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KMID : 1037420200150020090
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Journal of Korean Skull Base Society
2020 Volume.15 No. 2 p.90 ~ p.97
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Modified Torkildsen shunt: Application of the historical procedure for 4th ventricle tumors
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Kang Min-Gyu
Jang Chang-Ki
Park Hun-Ho
Jang Dong-Su
Lee Kyu-Sung
Hong Chang-Ki
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Abstract
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Background : The Torkildsen shunt is a procedure used in the 1940s and 1950s to bypass the cerebrospinal fluid flow from the lateral ventricle to the cisterna magna, before the introduction of extracranial shunts. The aim of this study was to re-evaluate and modify the Torkildsen shunt to prevent obstructive hydrocephalus in patients with 4th ventricle tumors.
Methods : Fifteen patients underwent surgery for benign or malignant 4th ventricle tumors via the midline suboccipital approach from August 2010 to August 2016. Among them, eight received a modified Torkildsen shunt to prevent obstructive hydrocephalus. Permanent ventricular catheter is placed in the 4th ventricle from the obex to the cerebral aqueduct, bridging the 3th ventricle and the cervical subarachnoid space at the foramen magnum.
Results : Among the eight patients who underwent tumor removal with the modified Torkildsen shunt, three had hydrocephalus preoperatively, but none had hydrocephalus postoperatively. Four patients presented preoperative hydrocephalus on control group. The rate of hydrocephalus resolution after tumor removal without ventricle shunting procedure was 25%. Three patients required external ventricular drainage before tumor removal; one patient needed ventriculo-peritoneal shunt owing to progression of hydrocephalus two-month later after the operation. No shunt-related complications or malfunction were observed over a mean follow-up period of 35 months.
Conclusions : The modified Torkildsen shunt can be effective option in resolving postoperative hydrocephalus in 4th ventricle tumors. It is a simple and efficient procedure without the need for an endoscopic procedure or ventriculo-peritoneal shunt if we choose careful patient selection.
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KEYWORD
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Fourth ventricle tumor, Obstructive hydrocephalus, Torkildsen shunt, Ventriculoperitoneal shunt
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