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13-year-boy presented with headache and giddiness while bending forward. MRI showed Blake's pouch cyst, tetraventriculomegaly and syringomyelia to T-11 level. There was no flow of CSF between the cyst and the posterior cervical subarachnoid space and hyperdynamic flow was seen within the third ventricle, aqueduct as well as fourth ventricle. The foramen to Monro was relatively smaller as compared to triventriculomegaly cases. As the inflated balloon was withdrawn accidentally there was some bleeding which was controlled with further dilatation of the balloon and hemostasis was achieved. #Blakespouch #neurosurgery #hydrocephalus #Dandywalker #endoscopy #ETV Stay updated by subscribing to look for a follow-up MRI after six months.