A giant ganglioglioma in the right hemisphere was diagnosed in a 7-month-old male infant. Following unsuccessful chemotherapy, the tumor was completely resected 7 months later in two sittings. The postoperative course was initially uneventful. The young patient developed very well with slight psychomotor retardation. 1 1/2 years after the operation, the boy presented with headaches, nausea and vomiting. The MR imaging showed an obstructive hydrocephalus caused by aqueductal stenosis with considerable expansion of the lateral ventricles and the third ventricle. A ventriculostomy was then performed in another hospital and, due to ventriculostomy closure, two further re-ventriculostomies were carried out 14 days and 4 weeks after the initial ventriculostomy. When the boy presented at our hospital, again considerable expansion of the ventricles of the brain and reclosure of the ventriculostomy with absence of flow signal in the area of the ventriculostoma were diagnosed. Given the clear closure of the aqueduct with a verified obstructive hydrocephalus, re-ventriculostomy was indicated.
The symptoms related to the raised intracranial pressure caused by the hydrocephalus resolved quickly after the operation. The postoperative MR images show a clear decrease in ventricle size as well as a wide open ventriculostomy. The last MR images two years after the operation confirm that the ventriculostomy remains open with a strong flow phenomenon and normally sized ventricles of the brain. With the exception of left hemianopsia as a result of the tumor and a slight psychomotor retardation, the boy is neurologically normal.
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