ABSTRACT
@#Dandy-Walker malformation (DWM) is an uncommon congenital anomaly characterised by enlarged posterior fossa involving the cerebellum and fourth ventricle. Most of DWM patients with hydrocephalus require ventriculo-peritoneal shunt (VPS) especially in those with symptoms such as headache and seizures. In cases with worsening hydrocephalus although on VPS, computed tomography and magnetic resonance imaging can be performed to assess ventricular sizes, and an obstructed shunt may be confirmed with iodinated contrast media injection into shunt reservoir under fluoroscopy guidance. VPS scintigraphy is one of infrequently performed nuclear imaging studies that has the capability to assess shunt patency and detect site of blockage with minimal radiation exposure. We describe here a 32-year-old lady with underlying DWM and hydrocephalus on VPS complicated by refractory epilepsy. Radionuclide scintigraphy has proven to be a safe, simple and useful tool in evaluating shunt function and localising the site of VPS obstruction in this patient.
Subject(s)
Drug Resistant EpilepsyABSTRACT
Initial underdilation of transjugular intrahepatic portosystemic shunt (TIPS) stents has been a widely proposed and commonly practiced technique to balance portal hypertension relief and the adverse effects associated with excess shunting, especially hepatic encephalopathy. However, this technique has been scrutinized by a number of studies which have shown that underdilated TIPS stents tend to passively expand with time. The recently launched GORE® VIATORR® TIPS Endoprosthesis with Controlled Expansion (VIATORR CX®) may address this problem with its novel diameter control capabilities. This article reviews literature concerning passive expansion of initially underdilated TIPS stents and explores preliminary data investigating the use and efficacy of the VIATORR CX® endoprosthesis.