Isolated fourth ventricle syndrome is an uncommon entity due to obstruction of both
            inlet and outflow foramina. The resulting mass effect from the progressively expanding
            fourth ventricle may cause symptoms from both cerebellar and brainstem compression.
            Although a variety of treatment modalities have been advocated for this condition,
            an in-depth description of placement of a fourth ventriculopleural (VPL) shunt from
            a single-stage prone approach has not yet been published in the literature. We describe
            here a case of successful placement of a fourth VPL shunt in a 22-year-old female
            with a history of a prior posterior fossa pilocytic astrocytoma resection who presented
            with symptomatic isolated fourth ventricular hydrocephalus
         Key-words:
Fourth ventricle - hydrocephalus - ventriculoperitoneal shunt - ventriculopleural
            shunt