Dandy Walker Complex

FACTS

 
Dandy Walker Complex includes
ㅤ
P fossa enlargement
Vermian Remant
Other
A) Dandy Walker Cyst (DWM)
enlarged
minimal / none
80% have hydro
+/- aqueductal stenosis
B) Dandy Walker variant (DWV)
enlarged
partially preserved/lobulated
* remnant rotated superoanteriorly
* Hydro less common
C) Persistent Blake pouch: posterior fosa cyst in comm w/ 4th ventricle
modesly enlarged
fully present / lobulated
inferior vermis compresses, valleculae enlarged
D) Mega Cisterna Magna: expanded subarachnoid spaces of posterior fossa
modestly enlarged / normal
fully present / lobulated
valleculae normal
notion image
 
  • cystic dilation of fourth ventricle and vermis agenesis
  • common co-occuring pathology: agenesis of corpus callosum
  • pathophysiology of hydro: enlarged posterior fossa fluid expands → compresses other structures → hydrocephalus

HPI

  • most children present in years 1-2 of life
  • cerebellar symptoms
    • ataxia
    • speech cadence changes
  • hydrocephalus
    • progressive macrocephaly
    • bulging fontanelle
    • abnormal gaze palsy
  • other
    • weakness
    • respiratory difficulty

PHYSICAL EXAM

cortical blindness

IMAGING

evaluate for associated CNS abnormalities
agenesis of corpus callosum
schizencephaly
occipital encephaloceles
A/P
Operating planning for hydro:
  • really need to understand the communication of various fluid spaces to plan CSF diversion
  • MRI may be enough
  • can consider CT w/ contrast or CT cisternography
  • can consider MRI w/ phase-contrast