• TeoCDepartment of Pediatric Neurosurgery, Arkansas Children's Hospital, Little Rock 72202, USA., BursonT, and MisraS.
• Department of Pediatric Neurosurgery, Arkansas Children's Hospital, Little Rock 72202, USA.
• Neurosurgery. 1999 Jun 1; 44 (6): 1257-61; discussion 1261-2.

ObjectiveTo propose endoscopic treatment as an effective initial alternative for patients with a trapped fourth ventricle. MethodsWe reviewed the records of the last 16 consecutive patients with a symptomatic trapped fourth ventricle seen at the Arkansas Children's Hospital. The first eight patients underwent a shunt procedure; the next eight had endoscopic procedures. The shunt procedures consisted of either separate shunts or combined supra- and infratentorial shunts with shared distal catheters. The endoscopic procedures consisted of either fenestration into the lateral ventricle or aqueductal plasty with or without a stent. ResultsAll patients underwent successful procedures with good outcomes, although the patients with shunts appeared to have a higher-than-expected rate of revision (50%). Seven revisions were performed on four patients, with a complication rate of 25%. Of the patients who had endoscopic procedures, one eventually required a shunt. The overall complication rate for patients who had endoscopic procedures was also 25%. ConclusionEndoscopic treatment of the trapped fourth ventricle is effective in most cases. In view of the higher-than-expected revision rate with fourth ventricular shunts and an equivalent complication rate, endoscopic treatment is a reasonable initial treatment option for patients with a trapped fourth ventricle.

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