventricular hydrocephalus, suggesting aqueductal stenosis. font-family: "rubrik",Arial,sans-serif; Yagmurlu B, Fitoz S, Atasoy C, Erden I, Deda G, Unal O. A number sign (#) is used with this entry because X-linked hydrocephalus is caused by mutation in the gene encoding the L1 cell adhesion molecule (L1CAM; 308840).MASA syndrome is an allelic disorder.There may be a separate form of X-linked hydrocephalus; Strain et al. -. An official website of the United States government. A Caesarian section was planned, but the mother went into spontaneous labor, and the baby was delivered vaginally before the procedure could be performed. -, Bondurant CP, Jimenez DF. Venous lesions as a cause of sylvian aqueductal obstruction: case report. Late chronic type IV seems to result in similar outcome after VP-shunt and ETV. z-index:90000; Unable to load your collection due to an error, Unable to load your delegates due to an error. 1997;27(2):6370. The ePub format is best viewed in the iBooks reader. Therefore, an MRI scan is obtained and interpreted by an experienced pediatric neuroradiologist to rule out any additional CNS anomalies. ), CT, computed tomography; DVA, developmental venous anomaly; ETV, endoscopic third ventriculostomy, Aqueductal developmental venous anomaly as an unusual cause of congenital hydrocephalus: a case report and review of the literature. font-family: "rubrik", Arial, sans-serif; position: absolute; We hope adding to the literature will improve understanding of this very uncommon cause of hydrocephalus and, therefore, will aid in treatment. Esparza J, Lobato RD, Munoz MJ, Chillon D, Portillo JM, Lamas E. Giant cerebral arteriovenous malformation producing a noncommunicating hydrocephalus. The patient transferred to our institution was a three-day-old, African-American baby girl with a diagnosis of congenital hydrocephalus. Data were recorded on google data collection form and analyzed using Google spreadsheets. 1Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas. -webkit-transform: rotate(90deg) skew(-25deg) translateY(16.6666666667px); A linear skin incision in the midline periumbilical area was made to access the peritoneum for the distal end of the shunt catheter. 8600 Rockville Pike doi: 10.1016/j.wneu.2012.02.007. 3401 Civic Center Blvd. HHS Vulnerability Disclosure, Help Treatment options for hydrocephalus due to aqueductal stenosis includes insertion of ventriculopertitoneal shunt (VP) and Endoscopic Third ventriculostomy (ETV) [3-6]. This malformation is characterized by myelomeningocele and posterior fossa abnormalities, which have distinct sonographic appearances (the so-called lemon and banana signs).
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