Background: Trapped fourth ventricle (TFV) is a rare clinico-pathological syndrome, usually
resulting from inflammatory conditions (post-infective and post-hemorrhagic) that may present
with serious brain stem compression manifestations. Many treatment modalities have been
described with varying degrees of success.
Objectives: to evaluate our results in managing the trapped 4th ventricle by inserting 4th ventricular
catheter and connecting it to the previously implanted ventriculoperitoneal (V P) shunt via Y
connector.
Methods: A total number of 12 cases with TFV were diagnosed and treated surgically between
2014 and 2021 by a fourth ventricular catheter and connection to the pre-existing shunt via a Yconnector. Pre-operative clinical and radiological findings were reported. Postoperative
improvement was evaluated during a mean follow-up of 4.3 years. Post-operative complications
were reported
Results: 12 patients (6 males and 6 females), with a mean age of 3.3 years diagnosed with trapped
fourth ventricles were included. All patients had previous VP shunts. Headache, vomiting,
abnormal movement, gait disturbance, and nystagmus were the common symptoms. Trapped
Fourth Ventricle was post-infectious in 6(50%) patients, post-hemorrhagic in 4(33.3%) patients,
and congenital in 2(16.7%) patients. 6(50%) patients had preoperative slit lateral ventricles and
4(33.3%) had multiloculated hydrocephalus. Postoperatively 10(83.3%) patients had clinical
improvement while 2(16.7%) remained as preoperative. All patients had a decrease in the 4th
ventricular size. Complications of surgery were minor.
Conclusion: Fourth ventricular shunting with a Y connector is a valuable and effective modality
of treatment in TFV, especially when other methods fail or in specific complex pathological
situations, with fewer complications.
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