Evaluation of Connecting a Fourth Ventricular Catheter with Y Connector to a Previous Ventriculoperitoneal Shunt, as a Treatment Option for Patients with Symptomatic Trapped Fourth Ventricle

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 4^th ventricle by inserting 4^th ventricular catheter and connecting it to the previously implanted ventriculoperitoneal (VP) shunt via Y connector.
Patients and 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 Y- connector. Preoperative clinical and radiological findings were reported. Postoperative improvement was evaluated during a mean follow-up of 4.3 years. Postoperative 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 4^th 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.