• Angelo R Silva Neto, Ana Luíza R Uruguay, Damácio S Paiva, Alice L P Silva, Arthur H M Godeiro, and Letícia M N Eberlin.
• Pediatric Neurosurgery, Hospital Universitário Onofre Lopes, Natal, Brazil; Department of Integrated Medicine, Federal University of Rio Grande do Norte, Natal, Brazil; Santos Dumont Institute, Macaíba, Brazil. Electronic address: angelorsn@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 454-457.

BackgroundEndoscopic third ventriculostomy (ETV) is an option for hydrocephalus treatment in patients with myelomeningocele, mostly after a previous shunt dysfunction. Late failure of ETV is a rare event, traditionally associated with dramatic symptoms of intracranial hypertension. In patients with myelodysplasia and neurogenic bladder dysfunction, urodynamic deterioration can be a signal of neurologic worsening as a consequence of tethered cord or shunt problems.Case DescriptionWe describe here a rare case of a 12-year-old female patient with myelomeningocele and evidence of a failure 10 years after a previously successful ETV whose initial symptoms were worsening of urinary complaints. After 2 months, she was admitted to the emergency department with seizures and acute hydrocephalus and was shunted.ConclusionsPediatric neurosurgeons must follow myelomeningocele patients with successful ETV for a long time and take care of subtle alterations of organic functions that have a close relationship with central nervous system integrity. A multidisciplinary approach can facilitate this strategy and avoid a tragic outcome.Copyright © 2019 Elsevier Inc. All rights reserved.

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