Félix  Pastor-Escartín,Pau Capilla-Guasch,Vicent  Quilis-Quesada,Esteban  Vega Torres,Fernando  Talamantes Esbriba,José M.  González-Darder,
Delayed Fourth Ventricle Outlet Obstruction after Fourth Ventricle Tumor Removal Successfully Treated with Endoscopic Third Ventriculostomy in a Pediatric Patient
Global Surgery Case Reports
2020
2733-2535
http://dx.doi.org/10.31487/j.GSCR.2020.01.06
https://www.sciencerepository.org/delayed-fourth-ventricle-outlet-obstruction-after-fourth-ventricle-tumor-removal_GSCR-2020-1-106 
Abstract: Introduction: Fourth ventricle outlet obstruction (FVOO) at the level of Magendie’s and Luschka’s
foramina is a rare cause of non-communicating hydrocephalus.
Case Report: We present a case of a 15-year-old woman successfully operated on a fourth ventricle WHO
grade 1 pilocytic astrocytoma developing a delayed FVOO five months after surgery, when the patient
experienced progressive headache, nausea and gate disturbances. Magnetic resonance imaging (MRI) study
showed a tetra-ventricular hydrocephalus, with enlargement and bulging of both lateral recesses and
Luschka’s foramina. An endoscopic third ventriculostomy (ETV) was successfully performed.
Postoperative computed tomography (CT) and MRI studies showed a significant improvement of the
hydrocephalus.
Conclusion: FVOO is a rare cause of hydrocephalus. Posterior fossa and fourth ventricle microsurgical
procedures can produce a delayed FVOO leading to an unexpected deterioration of the clinical status of the
patient. The ETV is an effective and safe procedure to treat this unusual condition.
Keywords: Luschka foramina, fourth ventricle, ventriculostomy, hydrocephalus, arachnoiditis