Hydrocephalus Secondary to Intraventricular Myxopapillary Ependymoma: Case Report

Ependymomas are a somewhat diverse category of glial tumors that often develop from the lining of the brain’s ventricles, or the spinal cord’s central canal. They make up 5% of all neuroepithelial tumors, 10% of paediatric brain tumors, and up to 33% of brain tumors in children under the age of three. Hydrocephalus is one of the complications, and it can be identified as progressive macrocephaly or increasing head circumference crossing percentiles, nausea, vomiting, poor appetite, irritability, and regression of developmental milestones.

Current research of idiopathic normal pressure hydrocephalus:Pathogenesis,diagnosis and treatment

Idiopathic normal pressure hydrocephalus(iNPH)is caused by impaired cerebrospinal fluid absorption in the elderly;it is a surgically treatable form of dementia.Gait disturbance,dementia,and urinary incontinence are the triad of signs for iNPH.In addition to these clinical findings,imaging studies show characteristic ventricular enlargement.High Evans Index and‘disproportionately enlarged subarachnoid hydrocephalus’are other well-known imaging findings of iNPH.If the tap test shows improved symptoms,shunt surgery is performed.The disease was first described by Hakim and Adams in 1965,followed by the publication of the first,second,and third editions of the guidelines in 2004,2012,and 2020,respectively.Recent studies signal the glymphatic system and classical cerebrospinal fluid(CSF)absorption from the dural lymphatics as aetiological mechanisms of CSF retention.Research is also underway on imaging test and biomarker developments for more precise diagnosis,shunting technique options with fewer sequelae and complications,and the influence of genetics.Particularly,the newly introduced‘suspected iNPH’in the third edition of the guidelines may be useful for earlier diagnosis.However,less well-studied areas remain,such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs.This review briefly presents previous research on these and future issues.

CT Profile of Hydrocephalus in Children at the Charles de Gaulle Pediatric Teaching Hospital in Ouagadougou

Aim of the Study: The aim is to analyse the epidemiological, clinical and CT aspects of hydrocephalus in children. Method: This was a cross-sectional descriptive study with retrospective collection from 1 June 2021 to 31 December 2022 within the radiology department of Charles De Gaulle Pediatric Teaching Hospital in Ouagadougou, Burkina Faso. The study included the records of patients with hydrocephalus who underwent cerebral computed tomography within this radiology department. Results: Hydrocephalus is due to a disorder of the hydrodynamics of the cerebrospinal fluid causing an increase in the volume allocated to this fluid in the brain and being accompanied by an increase in the pressure of this fluid. Its diagnosis is established by Doppler ultrasound or MRI prenatally, transfontanellar ultrasound in newborns and young children whose fontanel is permeable and by CT or MRI in older children, who can also determine the etiology. MRI remains an imaging technique that is less available and less accessible than CT in developing countries like ours. In Burkina Faso, MRI is only available in two private health facilities. The objective of this study was to describe the epidemiological, clinical and computed tomography aspects of hydrocephalus in children at the Charles de Gaulle pediatric teaching hospital in order to contribute to the diagnostic assessment and better management of this pathology. Over 19 months, 105 cases of hydrocephalus were recorded out of a total population of 115 children, or an average of 6 cases per month. The mean age was 17.52 months, with extremes of 03 days and 13 years, and the sex ratio was 1.38. Macrocrania, convulsions and psychomotor retardation were the main clinical signs, with rates of 49%, 34% and 30% respectively. On cerebral CT scan, hydrocephalus was triventricular (41.90%), tetraventricular (40%), and predominantly non-communicating (60%), with a mean Evans score of 0.53. The aetiologies were malformations in 34.28% of cases, tumours in 10.47% and infections in 5.71%. Among the malformations, Arnold Chiari II syndrome associated with spina bifida and Dandy Walker syndrome were the most common, accounting for 25% each. Tumour causes were dominated by craniopharyngioma and astrocytoma, each accounting for 27.30% of cases. Conclusion: The incidence of hydrocephalus was high in our study. In the absence of MRI (due to its unavailability and inaccessibility), CT revealed hydrocephalus that was predominantly tri- and tetraventricular, and predominantly non-communicating.

Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage:A case report and review of the literature

BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.

MODIFIED GRAEB CRITERIA FOR PREDICTING THE POST-HEMORRHAGIC HYDROCEPHALUS IN INTRAVENTRICULAR HEMORRHAGE

Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.

Brucella meningoencephalitis with hydrocephalus masquerading as tuberculosis

Neurobrucellosis is a rare form of localized brucellosis usually with no systemic manifestations. We report a rare case of brucellosis presenting as meningoencephalitis associated with hydrocephalus.This patient had a lymphocytic predominant CSF and was initially treated with empirical anti tubercular therapy and steroids.A week later,when his CSF culture grew Brucella species,the treatment was changed to a combination of streptomycin,doxycycline and rifampicin and the patient improved with this therapy.This case illustrates the need to consider neurobrucellosis as a close differential diagnosis of neurotuberculosis in endemic areas when the patient presents with meningo encephalitis with lymphocytic CSF.

Lumboperitoneal shunts for the treatment of post-traumatic hydrocephalus

Objective: To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic hydrocephalus(PTH).Methods: A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People's Hospital from January 2014 to March 2017 was done.Experience with lumboperitoneal shunt placement for PTH was reviewed.The diagnosis of PTH was based on ventricular enlargement with the Evans' index(EI>0.3) before shunt implantation.Patients were evaluated for improvements in Glasgow Coma Scale(GCS), Glasgow Outcome Scale(GOS), and EI after shunt placement.Results: Totally, the study included 34 PTH patients with the average age of 49.32 years(range: 9–67 years).The average follow-up period was(3.9±3.5) months.Before lumboperitoneal shunt, the GOS score was(4±1), the GCS score was(8.53±3.38), and the EI score was(0.40±0.08).After shunt implantation, the GOS score was(3±1), the GCS score was(10.29±3.15), and the EI score was(0.34±0.13), respectively(P<0.05).Before lumboperitoneal shunt, 24(70.58%) patients had a GOS score of 4(vegetative state), and 10(29.42%) patients had a GOS score of 3(severe disabled).After lumboperitoneal shunt, 18(52.94%) patients had improvement in GOS(11 patients improve from GOS 4 to GOS 3, 5 patients from GOS 3 to GOS 2 and 2 patients from GOS 3 to GOS 1), 22(64.71%) patients achieved improvement in their GCS(14 patients GCS improvements ≥2 and 8 patients GCS improvement=1), 21(61.76%) patients had EI improvement(18 patients with EI<0.3).There was no complication in this study.Conclusion: Lumboperitoneal shunt placement is safe and effective for PTH, and serious complications are not observed.

Hydrocephalus after subarachnoid hemorrhage:A metaanalytic comparison of aneurysm treatments

AIM： To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of develop-ing hydrocephalus.METHODS： We reviewed the English language litera-ture on the risk of developing hydrocephalus after an-eurysm treatment. Data were divided by type of study （randomized controlled trial, cohort trial, nonrandomized comparison, prospectively- and retrospectively-collected observational study）. They were also divided by type of aneurysm treatment （microvascular - clipping, or endo-vascular - coiling）. Additional predictive variables collected for each publication were average age, gender distribu-tion, measures of hemorrhage volume and subarachnoid hemorrhage severity, aneurysm locations, time to treat-ment, duration of follow-up and date of publication. Weemployed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling. Meta-regression was used to correct pooled results for covariates.RESULTS： Because indications for the two treatments are different, there is little clinical equipoise for treat-ing most cases. The single randomized, controlled trial dealt with a small subset of ruptured aneurysms. Nei-ther this nor pooled values from other studies which compared the two treatments had the power to dem-onstrate signifcant differences between the two treat-ments. Nor was there an apparent difference when observational data were meta-analytically pooled. How-ever, when meta-regression was used to correct for predictive variables known to differ between the two treatment groups, a highly-significant difference ap-peared. Coiling is used more commonly in older, sicker patients with aneurysms in certain locations. These cases are more likely to develop hydrocephalus. When corrected for these covariates, the risk of hydrocepha-lus was found to be significantly lower in coiled vsclipped cases （P = 0.014）.CONCLUSION： Pooled observational data were nec-essary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

Adrenal Hemorrhage as a Rare Cause of Neonatal Anemia Associated with Hydrocephalus Secondary to Intraventricular Hemorrhage—A Case Report

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.

Non-Tumor Obstructive Hydrocephalus Treated with Endoscopic Third Ventriculostomy in Cameroon

Objective: In Sub-Saharan Africa, shunt dependence is a real threat for patients. For this reason, any method allowing shunt independence such as endoscopic third ventriculostomy should be promoted. The goal of this study was to show the advantages of neuroendoscopy in treating non-tumor obstructive hydrocephalus in Cameroon. Methods: We retrospectively reviewed the cases of non-tumor obstructive hydrocephalus treated with endoscopic third ventriculostomy in our hospital. Results: Twenty patients (15 males, 5 females) underwent endoscopic third ventriculostomy as first choice treatment for non-tumor obstructive hydrocephalus. Their ages ranged from six months to 41 years (mean 11.96 years, median 20.75 years). Fourteen patients (70%) were children (≤18 years old), 6 were adults, 7 were under age of two years and 3 were below one. Computed tomography scan was the radiological tool used in all cases. None did a magnetic resonance imaging scan. Etiology of hydrocephalus was aqueductal stenosis in 18 cases and stenosis of the foramina of Luschka & Magendie in two. Aqueductal stenosis was associated with myelomeningocele in one case and shunt failure in another one. Endoscopic third ventriculostomy was successful in alleviating clinical symptoms with shunt independence in 19 cases (95%), but failed in one case. ETV success was not related to patient age. Cerebrospinal fluid leak occurred in two patients as post-operative complication (10%). Overall, ETV diminished treatment cost by 600 USD. Conclusion: Even in areas with limited medical equipment like in Sub-Saharan Africa where shunt dependence is a real danger, ETV can be routinely used to successfully treat non-tumor obstructive hydrocephalus.

Visual acuity evaluation in children with hydrocephalus:An electrophysiological study with sweep visual evoked potential

The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted be-fore 15 days had better VA results in com- parison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the di-agnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.

Advanced diffusion-weighted magnetic resonance imaging in the evaluation of white matter axons in patients with idiopathic normal pressure hydrocephalus

With the increasing application of regenerative medicine in vivo,non-invasive and accurate methods for estimating the white matter axons in neuronal tissue have become increasingly important.As a non-invasive method for patients,magnetic resonance（MR）imaging has demonstrated potential as a promising tool for evaluating axons in vivo.In particular,diffusion-weighted MR imaging（d MRI）and its applications,

Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty:A case report

BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.

Endoscopic third ventriculostomy in obstructive hydrocephalus: A case report and analysis of operative technique

BACKGROUND The endoscopic third ventriculostomy(ETV)is a neuroendoscopical procedure that represents a more suitable alternative to the extracranial shunting.It consists of fenestrating the floor of the third ventricle and thus establishing a free flow of the cerebrospinal fluid from the ventricles to the site of resorption in the subarachnoid space.It offers a more physiological solution and a chance at a shunt-free life for children with hydrocephalus.The main indication for the procedure is obstructive hydrocephalus,however,it can also be useful in patients with other forms of hydrocephalus.CASE SUMMARY We present a treatment flow of a 9-year-old patient,diagnosed with an obstructive hydrocephalus due to tectal glioma that was successfully treated with an ETV.We review the important factors influencing the success rate such as age,aetiology,shunt history,preoperative planning and visualisation of the basilar artery.CONCLUSION Even though the ETV effectively controls obstructive hydrocephalus in more than 75%of all cases,the overall success rate of the procedure varies and could be approved by the correct preoperative patient selection.

Prevalence of congenital hydrocephalus in the Hashemite kingdom of Jordan: A hospital-based study

Background: Congenital hydrocephalus, an important cause of neurologic morbidity and mortality in children, is a medical condition characterized by an abnormal accumulation of cerebrospinal fluid in the brain. It can be caused by abnormal brain development, obstruction of the cerebral aqueduct flow, Chiari malformations, and Dandy-Walker malformation. The prevalence of congenital hydrocephalus is 2.2 to 18 per 10,000 live births. Objectives: To determine the prevalence of congenital hydrocephalus among livebirths in the Hashemite Kingdom of Jordan (HKJ). Methods: Clinical data were collected from medical records of all livebirths with congenital hydrocephalus born at Al Bashir Hospital, Amman/The Hashemite Kingdom of Jordan in 2004-2005 and 2008-2011. Descriptive analysis was carried out using the Statistical Package for the Social Science (SPSS 20). Results: The prevalence of hydrocephalus was 0.092% with a relative predominance among males. Conclusion: The study concluded that the prevalence of congenital hydrocephalus is comparable to that of developed countries. The efforts made by the Ministry of Health seem to have paid off. More research on stillbirths is recommended.

Early fault prediction and detection of hydrocephalus shunting system

Trends of various intracranial pressure (ICP) parameters for high pressure hydrocephalus patients are utilized to detect various shunt faults in their early stages, as well as, to monitor the effect of such faults on shunt performance. A method was proposed to predict the time required for ICP to be abnormal and for the valve to reach full blockage condition. Furthermore, an auto valve schedule updating method is proposed and used to temporarily deal with detected faults until the patient is checked up by his/her physician. The proposed algorithms were evaluated using numerical simulation.

Normal Pressure Hydrocephalus: A Simple Hypothesis

Normal pressure hydrocephalus is a devious phenomenon. It is a disease that is difficult to diagnose and difficult to treat, the only treatment being a ventriculo-peritoneal shunt, though good shunting results rarely pass a 70% level of effectiveness. We need to understand its pathophysiology better before things will improve. Although some colleagues know it as a possible “reversible dementia” others hardly know about its existence. Solutions would also have value for the general understanding of hydrocephalus of other types. Many theories have been published recently in the search for the missing pieces in this puzzle and I feel that my own postulations could turn out to be useful. After years of diagnosing and operating on hydrocephalus patients I propose that: 1) There is reason to believe that patients with the Apoprotein E3/3 genotype and a high head size percentile are particularly vulnerable to developing idiopathic normal pressure hydrocephalus (iNPH). 2) The classical theory that the arachnoid granulations (AG) transport cerebrospinal fluid (CSF) into the venous circulation is wrong. I postulate, that the AG essentially are sensors, registering the pressure differences between the CSF in the subarachnoidal space at the top of the skull and the venous pressure in the sagittal sinus. The AG’s endothelium produces nitric oxide (NO) as a messenger that is received by the vagus nerve at the jugular foramen. 3) The disease has its fundamental pathology in the subpial space in the large cisternas and along the large vessels under the brain. Here the intravenous absorption of cerebrospinal fluid (CSF) takes place. Cerebrospinal fluid is transported into the subpial venules and veins, driven by the pulse pressure of the subpial arteries. Morphological changes in the pial/subpial anatomy explain the existence of acquired normal pressure hydrocephalus (aNPH).

Resection of Multiple Neurinomas of the Cauda Equina Improves Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a treatable neurological condition characterized by dementia, gait disturbances, and urinary incontinence. This case study aimed to evaluate the effectiveness of surgical intervention in treating NPH associated with spinal cord tumors. A patient suffering with NPH underwent a spinal tap procedure and surgical resectioning of three neurinomas on the cauda equina. The patient exhibited marked improvement in neurological and motor symptoms related to NPH following surgical intervention. These findings suggest that surgical resectioning of neurinomas is an effective intervention for treating NPH associated with spinal cord tumors.

Endoscopic Third Ventriculostomy for Non-Tumor Obstructive Hydrocephalus in Children under Two Years of Age

The goal of this work is to report on the efficacy of endoscopic third ventriculostomy (ETV) for non-tumor obstructive hydrocephalus in children aged two years and below. In the period between June 2007 and December 2014, we had performed ETV in 30 patients with hydrocephalus from diverse etiologies. Among them were eight children aged two years or below. Clinical, radiological and outcome data of these children were retrospectively reviewed to assess ETV efficiency in this age group. Eight children (6 boys, 2 girls) with age range from 6 to 24 months (mean 12.5 months, median 15 months) suffering from non-tumor obstructive hydrocephalus underwent ETV as primary treatment. Seven patients (87.5%) were under two years and 3 had less than one year of age at the time of surgery. Macro crania, suture diastasis, scalp vein bulging and sunset gaze were the most common findings on physical examination. Computed tomography scanning was done in all patients but none had magnetic resonance imaging. Hydrocephalus was due to primary (congenital) aqueductal stenosis in all cases and was associated with myelomeningocele in one. ETV was successful in 7 (87.50%) cases but failed in one. Operation time varied from 28 to 35 minutes (mean 31.12 minutes, median 31.5 minutes). No intraoperative complication occurred. The child in whom ETV failed had postoperative CSF leak. No death related to procedure occurred. Hospital stay ranged from 2 to 4 days (mean, 2.87 days, median, 3 days). Follow up range was 5.5 to 86 months (0.46 to 7.16 years);mean, 59.14 months (4.92 years);median, 45.75 months (3.81 years).