Ventriculocisternal Shunt Redivivus: Third Ventricle-Cisterna Magna Intradural Shunt: A Technical Note and Case Report.

Abstract

To present a hitherto unreported modification of the classic Torkildsen procedure: passing a catheter intracranially, between the third ventricle and cisterna magna. We applied our technique to a 56-year-old man who presented to our department for treatment of a pineal region mass. The patient was placed in sitting position and the mass was gross totally removed through a supracerebellar infratentorial approach. After the completion of the tumor resection, the patency of the cerebral aqueduct was checked, but the permeability was doubtful. During the same procedure, a shunt was inserted, under direct microsurgical control, into the third ventricle and passed over the cerebellar surface into the cisterna magna. The postoperative course was uneventful, and the patient was discharged from our unit with no neurological deficits and able to carry on with his day-to-day life. Our case illustrates that ventriculocisternal shunting can successfully be used in selected cases. The variation we describe can be a valuable surgical strategy in patients with pineal region masses, in whom a supracerebellar infratentorial route is used and in whom uncertainty exists regarding the patency of the sylvian aqueduct.