An Asymptomatic Child with a Large Dandy–Walker Cyst despite the Presence of a Ventriculoperitoneal Shunt - Abstract
Introduction: Hydrocephalus occurs in 80% of patients with Dandy–Walker (DW) syndrome. Accord-ing to the literature, when permeability of the cerebral aqueduct is demonstrated, it is possible to use a sin-gle shunt, either ventriculoperitoneal or cystoperitoneal. The case of an asymptomatic child with a large Dandy-Walker cyst despite the presence of a ventriculoperitoneal shunt is reported herein.
Case report: A 1-year-old female child was brought to an emergency department (General State Hospital) with a clinical picture of macrocephaly and signs of intracranial hypertension (headache, vomit-ing, and papilledema). A CT scan of the head revealed hydrocephalus and other changes, such as a cyst in the fourth ventricle and hypoplasia of the cerebellar vermis, which were compatible with Dandy-Walker malformation (DWM). It was decided to place a
ventriculoperitoneal shunt. After six years of follow-up, the child still had the cyst in the fourth ventricle, which caused compression of the brainstem and hypoplasia of the cerebellar vermis, but there was no hydrocephalus. Nevertheless, the child remains asymptomatic, with normal motor development.
Discussion/Conclusion: The treatment of hydrocephalus and DWM remains complex and therefore controversial. However, some children may benefit from a ventriculoperitoneal shunt and remain asymp-tomatic despite the persistence of Dandy-Walker cysts.