• J Torrez-Corzo, R Rodriguez-Della Vecchia, J C Chalita-Williams, and L Rangel-Castilla.
• Neuroendoscopic Clinic, Department of Neurosurgery, Instituto Potosino de Neurociencias, San Luis Potosi, Mexico.
• Childs Nerv Syst. 2009 May 1; 25 (5): 627-30.

IntroductionWe report a patient who suffered from brainstem injury following ventriculoperitoneal (VP) shunt placement in the fourth ventricle.DiscussionA 20-year-old man with complex hydrocephalus and trapped fourth ventricle underwent a suboccipital placement of a VP shunt. Postprocedure patient developed double vision. Magnetic resonance imaging showed that the catheter was penetrating the dorsal brainstem at the level of the pontomedullary junction. Patient was referred to our Neuroendoscopic Clinic. Physical exam demonstrated pure right VI cranial nerve palsy. Patient underwent flexible endoscopic exploration of the ventricular system. Some of the endoscopic findings were severe aqueductal stenosis and brainstem injury from the catheter. Aqueductoplasty, transaqueductal approach into the fourth ventricle, and endoscopic repositioning of the catheter were some of the procedures performed. Patient recovered full neurological function. The combination of endoscopic exploration and shunt is a good alternative for patients with complex hydrocephalus. A transaqueductal approach to the fourth ventricle with flexible scope is an alternative for fourth ventricle pathology.

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