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Tfv
This document summarizes a literature search on surgical treatments for trapped fourth ventricle. The search found one review and 40 case series or case studies totaling 199 patients, mostly from North America before 2000. Surgical techniques included placing shunts from the fourth ventricle to the ventricles or subarachnoid space, endoscopic fenestration or catheterization, and posterior fossa decompression. The evidence was limited to small, heterogeneous case studies with variable outcomes and follow-up. Both shunting and endoscopic techniques appear safe but higher quality evidence is needed to determine the best approach.
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Tfv
- 1. • 16/2/17 Evidence BasedSurgery • Shinuo Liu
- 2. AHV6121 • 55 yoman, original AVM operation 2014
- 3. PICO • P =All patients with trapped fourth ventricle • I = Best mode of surgical treatment (eg. Posterior fossa decompression) • C = Other forms of surgical treatment • O = Efficacy (progression free survival) • In all patients with entrapped fourth ventricle, what is the best form of (surgical) treatment?
- 4. Search Terms • EntrappedFourth Ventricle • Trapped Fourth Ventricle • Isolated Fourth Ventricle • Sequestered Fourth Ventricle • Surgery • Therapy • Shunt
- 5. Search criteria • Inclusion •?All patients • Exclusion • ?adults • Case reports? • Related to neural tube defects
- 6. Scopus – “entrappedfourth ventricle”
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- 13. • 1 review •40 articles – all case series or case studies • No higher level evidence • N = 199 (adult n = 33) • Mostly North American studies • Prior to 2000, 4th ventricular catheterisation • After 2000, endoscopic techniques • F/U = 2 to 90 months
- 14. • All smallcohorts • Heterogeneous population • Unclear aetiology • Unclear previous treatment • Unclear outcome, variable F/U • Vast majority had clinical and radiological success = publication bias?
- 15. • Techniques: • 4thventricle VP shunt • 4th ventricle SAS • EA ST • EA IT • +/- stent • Posterior fossa decompression, adhesiolysis, duraplasty • Endoscopic fenestration (ST) • Endoscopic transtentorial catheterisation • +/- ETV • Shunting and endoscopic techniques are probably both safe, although one is safer. • Posterior fossa arachnoiditis deserves consideration • Largest cohort was Garber et al in JNS 2013 with n = 29
- 17. • Case bycase – consider aetiology • Unclear whether paeds = adults • Stenting ?