Background: Dandy Walker Syndrome is a congenital brain malformation involving the cerebellum, oftenly accompanied with hydrocephalus and associated with neurologic impairment and heart, face and limbs malformations. Laparoscopic surgery is being increasingly performed for the management of
abdominal problems in children.
Case Report: 9-year-old male (weight 26 kg) with Dandy Walker syndrome and ventriculoperitoneal shunt was scheduled for elective laparoscopic splenectomy and cholecystectomy due to spherocytosis and cholelithiasis respectfully. He had enuresis and fecal incontinence but no associated heart malformation. Neurosurgeon was consulted prior to surgery to verify the proper functioning of the VP
shunt. Standard American Society of Anesthesiologists anesthetic monitoring was used. Pre-medication with midazolam 4 mg PO was given. Anesthesia induction was conducted with propofol, fentanyl and rocuronium bromide. Patent was intubated with endotracheal tube and anesthesia was maintained with sevoflurane, fentanyl and rocuronium bromide. Arterial CO2 was measured: after induction, after insufflation of CO2 and after 1 hour of operation. Measured arterial CO2 reflected the values of etCO2. The shunt reservoir was checked occasionally for over inflation. Vital signs were stable during the operation, which underwent uneventfully. The patient was discharged from the recovery room 2 hours after procedure without any complications.
Discussion: The concern with laparoscopic surgery in patients with VP shunt is that pneumoperitoneum and required positioning of the patient may cause an increase in intracranial pressure and shunt malfunction. Associated heart malformation can in addition complicate anesthetic management. In two cases complications related to laparoscopic surgery in patients with VP shunts were reported but there is a small body of evidence indicating that it is safe to perform laparoscopic surgery on pediatric patients with VP shunt with routine anesthetic management.[1]


03 / Dandy Walker syndrome with VP shunt and laparoscopic surgery- an anesthetic challenge